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Gallstones and biliary colic

Background Knowledge ๐Ÿง 

Definition

  • Gallstones: Solid particles that form in the gallbladder from cholesterol, bilirubin, and other components of bile.
  • Biliary colic: Intermittent pain caused by the contraction of the gallbladder against a blocked cystic duct.

Epidemiology

  • More common in females, especially those of child-bearing age.
  • Increased prevalence with age, obesity, pregnancy, rapid weight loss, and certain medications.
  • Associated with the “Four F’s”: Fat, Forty, Female, Fertile.

Types of Gallstones

  • Cholesterol stones: Most common type, yellow-green, predominantly from cholesterol.
  • Pigment stones: Black or brown, made of bilirubin.

Clinical Features ๐ŸŒก๏ธ

Symptoms

  • Many gallstones are asymptomatic.
  • Biliary colic:
    • Sudden onset of severe pain in the right upper quadrant or epigastrium.
    • Lasts 1-5 hours, can radiate to the right shoulder.
    • Nausea and vomiting may accompany the pain.
  • Triggered by fatty meals.

Investigations ๐Ÿงช

Investigations

  • Ultrasound: First-line imaging; reveals gallstones and gallbladder wall thickening.
  • MRCP (Magnetic Resonance Cholangiopancreatography): If stones in the common bile duct are suspected.
  • Liver function tests: Can show elevated bilirubin and alkaline phosphataseย if there’s obstruction.

Management ๐Ÿฅผ

Management

  • Asymptomatic gallstones: Usually no treatment needed.
  • Biliary colic: Pain relief with NSAIDs or opioids.
  • Cholecystectomy (surgical removal of the gallbladder) for recurrent biliary colic or complications.
  • Ursodeoxycholic acid: Medication to dissolve cholesterol gallstones, but used less commonly due to slow action and recurrence of stones.

Complications

  • Cholecystitis: Inflammation of the gallbladder.
  • Choledocholithiasis: Stones in the common bile duct.
  • Cholangitis: Infection of the bile duct.
  • Gallstone pancreatitis: Stone blocking the pancreatic duct.

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