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Flashcards in Gallstones Deck (24)
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1
Q

What are the main types of gallstones?

A

Cholesterol stones

  • purely cholesterol
  • excess cholesterol production

Pigment stones

  • purely bile pigments
  • commonly seen in those with haemolytic anaemia

Mixed stones
- comprised of both cholesterol and bile pigements

2
Q

Risk factors of gallstones

A
Female
Diabetes
Obesity
Pregnancy
Oral contraceptive
3
Q

What is biliary colic?

A

Neck of gallbladder is impacted by a stone, contraction of gallbladder causes pain

4
Q

Clinical features of biliary colic

A

Intermittent colicky pain

Pain precipitated by fatty foods

5
Q

What is acute cholecystitis?

A

Impaction of stone with signs of inflammation

6
Q

Clinical features of acute cholecystitis

A

Constant pain - RUQ + epigastric
Pain radiates to back
Fever
N+V

7
Q

What is Murphy’s sign?

A

Apply pressure in RUQ
Ask patient to inspire

Positive = halt in inspiration due to pain

Sign of an inflammed gallbladder

8
Q

Investigations for biliary colic/acute cholecystitis

A
Urinanalysis - rule out renal cause/pregnancy
Bloods 
- FBC
- CRP
- LFT (raised ALP)
Ultrasound
MRCP
9
Q

Management of biliary colic

A

Analgesia
Low fat diet

Cholecystectomy

10
Q

Management of acute cholecystitis

A

Antibiotics
Fluids
Analgesia

Cholecystectomy

11
Q

Complications of biliary colic/acute cholecystitis

A
Gallbladder empyema
Chronic cholecystitis
Gallbladder-duodenum fistula
Bouveret's syndrome
Gall stone ileus
12
Q

What is gallbladder empyema?

A

Gallbladder is infected and abscess forms inside

Diagnosed by ultrasound or CT

Management: cholecystectomy

13
Q

What is chronic cholecystitis?

A

Recurrent/untreated cholecystitis

Ongoing RUQ/epigastric pain

Diagnosed by CT

Management: cholecystectomy

14
Q

What is Bouveret’s syndrome?

A

Gallstone passes into duodenum and causes obstruction

15
Q

What is Gallstone illeus?

A

Gallstone passes into bowel and causes obstruction at terminal illeum

16
Q

What is cholangitis?

A

Infection in biliary tract

17
Q

Cause of cholangitis

A

Combination of biliary outflow obstruction and biliary infection

Stasis of fluid allows bacterial colonisation

18
Q

What are the common organisms of cholangitis?

A

Escherichia Coli
Klebsiella species
Enterococcus

19
Q

Clinical features of cholangitis

A

RUQ pain
Fever
Jaundice
Previous gallstones

20
Q

What is Charcots triad?

A

Jaundice
Fever
RUQ pain

Associated with cholangitis

21
Q

What is Reynold’s pentad?

A
Jaundice
Fever
RUQ pain
Hypotension
Confusion 

Associated with cholangitis

22
Q

Management of cholangitis

A

Definitive treatment:
- endoscopic biliary decompression

Beware of sepsis

23
Q

What is choledocholithiasis?

A

Gallstones impacted in common bile duct

24
Q

Clinical features of choledocholithiasis

A

Jaundice
Tachycardia
RUQ pain
Fever