3 Gallstones Questions What are the complications of gallstones in the cystic duct? What are the complications of gallstones in the common bile duct? What tests would you perform to confirm gallstones? Gallstones are very common, with prevalence at postmortem of 15–25%. However, 80% of stones remain asymptomatic. Aetiology A number of factors are associated with the occurrence of gallstones (the ‘Fs’: fat, fertile females over forty): gender (female to male 2:1) and age (> 40 years) are the most important determinants obesity: increases hepatic synthesis/secretion of cholesterol pregnancy: increased oestrogen causes choleostasis diabetes mellitus ileal disease or resection: leading to bile salt loss total parenteral nutrition: owing to gallbladder stasis. There are three types of stone: mixed (80%): cholesterol is the main component, with bile pigments and calcium salts pigmented (10%): contain calcium bilirubinate, are associated with haemolytic disorders (haemolytic anaemia, malaria) and are rare in Western countries pure cholesterol (10%). Investigations Blood tests Liver function tests may be normal or show an obstructive picture (bilirubin, alkaline phosphatase, alanine aminotransferase or aspartate aminotransferase may be raised). Serum amylase excludes associated acute pancreatitis. Blood cultures identify septicaemia in the seriously ill. Ultrasound The best test in the acute phase as it demonstrates gallstones (as an ‘acoustic shadow’) in over 90% of patients. (Only 10% of stones are radioopaque and so plain radiograph is unsuitable.) Ultrasound also will show wall thickening, pericholecystic collections, dilatation of common bile duct (CBD) and intrahepatic biliary tree.< div class='tao-gold-member'> Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Shoulder trauma Examination of the neck Breast cancer Shoulder pain Thyroid disorders Pancreatic disorders Stay updated, free articles. Join our Telegram channel Join Tags: The Flesh and Bones of Surgery Jul 3, 2016 | Posted by admin in MUSCULOSKELETAL MEDICINE | Comments Off on Gallstones Full access? Get Clinical Tree
3 Gallstones Questions What are the complications of gallstones in the cystic duct? What are the complications of gallstones in the common bile duct? What tests would you perform to confirm gallstones? Gallstones are very common, with prevalence at postmortem of 15–25%. However, 80% of stones remain asymptomatic. Aetiology A number of factors are associated with the occurrence of gallstones (the ‘Fs’: fat, fertile females over forty): gender (female to male 2:1) and age (> 40 years) are the most important determinants obesity: increases hepatic synthesis/secretion of cholesterol pregnancy: increased oestrogen causes choleostasis diabetes mellitus ileal disease or resection: leading to bile salt loss total parenteral nutrition: owing to gallbladder stasis. There are three types of stone: mixed (80%): cholesterol is the main component, with bile pigments and calcium salts pigmented (10%): contain calcium bilirubinate, are associated with haemolytic disorders (haemolytic anaemia, malaria) and are rare in Western countries pure cholesterol (10%). Investigations Blood tests Liver function tests may be normal or show an obstructive picture (bilirubin, alkaline phosphatase, alanine aminotransferase or aspartate aminotransferase may be raised). Serum amylase excludes associated acute pancreatitis. Blood cultures identify septicaemia in the seriously ill. Ultrasound The best test in the acute phase as it demonstrates gallstones (as an ‘acoustic shadow’) in over 90% of patients. (Only 10% of stones are radioopaque and so plain radiograph is unsuitable.) Ultrasound also will show wall thickening, pericholecystic collections, dilatation of common bile duct (CBD) and intrahepatic biliary tree.< div class='tao-gold-member'> Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Shoulder trauma Examination of the neck Breast cancer Shoulder pain Thyroid disorders Pancreatic disorders Stay updated, free articles. Join our Telegram channel Join Tags: The Flesh and Bones of Surgery Jul 3, 2016 | Posted by admin in MUSCULOSKELETAL MEDICINE | Comments Off on Gallstones Full access? Get Clinical Tree
