Gallstones AAFP and EASL

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Questions and Answers

What type of gallstones is most commonly found?

Calcium stones

Black pigment stones

Cholesterol gallstones (correct)

Brown pigment stones

Which of the following is NOT a recommended dietary component to prevent gallstones?

Fruits and vegetables

Saturated fats (correct)

Polyunsaturated fats

Regular Vitamin C intake

What is the anatomical location where black pigment stones form?

Gallbladder (correct)

Cystic duct

Hepatic duct

Main bile duct

In which condition is ursodeoxycholic acid (UDCA) indicated for preventing gallstones?

Rapid weight loss scenarios Signup and view all the answers

What characteristic symptom suggests the presence of symptomatic gallbladder stones?

Episodic severe pain with specific characteristics Signup and view all the answers

What disadvantage is associated with pharmacological treatment for gallstone prevention in the general population?

Lack of effectiveness Signup and view all the answers

Which dietary component has been shown to modify biliary bile acid composition and prolong crystallization time of biliary cholesterol?

Vitamin C Signup and view all the answers

What type of stones is likely found in the main bile duct?

Brown pigment stones Signup and view all the answers

What is the primary method for treating patients with biliary-type symptoms due to gallstones?

Laparoscopic cholecystectomy Signup and view all the answers

In patients presenting with highly suggestive gallstone symptoms but no gallstones on imaging, what scan should be considered?

Cholecystokinin-HIDA scan Signup and view all the answers

Which antibiotic should be given as a single preoperative dose for antibiotic prophylaxis in gallbladder surgery?

Cefazolin Signup and view all the answers

What is the primary treatment for acute biliary colic?

Pain control with NSAIDs or narcotics Signup and view all the answers

For cholesterol-containing gallstones, which medical intervention is typically suggested?

Litholysis Signup and view all the answers

Which of the following statements regarding gallstone size and surgery is accurate?

Gallstones 5 mm or smaller are not candidates for surgery. Signup and view all the answers

Can prolonged fasting lead to the formation of gallstones?

Yes, it can. Signup and view all the answers

Which of the following therapies is contraindicated for pregnant women with symptomatic gallstones?

Chenodeoxycholic acid Signup and view all the answers

What is the primary imaging modality recommended for assessing upper abdominal pain suspected to be related to gallbladder issues?

Abdominal ultrasonography Signup and view all the answers

Which complication is most frequently associated with gallstone disease?

Acute cholecystitis Signup and view all the answers

What is the necessary condition for the inflammation of the gallbladder in acute cholecystitis?

Obstruction of the cystic duct Signup and view all the answers

Which symptom is often a significant indicator of acute cholecystitis?

Murphy’s sign Signup and view all the answers

What does the term choledocholithiasis refer to?

Migration of gallstones into the common bile duct Signup and view all the answers

What is the effectiveness of endoscopic ultrasound in diagnosing gallstones or their complications?

High sensitivity and specificity Signup and view all the answers

What is the recommended management approach for patients with choledocholithiasis?

Intravenous antibiotics and ERCP Signup and view all the answers

What laboratory finding is often elevated in a patient presenting with gallstone pancreatitis?

Increased amylase and lipase levels Signup and view all the answers

What diagnostic test evaluates for cystic duct obstruction to help diagnose acute cholecystitis?

HIDA scan Signup and view all the answers

Which of the following is NOT recommended for the dissolution of gallbladder stones?

Laparoscopic cholecystectomy Signup and view all the answers

What is the predictive triad for ascending cholangitis termed?

Charcot triad Signup and view all the answers

Which risk factor is associated with the formation of gallstones?

High-calorie diets Signup and view all the answers

What is the significance of the term 'Murphy's sign' in clinical examination?

Indicates cholecystitis Signup and view all the answers

When is computed tomography particularly considered for assessing gallstones?

If complications of gallstones are suspected Signup and view all the answers

Study Notes

Gallstones Overview

Cholesterol gallstones are the most common type.
Black pigment stones are typically seen in chronic hemolytic disorders and cirrhosis.
Gallbladder is the site of formation for cholesterol and black pigment stones.
Brown pigment stones develop in the main bile duct.
Sludge arises from stasis and reduced enterohepatic bile circulation but is not a direct cause of gallstones.

Preventive Measures and Diet

A diet rich in fruits, vegetables, polyunsaturated and monounsaturated fats, alongside regular Vitamin C intake, is protective against gallstones.
Vitamin C at dosages of 500 mg four times daily can alter bile acid composition and inhibit cholesterol crystallization.
Pharmacological prevention of gallstones in the general population is not advisable, with no recommended use of UDCA or aspirin for prevention.

Clinical Presentation and Symptoms

Symptomatic gallbladder stones are characterized by episodic severe pain in the right upper quadrant or epigastrium, lasting at least 15-30 minutes and responsive to analgesics.
Signs of biliary pain include irregular pain periodicity, onset about 1 hour after meals, nighttime pain, and pain severe enough to awaken a patient.
Abdominal ultrasonography is the imaging of choice for upper abdominal pain; CT scans are not useful for gallbladder stones.

Acute Cholecystitis

Acute cholecystitis is the most common complication of gallstone disease, caused by obstruction of the cystic duct by stones.
Clinical findings include fever, severe RUQ pain (Murphy’s sign), leukocytosis, and possible right upper quadrant mass.
Appropriate investigations for diagnosing acute cholecystitis include fever, RUQ pain, and Murphy's sign.

Choledocholithiasis

Choledocholithiasis occurs when gallstones migrate to the common bile duct, potentially causing complications like gallstone pancreatitis or acute cholangitis.
Presenting symptoms may include Charcot's triad (fever, jaundice, and abdominal pain) and Reynolds' pentad (adding altered mental status and hypotension).

Imaging and Diagnostic Studies

HIDA scan assesses cystic duct obstruction, while MRCP is useful for gallstones when initial imaging is inconclusive.
Laboratory tests for complications include complete blood count, hepatic transaminases, total bilirubin, alkaline phosphatase, amylase, and lipase levels.

Management of Gallstones

Initial management for patients with biliary symptoms or complications is often laparoscopic cholecystectomy.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are typically used for pain control in acute biliary colic.
Antispasmodic agents, like scopolamine, may be employed to relieve gallbladder spasms.
Antibiotic prophylaxis is usually limited to a single preoperative dose of intravenous cefazolin.

Treatment Options

Asymptomatic gallstones do not require medical therapy aside from pain management; litholysis may be considered for symptomatic cholesterol-containing stones.
Dissolution therapy with ursodeoxycholic acid is an option for patients unable to undergo surgery with symptomatic small stones.
Extracorporeal shock wave lithotripsy may be used as a non-invasive alternative for symptomatic patients but carries risks of recurrence.

Special Considerations

In pregnant women, initial management of symptomatic gallstones is supportive, with pain control typically achieved through meperidine.
Ursodeoxycholic acid can be administered in pregnancy, whereas chenodeoxycholic acid is contraindicated.
Prolonged fasting, rapid weight loss, and the use of estrogen therapy or oral contraceptives can increase the risk of gallstone formation.

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Description

Test your knowledge about the different types of gallstones and their formation. This quiz covers cholesterol gallstones, pigment stones, and the anatomy related to their development. Perfect for students in medical or health-related fields.