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Gallstones

From Mediwikis

Gallstones form in the gallbladder from bile components. There is an 11% prevalence. 80% of gallstones consist of cholesterol, which build up (often asymptomatically at first) in the gall bladder.

Risk Factors

The Five F's

  • Fat
  • Female
  • Forty
  • Fecundity (multiple pregnancies)
  • Fair

Symptoms & Signs

The majority of gallstones are asymptomatic. However over a 15 year period, 20% will cause symptoms with 10% having severe complications. These can exist as "gallstone attacks" of right upper quadrant pain, nausea and vomiting, over several hours.
Biliary colic.jpg

Biliary Colic

Colic is defined as the contraction of a hollow viscous against an obstruction. Biliary colic is a griping upper abdominal pain, caused by a stone passing from the gallbladder, down the cystic duct and into the common bile duct, obstructing it.

At the lower end of the common bile duct, the stone passes though the sphincter of Oddi at the ampulla of Vater and into the duodenum.

The pancreatic duct also opens into the ampulla of Vater near the sphincter of Oddi.

Gallstones and biliary gravel may pass up the pancreatic duct causing Acute Pancreatitis.

Acute cholecystitis

This is inflammation in the gallbladder caused by retention of bile in the gallbladder, often with secondary infection. For further information see Cholecystitis.

Management

  • NSAIDs
  • Intra-Muscular/Opioid
  • Broad-spectrum antibiotic (e.g. - cephalosporin) to prevent secondary bacterial infection
  • Surgery
    • ERCP guided spincterotomy (opening the sphincter of Oddi to make it larger and allow stones to pass)
    • Cholecystectomy (removal of the gall bladder)