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Gallstones (Acute Cholecystitis (Treatment (Antibiotics e.g. co-amoxiclav,…
Gallstones
Acute Cholecystitis
Main difference from biliary colic is the inflammatory component which leads to local peritonism, fever, high WCC
If the stone moves to the common bile duct, there is obstructive jaundice and cholangitis
Can cause continuous epigastric or RUQ pain (this is referred to the right shoulder, dermatomes C3-C5)
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Murphy's Sign = Put two fingers over RUQ and ask to breathe in. Causes pain and arrest of inspiration as the inflamed gallbladder impinges on your fingers
Tests
Ultrasound: thick walled, shrunken gallbladder, pericholecystic fluid, stones, common bile duct dilation
Plain AXR (abdominal radiograph) - only identifies 10% of stones, may show porcelain GB
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Treatment
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Laparoscopic cholecystectomy - this is the treatment of choice, done within 7 days of episode. 1/4 of patients who have delayed surgery have recurrent or worsening symptoms
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Biliary Colic
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Investigate with urinalysis, chest x-ray and ECG
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Treat with analgesia, fluids and elective laparoscopic cholecystectomy (within 24 hours)
This is a condition in where gallstones are symptomatic with cystic duct obstruction or if passed into the common bile duct
If surgery is not done within 24 hours, complications such as acute pancreatitis can occur
Chronic Cholecystitis
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There is flatulent dyspepsia = abdominal discomfort, distension, nausea, flatulence + fat intolerance
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Types of Stone
Cholesterol stones: large, solitary, older, obesity, female sex
Mixed stones: faceted, calcium salts, pigment, cholesterol
Pigment stones: small, friable, irregular, haemolysis
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Cholangitis
Presents with Charcot's triad = RUQ pain, jaundice, rigors
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