Gallstones

Surgical emergencies MRCEM syllabus

Headline
Etiology Cholesterol stones most common, then pigmented and mixed.
Epidemiology Risk factors:
- F>M
- Rapid weight loss e.g. bariatric surgery... or GLP-1 inhibitors
- PMH: Crohn's, diabetes mellitus
- Lifestyle: Smoking, ↑ BMI
- Meds: Octreotide, ceftriaxone, HRT, oral contraceptives
Clinical presentation Bilary colic, Cholecystitis, obstructive jaundice, acute pancreatitis
Obstructing stone causing jaundice = Mirizzi syndrome
Pathogenesis bile supersaturated with cholesterol; accelerated nucleation; and/or gallbladder hypomotility
Diagnostic investigations USS abdo
MRCP - for common bile duct stones
Management management of clinical presentation
Cholecystectomy at some point

Only cholangitis has the infamous triad:

  • RUQ pain
  • Fever
  • Jaundice

#HPB #surgical