Gallstones

Question 1

what does bile contain

Answer 1

cholesterol, bile pigments, phospholipids

Question 2

what are pigment and cholesterol stones

Answer 2

depending on concentrations. pigment stones (

Question 3

what are some risk factors for stones becoming symptomatic

Answer 3

smoking, parity

Question 4

prevalence of gallstones

Answer 4

8% of those >40y. 90% remain asymptomatic

Question 5

what is acute cholecystitis

Answer 5

inflammation of the gallbladder

Question 6

what is acute cholecystitis due to

Answer 6

stone or sludge impaction in neck of gallbladder.

Question 7

symptoms acute cholecystitis

Answer 7

continuous epigastric or RUQ pain, vomiting, fever, local peritonism, GB mass

Question 8

what is the main difference between acute cholecystitis and biliary colic

Answer 8

inflammatory component- local peritonism, fever, incr WCC

Question 9

what happens if the stone moves to common bile duct

Answer 9

obstructive jaundice and cholangitis (infection of bile duct)

Question 10

what is Murphys sign

Answer 10

lay 2 fingers over RUQ and as inspiration occurs there is pain and arrest of inspiration. only positive if it fails to happen on LUQ

Question 11

what is a phelgmon

Answer 11

RUQ mass of inflamed adherent omentum and bowel may be palpable

Question 12

tests in acute cholecystitis

Answer 12

incr WCC, US- thick walled, shrunken GB, pericholecystic fluid, stones, CBD

Question 13

treatment acute chole

Answer 13

NBM, analgesia, IVI and cefuroxime. lap chole (remove GB)

Question 14

when would you do an open cholecystectomy

Answer 14

if GB perforation

Question 15

what could you perform in elderly for acute chole or if unsuitable for cholecystectomy

Answer 15

cholesytotomy- create stoma in gallbladder and insert a tube for drainage

Question 16

what are the symptoms of chronic cholecystitis

Answer 16

chronic inflammation +- colic. flatulent dyspepsia- vague abdo discomfort, distension, nausea, flatulence, fat intolerance- fat stimulated cholecystokinin release and GB contraction.

Question 17

treatment chronic chole

Answer 17

cholecystecomty

Question 18

what is biliary colic

Answer 18

when gallstones are symptomatic. cystic duct obstruction or if passed into the CBD.

Question 19

symptoms biliary colic

Answer 19

RUQ pain radiates to the back+- jaundice.

Question 20

treatment biliary colic

Answer 20

analgesia, rehydrate, NMB, elective lap chole

Question 21

complications gallstones in gallbladder and cystic duct

Answer 21

biliary colic, empyema, mucocoele, acute or chronic cholecystitis, carcinoma, Mirizzis syndrome

Question 22

complications gallstones in bile ducts

Answer 22

obstructive jaundice, cholangitis, pancreatitis

Question 23

complications gallstones in the gut

Answer 23

gallstone ileus

Question 24

what is Charcots triad

Answer 24

RUQ pain, jaundice, rigors

Question 25

treatment cholangitis

Answer 25

cefuroxime and metronidazole

Question 26

what is gallstone ileus

Answer 26

gallstone erodes through gallbladder into duodenum may then cause an obstruction in the terminal ileum

Question 27

what is the AXR in gallstone ileus

Answer 27

air in CBD, small bowel fluid levels, stone

Question 28

what is Mirizzis syndrome

Answer 28

stone in GB presses on bile duct causing jaundice

Question 29

how soon should lap chole be done in biliary colic

Answer 29

within 24h of acute episode