Gallstones

3 Gallstones

Questions

image What are the complications of gallstones in the cystic duct?
image What are the complications of gallstones in the common bile duct?
image 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):

image gender (female to male 2:1) and age (> 40 years) are the most important determinants
image obesity: increases hepatic synthesis/secretion of cholesterol
image pregnancy: increased oestrogen causes choleostasis
image diabetes mellitus
image ileal disease or resection: leading to bile salt loss
image total parenteral nutrition: owing to gallbladder stasis.

There are three types of stone:

image mixed (80%): cholesterol is the main component, with bile pigments and calcium salts
image pigmented (10%): contain calcium bilirubinate, are associated with haemolytic disorders (haemolytic anaemia, malaria) and are rare in Western countries
image 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.

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Jul 3, 2016 | Posted by in MUSCULOSKELETAL MEDICINE | Comments Off on Gallstones

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