Flashcards in Cholelithiasis Deck (10):
Presence of stones in gallbladder.
Usually asymptomatic, problems when stick in biliary tree.
Gallbladder concentrates bile, can=precipitation of stones.
-Pigment stones 10%- small, friable, irregular, black, multiple.
-Cholesterol stones 10%- large often solitary. Due to age and obesity.
-Mixed 80%- (Ca salt, pigment, cholesterol).
RFs- female, age, obesity, multiparity, diet, LDCs, OCP, ileal disease or resection (loss bile salts), haemolytic disease, rapid weight loss,
Can block bile flow and even pancreatic duct.
Peptic ulcer disease
Neoplasms- stomach, pancreas, colon, GB
Lifestyle- low fat but slow weight loss.
Analgesia, rehydration, NBM, IV AB if cholecystitis or cholangitis.
Asymptomatic no tx
Oral bile salts for small cholesterol stones.
Extracorporeal shock wave lithotripsy.
Symptoms and signs
- Biliary colic in cystic duct obstruction or if passed into CBD- RUQ pain radiates to back, possibly with jaundice. Pain 15mins to 24 hours, usually worse after food as CCK triggers gallbladder contraction.
- Acute cholecystitis due to stone impaction on gallbladder neck- contin epigastric or RUQ pain, vomit, fever, peritonism, GB mass, sepsis.
Murphy sign- 2 fingers over RUQ, pain on inspiration.
- chronic cholecystitis- chronic inflammation possibly with colic. Flatulent dyspepsia, vague abdo discomfort, distension, nausea, fat intolerance (steatorrhoea)
- cholangitis- BD infection. RUQ pain, jaundice, rigors.
- gallstone ileus- stone through to duodenum.
- gallbladder and cystic duct- biliary colic, acute and chronic cholecystitis due to stasis, mucocoele, empyema, carcinoma, perforation.
- In BD- obstructive jaundice, ascending cholangitis, pancreatitis, liver abcess, sepsis.
- gut- gallstone ileus.
Ascending cholangitis- RUQ pain, fever, jaundice.
Biliary colic RUQ/epigastric/back.
Nausea and vomiting
Pain upt o 24 hours and worse fater food.
Ascending cholangitis- RUQ pain, jaundice, rigours
ERCP uses endoscope and x rays
-biliary colic- RUQ pain intermittently, no fever, normal WCC, no jaundice.
-acute cholecystitis- continuous RUQ pain, fever, high WCC, no jaundice.
-cholangitis- RUQ pain, fever, high WCC, jaundice.