Gall Bladder Disease Notes

Gall Bladder Disease

Gallstones

• Very common in patients >40 years

• Usually asymptomatic

Bile contains

• Phospholipids

• Cholesterol

• Bile pigments (from Hb)

Stones can be

• Pigment stones (resulting from haemolysis e.g sickle cell disease)

• Cholesterol stones (risk factors = female, obesity, age)

Gallstones may cause

• Acute or chronic cholecystitis

• Biliary colic

• Cholangitis

• Pancreatitis

• Obstructive jaundice

Acute cholecystitis

Follows tone of sludge impaction in neck of gall bladder

Clinical features

• Epigastric/RUQ pain – can be referred to right shoulder tip

• Vomitting

• Fever

• Local peritonism

• Palpable mass

• Murphy’s sign (pain on inspiration when palpating RUQ)

Investigations

• Bloods

  • Raised WCC

• Imaging

  • USS – thick walled shrunken gallbladder, dilated CBD, stones

Management

• NBM

• Pain relief

• IV fluids

• Antibiotics

• Cholecystectomy

Chronic Cholecystitis

Chronic inflammation resulting from stones

Clinical features

• Vague abdominal discomfort

• Nausea

• Distention

• Flatulence

• Fat intolerance

• Fever

Investigations

• USS

• MRCP

• ERCP

Management

• Cholecystectomy

Biliary colic

Term used for pain associated with temporary obstruction of cystic or common bile duct

• Severe pain which increases in severity

• Symptoms related to food over indulgence esp fat

• Commonly episodes occur mid evening and last till early morning

• Epigastric pain – RUQ – R shoulder

• N+V may accompany severe attacks

• Cessation spontaneous after several hours/opiates

• More protracted pain or fever, rigor suggest secondary complications (cholecystitis, choleangitis, gallstone pancreatitis)

Choleangitis

Blockage of the bile duct usually caused by stones which leads to infection

Clinical features

• Biliary colic

• Fever

• Jaundice

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