Gallstones

epidemiology

24% of women and 12% men have gall stones, 50% are mixed and 50% are pure cholesterol

symptoms

colicky right upper quadrant pain postprandially, worst after a fatty meal

investigationsations

abdo ultrasound, liver func tests, , MRCP

biliary colic

colicky abdo pain worse after eating and after fatty foods

biliary colic management

if imaging shows gallstones and history then laparoscopic cholecystectomy

acute cholecystitis

right upper quadrant pain, fever, murphys sign, mildly skewed lots

acute cholecystitis managment

ultrasound and cholecystectomy within 48 hours

gall bladder abscess

usually prodromal, right upper quadrant pain, swinging pyrexia, systemically unwell

gall bladder abscess management

USS and CT, surgery or subtotal cholecystectomy or percutaneous drainage

cholangitis

Beverly septic and unwell, jaundiced, right upper quadrant pain

cholagnitis management

fluids, iv abx, early ERCP

gallstone ileus

small bowel obstruction could be intermittent, previous cholecystitis and known gall stones

gallstone ileus mangement

laparotomy and removal of gallstone from small bowel

acalculous cholecystitis

patients with intercurrent illness, systemically unwell, gall bladder inflammation, absence of stones, high fever, treat with cholecystectomy

gallstones management

if symptomatic then treatment of choice is cholecystectomy via laparoscopic route or ERCP

biliary colic risk factors

fat (incr cholesterol synthesis and secretion), female, fertile, forty, DM, crohns, rapid weight loss, drugs

biliary colic what it is

incr cholesterol, decreased bile salts and biliary stasis, pain occurs due to gallbladder contracting against stone stuck in cystic duct