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Surgery: The Acute Abdomen > Gallstones > Flashcards

Flashcards in Gallstones Deck (7)
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1
Q

What are the different types of gallstone?

A

Cholesterol:
- Supersaturated bile, may be due to loss of bile salts.

Pigment:
- Occurs in haemolytic anaemia due to increased pigment (bilirubin from RBC breakdown)

Mixed:
- Alteration in bile composition leads to precipitation of cholesterol along with bile pigment

2
Q

What is the clinical presentation of gallstone-related disease?

A

Either biliary colic or acute cholecystitis

Biliary colic:

  • Severe, constant, crescendo pain
  • Epigastic (may be RUQ, or radiate over right shoulder/subscapular)
  • May be associated with over-indulgence with food

Acute cholecystitis:

  • Severe localised RUQ pain
  • Associated with tenderness and muscle-guarding/rigidity
3
Q

What investigations can be carried out in gallstone-related disease?

A

FBC:

  • Biliary colic = no real changes
  • Acute cholecystitis = moderate leucocytosis and increased CRP/ESR

LFTS:
- Serum bilirubin, ALP and ALT/ASP may increase

Ultrasound to look for:

  • Gallstones
  • Thickening of gall bladder wall
  • Diameter of common bile duct
4
Q

What are the differential diagnoses of biliary colic?

A
  • Renal colic
  • Pancreatitis
  • Atypical peptic ulcer disease
  • IBS (spasm of hepatic flexure)
  • Right colonic carcinoma
5
Q

What are the differentials in acute cholecystitis?

A
  • Acute pancreatitis
  • Perforated peptic ulcer
  • Hepatic abscess
6
Q

What is the management of gallstone-related disease?

A

Medical:

  • IV fluids
  • Opiate analgesia
  • IV antibiotics
  • Nil by mouth

Surgical:
- Laproscopic cholecystecomy

7
Q

What is Courvoisier’s law?

A

Courvoisier’s law states that, in the presence of jaundice, an enlarged gallbladder is unlikely to be due to gallstones; rather carcinoma of the pancreas or the lower biliary tree is more likely.