Gallstones Flashcards
(40 cards)
What percentage of gallstones are asymtomatic?
90%
What are the “five F’s” that predispose an individual to gallstones?
Fasting, fat, fertile, females over forty
PREGANCY IS AN IMPORTANT FACTOR TOO
What are the mechanisms of risk factors for gallstone formation?
Increased cholesterol secretion
Impaired gallbladder emptying
Decreased bile salt secretion
There are three types of gallstone, what are they and give the percentage of cases they make up…
Mixed 80%= cholesterol with bile pigments and calcium salts
Pigmented 10%= contain calcium bilirubinate
Pure cholesterol 10%
What are pigmented gallstones associated strongly with?
Haemolytic disorders (haemolytic anaemia, malaria) they are very rare in western countries
What risk factors increase the chance of the gallstones becoming symptomatic?
Smoking and parity (the number of times a woman has carried a baby past a gestational age of 20 weeks)
When bile is super saturated with with cholesterol (due to high cholesterol or relative low bile salts I.e. In pregnancy) it is termed what type of bile?
Lithogenic bile
What is the name of the factors which increase crystallisation of litho genie bile?
Nucleation factors
Biliary sludge can be produced under normal conditions and is usually dissolved. What percentage of patients develop gallstones?
15%
Name the complications of gallstones that may occur?
Biliary colic, dyspepsia following fatty foods, cholecystitis, pancreatitis, mucocele/empeyema, obstructive jaundice, ascending cholangitis, gallstone ileus
What is biliary colic? What does it indicate?
It is a progressive build up of pain in the RUQ usually for about 2 hours. If it hasn’t passed for 6 hours then a complication of cholycystitis or pancreatitis is likely.
Pain brought on by fatty foods
What investigations would you do for gallstones?
LFTs, serum amylase, blood cultures, ultrasound, ERCP, MRCP
What are the features of an obstructive picture on LFTs?
Raised: bilirubin, ALP, ALT and AST)
Why would you do a serum amylase test?
To rule out pancreatitis
How sensitive is USS?
90%
Where can the pain from biliary colic be referred to?
The right shoulder
What causes acute cholecystitis?
A stone/sludge that has become embedded in Hartmann’s pouch of the gallbladder with bacterial infection (often the gram -ve e. Coli gut flora)
What are the symptoms of acute cholecystitis? (Similar to biliary colic but with an inflammatory component)
Continuous RUQ/epigastric pain, referred pain to the right shoulder, N+V, fever, local peritonism, GB mass, tachycardia
What sign may indicate acute cholecystitis? When is it positive?
Murphy’s sign - two fingers pressed on the RUQ, inhale causes pain and pain dissipates on exhalation. It is positive if there is no pain on the left side when repeated on the LUQ
What does Chronic cholecystitis lead to?
Fibrosis and enlarged gallbladder with atrophied mucosa
What is the name of the rare form of cholecystitis that occurs without gallstones?
Acalculous cholecystitis (caused by burns, sepsis and diabetes)
What investigations would you do for acute cholecystitis?
FBC (raised WCC), USS, HIDA cholescintigraphy, AXR
What are the features of acute cholecystitis on an USS?
Thick walled, shrunken, stones present, biliary sludge
What is the treatment for acute cholecystitis?
Nil by mouth, IV cefuroxime, IV pain relief, laparoscopic cholecystectomy (or open if perforated)
