Gallstones

Question 1

What are the types and causes of gallstones?

Answer 1

Pigment stones are small and irregular - caused by haemolysis
Cholesterol stones are large and often solitary - caused by age and obesity
Mixed stones are faceted and caused by a mix of things

Question 2

What are the symptoms and treatment for biliary cholic?

Answer 2

The symptoms are right upper quadrant pain that radiates to the back may or may not have jaundice
Treated with analgesia, rehydration and elective cholecystectomy

Question 3

What are the symptoms of cholecystitis?

Answer 3

This is when a stone gets stuck in the cystic duct or gallbladder and causes continous pain RUQ.
This causes inflammation and this causes vomiting, fever, local pertonism (rebound tenderness)

Question 4

What is murphys sign?

Answer 4

Lay 2 fingers over the right upper quadrant and ask the patient to breathe in. Pain will cause inspiration to halt when positive. Shows cholecystitis

Question 5

What are the tests to do for acute cholecystitis?

Answer 5

Increased WCC
US shows thick shrunken gallbladder
Plain AXR only shows 10% of stones

Question 6

What is the treatment for acute cholecystitis?

Answer 6

Nil by mouth
Pain relief
Co-amoxiclav IV
Laproscopic cholecystectomy treatment of choice

Question 7

What are the symptoms of chronic cholecystitis?

Answer 7

vague abdominal discomfort, distension, flatulence, fat intolerance

Question 8

When is ERCP indicated?

Answer 8

If there is a stone blocking the common bile duct causing dilation ERCP is used to remove it before lap cholecystectomy

Question 9

What are the symptoms of cholangitis?

Answer 9

Can develop from acute cholecystitis

Causes charcots triad: RUQ pain, Fever and jaundice

Question 10

How is cholangitis treated?

Answer 10

Treated with tazobactam 4.5g/8hr IV