Gallstones & Cholecystitis Flashcards Preview

Gastrointestinal Conditions > Gallstones & Cholecystitis > Flashcards

Flashcards in Gallstones & Cholecystitis Deck (24):
1

What are gallstones:

Solid masses that form when the concentrations of the different components of bile vary

2

Most common presentations of gallstones:

* Biliary colic (56%)
* Acute cholecystitis (36%)

Others:
- Chronic cholecystitis
- Pancreatitis
- Obstructive jaundice

3

What percentage of individuals with gallstones are asymptomatic:

90%

4

Risk factors for becoming symptomatic with gallstones

Smoking
Parity

5

Risk factors for gallstone formation:

Haemolysis
Cirrhosis
Female
Advancing age
Obesity
Diabetes
Loss of bile salts (e.g. ileal resection/terminal ileitis)
Oral contraceptives

6

Types of gallstone:

Cholesterol
Most common (80%)
Large, often solitary
Risk Fx
Fair
Fat
Female
Fertile
Forty

Pigment
Small, friable, irregular
Radiolucent
Caused by haemolysis and cirrhosis

Mixed stones
Faceated
Comprise calcium salts, pigment and cholesterol
10% are radiopaque

7

Cause of biliary colic:

Cystic duct obstruction or obstruction of the common bile duct

8

Symptoms of biliary colic

Pain
RUQ
Radiating to back
Sudden onset

Jaundice (if CBD obstruction)

Nausea and vomiting

9

Cause of acute cholecystitis:

Gallstone impaction in neck of gallbladder + infection

10

Symptoms of acute cholecystitis:

Pain
Continuous
RUQ/epigastric
Referred to R shoulder
Vomiting
Fever

Vomiting

Fever

11

Chronic cholecystitis symptoms:

Flatulent dyspepsia

* Vague abdo discomfort
* Distention
* Nausea
* Flatulence
* Fat intolerance

12

Cholangitis symptoms:

Charcot's triad
RUQ pain

Jaundice

Rigor's

13

Other than colic, cholecystitis and cholangitis, gallstones may present in this way:

Pancreatitis

due to blockage of pancreatic duct

Severe epigastric pain
Radiating to back
Relieved by sitting forwards

Prominent vomiting + nausea

14

Signs of biliary colic:

Jaundice if there is obstruction of the common bile duct

15

Signs of acute cholecystitis:

Local peritonism
Abdo pain
Tenderness
Guarding
Rebound tenderness

Fever

Murphy's sign
Only + if not elicited on L side

Palpable gallbladder mass

16

Signs of cholangitis:

Pyrexia

Rigors

17

Differential diagnosis of gallstones:

* Acute pancreatitis
* Appendicitis
* Bile duct strictures
* Bile duct tumours
* Cholecystitis
* Peptic ulcer disease
* Pancreatic cancer
* Atypical MI
* Pneumonia

18

Investigations in gallstone presentations:

1. Bloods: FBC, CRP, LFTs

2. USS

3. Others: Urine, CXR, ECG (rule out other causes)

19

Management of symptomatic presentation of gallstones:

Pharmacological
1. Analgesia: Pethidine/morphine

2. ABX: Co-Amoxiclav (cholecystitis), Tazocin (cholangitis)

3. IV fluids (+NBM if surgery anticipated)

Surgical
1. Cholecystitis: Lap chole. Open surgery if perforation

2. Biliary colic: Elective lap chole

20

Complications of gallstones in the common bile duct:

* Cholestatic jaundice
* Cholangitis
* Pancreatitis



21

Complications of gallstones in the gallbladder or cystic duct:

* Biliary colic
* Acute/chronic cholecystitis
* Mucocoele
* Empyema
* Carcinoma
* Mirizzi's syndrome
Stone in GB presses on bile duct causing jaundice

22

Complications of gallstones in the GIT:

* Gallstone ileus

Stone erodes into duodenum. Can obstruct terminal ileum

23

Complications of cholecystectomy:

* Bile duct injury (0.2%)
* Fat intolerance

* Post-cholecystectomy syndrome
Abdo pain
Jaundice
Dyspeptic Sx
(RARE)

24

Prognosis of gallstones:

Almost all who have cholecystectomy experience elimination of symptoms