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41 Cards in this Set
- Front
- Back
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Who gets gallstones?
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Women
Native americans, Hispanics>Caucasians>AAs |
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What's the natural history of gallstones?
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70-80% aren't symptomatic!
You only take out the gall bladder if there are symptoms |
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What are the types of stones?
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Cholesterol (80%)
Black (20%) Brown |
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Where do brown pigment stones form/
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Bile ducts; denovo
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What is the impact of a higher cholesterol content in stones?
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More cholesterol = dissolve earlier
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What are risk factors for formation of black gallstones?
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Female
Chronic hemolysis (SC, hereditary spherocytosis) Advanced age Liver cirrhosis |
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What are risk factors for cholesterol stones?
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Female
Obese Pregnancy Rapid significant weight loss Terminal ileal disease Drugs DM |
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Why does terminal ileal disease predispose to cholesterol stones?
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Lack of absorption of bile salts means that you can't solubilize cholesterol as well, which leads to the formation of stones
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What drugs predispose to cholesterol stones?
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Octreotide
Ceftriaxone |
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What are the steps in the pathogenesis of cholesterol gallstones?
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Cholesterol super saturation
Nucleation Progressive stone growth along the wall |
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What are diseases that give you gallbladder hypomotility?
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TPN
Pregnancy |
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What are requirements for the formation of prigment stones?
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Lots of bilirubin
Beta-glucuronidase Under-saturation of CaCO4 Gall bladder stasis |
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What is inside of brown pigment stones?
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Ca bilirubinate + Ca soaps of FAs
More cholesterol than black pigment stones |
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What kind of stones to people who have already had a cholecystectomy have?
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Brown pigment stones
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Whawt are risks for brown pigment stones/
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Stasis
-Bile duct strictures -Primary sclerosing cholangitis -S/P cholecystectomy Infection -Cholangitis -Parasites |
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Can someone have both a black and a cholesterol stone?
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NO.
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What are the ways that gallstones can present?
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What is a precursor to gallbladder stones?
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Gallbladder sludge
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What is inside gallbladder sludge?
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Crystals
Mucus |
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What are the symptoms of gallstones?
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Biliary colic
Acute cholecystitis Gallstone pancreatitis Bile duct obstruction +/- cholangitis NOT DYSPEPSIA! |
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What are the symptoms of biliary colic?
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Severe, episodic, epicgastric or RUQ pain
Pain is hours long Post-prandial (maybe) Radiates to the shoulder blades (R) May have associated N/V |
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What occurs in acute cholecystiits?
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Continued cystic duct obsruction
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What's the presentation of acute cholecystitis?
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Pain that persists for hour-days
90% resolve spontaneously |
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What's the mortality for acute cholecystitis?
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5-10% motality due to infectious complications
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How do you go about diagnosing gallstones?
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US
95% sensitivity for gallbladder stones 25% sensitive for bile duct stones |
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What's diagnostic for acute cholecystitis on an US?
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Wall thickening and pericholecystic fluid
Murphy's sign: pain upon pressing with the probe over the gall bladder |
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What is the role of cholescintigraphy in cholecystitis?
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Only use it in unclear situations - when US isn't conclusive
You just inject dye up the duct and see if there's an obstruction |
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How can you test for the ejection fraction of the gall bladder?
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Cholescintigraphy with CCK infusion
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What are contraindications to laparascopic cholecystectomy?
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Adhesions
Coagulopathy |
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What are the treatments for gallstones?
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Lap Chole: gold standard
Oral dissolution |
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What are oral meds for gallstone treatment?
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Ursodeoxycholic acid
Long-term therapy Only good for cholesterol stones |
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What can you do for someone who is inoperable but has acute cholecystitis?
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Cholecystostomy
IR puts in an ostomy from the gall bladder to the outside; prevents infectious complications |
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What is choledocholithiasis?
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Stones in the bile duct
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What gives high clinical suspicion for choledocholithiasis? What do you do?
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1. Dilated bile duct
2. Elevated liver levels ERCP |
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What should you do for a low-moderate suspicion of choledocholithiasis?
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MRCP
EUS |
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What is the management for concomitant GB + bile duct stones?
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High suspicion duct stones: pre-op ERCP
Low suspicion of duct stones: intra-op cholangiogram Lap-chole |
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What's the presentation of a malignant biliary obstruction?
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Painless jaundice
Weight loss |
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What are malignant causes of biliary obstruction?
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Pancreatic cancer
Cholangiocarcinoma Ampullary carcinoma Gallbladder cancer Metastatic lymph nodes |
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What's a double duct sign? What does this mean?
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When there's a dilated pancreatic duct and bile duct
Pancreatic cancer |
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What do we do for most malignant causes of biliary tract obstruction?
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Pailliative care
Put in stents to open up tubes, etc. |
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What are non-malignant causes of biliary obstruction?
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Choledocholithiasis
Benign (prior surgery common; had to convert to open) Chronic pancreatitis/pseudocysts Primary schlerosing cholangitis Sphincter of Oddi dysfunction |
