gallstones.

How do gallstones form?

From concentrated bile from the bile ducts.

What are most gallstones made of?

Cholesterol.

What happens when gallstones block the pancreatic duct?

Pancreatitis.

Describe the basic anatomy of the gallbladder and bile ducts.

Right hepatic duct and left hepatic duct join to become common hepatic duct. Cystic duct from gallbladder joins common hepatic duct. Pancreatic duct joins common hepatic duct. Common bile duct and pancreatic duct join to become ampulla of Vater, which opens into the duodenum. Sphincter of Oddi controls flow of bile and pancreatic secretions into duodenum.

What is cholestasis?

Blockage to the flow of bile.

What is cholelithiasis?

Presence of gallstones.

What is choledocholithiasis?

Gallstones in the bile duct.

What is biliary colic?

Intermittent, colicky, right upper quadrant pain caused by gallstones irritating bile ducts.

What is cholecystitis?

Inflammation of the gallbladder.

What is cholangitis?

Inflammation of the bile ducts.

What is gallbladder empyema?

Pus in the gallbladder.

What is cholecystectomy?

Surgical removal of the gallbladder.

What is cholecystostomy?

Inserting a drain into the gallbladder.

What is the mnemonic for remembering the risk factors for gallstones?

The four F's: Fat, Fair, Female, Forty.

Can patients with gallstones be asymptomatic?

Yes

What triggers biliary colic?

Meals, particularly high fat meals.

How long does biliary colic typically last?

Between 30 minutes and 8 hours.

What are the associated symptoms of biliary colic?

Nausea and vomiting.

What are the complications of gallstones?

Acute cholecystitis, acute cholangitis, obstructive jaundice, pancreatitis.

What triggers gallbladder contraction?

Cholecystokinin (CCK) release triggered by fat entering the digestive system.

Why are patients with gallstones advised to avoid fatty foods?

To prevent CCK release and gallbladder contraction.

What does raised bilirubin with pale stools and dark urine indicate?

Obstruction within the biliary system.

What can cause obstruction in the biliary system?

Gallstone in the bile duct or external mass pressing on the bile ducts.

What is alkaline phosphatase (ALP)?

A non-specific marker originating in the liver, biliary system, and bone.

What can abnormal ALP results indicate?

Liver or bone problems.

Why is ALP often raised in pregnancy?

Due to production by the placenta.

What does a raised ALP indicate in the presence of right upper quadrant pain and/or jaundice?

Biliary obstruction.

What can cause raised alkaline phosphatase?

Liver or bone malignancy, primary biliary cirrhosis, Paget's disease of the bone, and others.

What are aminotransferases?

Enzymes produced in the liver that indicate hepatocellular injury.

What is the difference between ALT and AST in cholestasis?

ALT and AST may increase slightly, but ALP rises more.

What does a high ALT and AST compared to ALP indicate?

A problem inside the liver with hepatocellular injury.

What is an ultrasound scan used for?

First-line investigation for gallstone disease and biliary symptoms.

What are the limitations of ultrasound?

Patient's weight, gaseous bowel, and probe discomfort.

What can ultrasound help identify?

Gallstones, bile duct dilatation, acute cholecystitis, and pancreatic abnormalities.

What is MRCP?

Magnetic resonance cholangio-pancreatography, an MRI scan for the biliary system.

What is MRCP sensitive and specific for?

Biliary tree disease, such as stones and malignancy.

When is MRCP used?

To gain a detailed picture of the biliary system and identify abnormalities.

What is MRCP used for in gallstone disease?

To investigate further if ultrasound scan does not show stones in the duct, but there is bile duct dilatation or raised bilirubin suggestive of obstruction.

What does ERCP stand for?

Endoscopic Retrograde Cholangio-Pancreatography.

What is the main indication for ERCP?

To clear stones in the bile ducts.

What can be done during an ERCP?

Inject contrast and take x-rays to visualize the biliary system

perform a sphincterotomy on the sphincter of Oddi

clear stones from the ducts

insert stents to improve bile duct drainage

take biopsies of tumours

What are the key complications of ERCP?

Excessive bleeding, cholangitis, and pancreatitis.

What are CT scans useful for in gallstone disease?

Looking for differential diagnoses and complications such as perforation and abscesses.

How are asymptomatic patients with gallstones managed?

Conservatively, with no intervention required.

When is cholecystectomy indicated?

When patients are symptomatic of gallstones or the gallstones are leading to complications.

What can be done before or during cholecystectomy if there are stones in the bile ducts?

They can be removed by ERCP.

What is the purpose of performing a sphincterotomy during ERCP?

To unblock the flow if the sphincter of Oddi is dysfunctional.

What is the purpose of inserting stents during ERCP?

To improve bile duct drainage, especially in cases of strictures or tumors.

What are the complications of ERCP?

Excessive bleeding, cholangitis, and pancreatitis.

What is laparoscopic cholecystectomy?

Keyhole surgery to remove gallbladder.

What are the complications of cholecystectomy?

Bleeding, infection, pain, scars, bile duct damage, stones in bile duct, bowel/organ damage, anaesthetic risks, venous thromboembolism.

What causes post-cholecystectomy syndrome?

Changes in bile flow after gallbladder removal.

Do symptoms of post-cholecystectomy syndrome improve?

Yes, often improve with time.

What are the symptoms of post-cholecystectomy syndrome?

Diarrhea, indigestion, pain, nausea, intolerance of fatty foods, flatulence.

What is a possible complication of cholecystectomy related to the bile duct?

Leakage and strictures.