Gallstones and Biliary Colic

Answer Explanation:

• The correct answer is ‘Females are at greater risk of developing cholesterol gallstones’. This is true as females are twice as likely as males to develop gallstones. This is due to the effects of female hormones. During pregnancy, for example, the concentration of cholesterol in bile is increased, and the gallbladder does not empty as effectively, both of which can lead to gallstone formation.

Incorrect Options Explanation:

• ‘Any cause of haemolysis is a risk factor for cholesterol gallstones’ is incorrect. Haemolysis is a risk factor for pigment gallstones, not cholesterol gallstones.
• ‘Pigment stones are large and solitary’ is incorrect. Pigment stones are usually small and numerous.
• ‘Approximately 50 per cent are radiopaque and visible on plain abdominal radiograph’ is incorrect. Most gallstones (around 80%) are radiolucent and not visible on a plain abdominal radiograph.
• ‘The majority of stones are pigment stones’ is incorrect. The majority of gallstones are cholesterol stones, not pigment stones.

Overview of Gallstones:

Epidemiology:

• Gallstones are a common condition, affecting around 10-15% of adults in the UK.
• They are more common in females, and the risk increases with age.

Types of Gallstones:

• Cholesterol stones: These are the most common type of gallstone, making up around 80% of cases. They are formed when there is an imbalance in the composition of bile leading to precipitation of cholesterol.
• Pigment stones: These are less common and are formed from bilirubin, usually as a result of haemolysis.

Risk Factors:

• Female gender
• Increasing age
• Obesity
• Rapid weight loss
• Family history of gallstones

Clinical Features:

• Many people with gallstones are asymptomatic.
• Symptoms, when they occur, can include right upper quadrant pain, nausea, vomiting, and complications such as cholecystitis, pancreatitis and cholangitis.

Investigations:

• Ultrasound is the first-line investigation for suspected gallstones.
• Other investigations may include liver function tests, full blood count, and imaging such as CT or MRI.

Management:

• Asymptomatic gallstones do not usually require treatment.
• Symptomatic gallstones are usually treated with cholecystectomy (surgical removal of the gallbladder).

Answer Explanation:

The correct answer is Pancreatitis.

• Gallstones can lead to pancreatitis if a stone passes from the gallbladder into the common bile duct and blocks the pancreatic duct. This blockage can cause inflammation of the pancreas, leading to pancreatitis.
• The other options listed, such as Acute viral hepatitis, Haemolytic anaemia, Hypercholesterolaemia, and Urinary tract infection, are not direct complications of gallstones.

Overview of Gallstones:

Gallstones are hard deposits that form in your gallbladder, a small organ under the liver. They are formed when there is an imbalance in the substances that make up bile.

• Types of gallstones: There are two main types of gallstones: cholesterol stones and pigment stones. Cholesterol stones are the most common and are made up of excess cholesterol. Pigment stones are made up of excess bilirubin and are less common.
• Symptoms: Many people with gallstones do not have symptoms. However, if a gallstone blocks a bile duct, symptoms can include sudden and rapidly intensifying pain in the upper right portion of your abdomen, back pain between your shoulder blades, or pain in your right shoulder.
• Complications: Complications of gallstones may include inflammation of the gallbladder (cholecystitis), blockage of the common bile duct (choledocholithiasis), blockage and inflammation of the pancreas (pancreatitis), and gallbladder cancer.
• Treatment: Treatment for gallstones usually involves surgical removal of the gallbladder. However, if gallstones are not causing symptoms, treatment may not be necessary.

Answer Explanation:

• The correct answer is Abdominal ultrasound. This is because:
• Abdominal ultrasound is a non-invasive, readily available, and cost-effective imaging modality.
• It has a high sensitivity and specificity for detecting gallstones in the gallbladder and can also identify stones in the common bile duct.
• It can also provide information about the size, number, and location of the stones, as well as any associated complications such as cholecystitis or pancreatitis.
• Oesophago-gastroduodenoscopy, plain abdominal radiograph, mesenteric angiogram, and small-bowel barium follow-through are not typically used to identify gallstones in the common bile duct.

Overview of Gallstones:

• Gallstones are hard, pebble-like deposits that form inside the gallbladder. They can range in size from a grain of sand to a golf ball.
• There are two main types of gallstones: cholesterol stones and pigment stones.
• Cholesterol stones, which are usually yellow in color, are the most common type. They are made primarily of hardened cholesterol.
• Pigment stones, which are dark in color, are made of bilirubin, a byproduct of red blood cells.
• Gallstones can cause a variety of symptoms and complications, depending on their size, number, and location.
• Common symptoms include pain in the right upper or middle upper abdomen, back pain between the shoulder blades, and right shoulder pain.
• Complications can include inflammation of the gallbladder (cholecystitis), blockage of the common bile duct (choledocholithiasis), and inflammation of the pancreas (pancreatitis).
• Treatment options for gallstones depend on the severity of symptoms and complications. They can include lifestyle changes, medications to dissolve the stones, and surgical removal of the gallbladder (cholecystectomy).