Gallstone disease

• What are gallstones also called?

  Cholelithiasis
• How do gallstones form?

  Concentrated bile in bile ducts (usually made from cholesterol)
• What are the symptoms of gallstones?

  May be asymptomatic or cause biliary colic
• What are the possible complications of gallstones?

  Acute cholecystitis

  Acute cholangitis

  Pancreatitis (if gallstone blocks pancreatic duct)

  Obstructive jaundice
• What is cholestasis?

  Blockage to flow of bile
• What is choledocholithiasis?

  Gallstones in bile duct
• What are the RFs for gallstones?

  Fat

  Female

  Fertile

  Forty
• What causes gallbladder contraction?

  Cholecystokinin (CCK) release from the duodenum
• What does a raised ALP indicate?

  Biliary obstruction

  'pipes'

  NOTE: ALP can also indicate bone damage
• What are the Inx for gallstones?

  Obs

  Full Hx & examination

  Bloods (LFTs, CRP, FBC)

  Abdo USS

  CT

  MRCP/ERCP
• What are the possible complications of ERCP?

  Excessive bleeding

  Cholangitis

  Pancreatitis
• What is the management of gallstones?

  Conservation (if asymptomatic)

  Cholecystectomy
• What are the possible complications of cholecystectomy?

  Bleeding, infection, pain & scars

  Damage to bile duct (leakage & strictures)

  Stones left in cile duct

  Damage to bowel, blood vessels or other organs

  Anaesthetic risk

  VTE

  Post-cholecystectomy syndrome
• What is post-cholecystectomy syndrome?

  Group of non-specific symptoms

  Often improve with time

  • diarrhoea
  • indigestion
  • epigastric or RUQ pain
  • nausea
  • intolerance to fatty foods
  • flatulence