GALL STONES : Complications

• Biliary colic
• Acute cholecystitis
• Empyema
• Mucocele
• Chronic cholecystitis.

• Obstructive jaundice.
• Cholangitis
• Pancreatitis.
  

• Gall stone ileus.

• Stone impacts in neck of GB
• Sustained GB contraction = increased pressure in GB = PAIN.
• Pain in RUQ  epigastrium and lower pole of scapula.
• Biliary colic has a slow periodicity.  30mins –2 hrs.
• Apyrexial.
• WCC & CRP normal.
• X-ray- 10% galls stones seen.
• USS- detects 98% of GS
• Management: Analgesia,Cholecystectomy

Acute cholecystitis

• A stone impacts at the GB outlet.
  
• Similar symptoms to colic but > 12hrs.
  

Pathology

• Impaction of stone in cystic duct.

• Sustained high pressure in GB, therefore decreased blood flow to mucosa.

• Mucosal damage by detergent action of bile.

• !st, chemical cholecystitis with inflammation and oedema of GB wall. 2^nd, bacterial infection --> 48 hrs.

Clinical Features

• Pain RUQ

• MURPHY’S SIGN: When the examining hand is placed in theRUQ and patient inhales = PAIN

• BOAS’S SIGN: Hyperaesthesia of skin on 9-11 ribs

Investigations

• WCC

• Bilirubin

• serum Amylase

Imaging: USS

Management:

• Initially conservative: Analgesia and Antibiotics.

• If symptoms do not resolve, operation. Why-> Gangrene at fundus -> peritonitis.

Empyema

• If no perforation occurs, GB remains inflamed.

• Contents become purulent. Bacteria and neutrophil exudates.

• Essentially an abscess with GB wall as casing
  
  

Mucocele

• Impacted stone with no bacterial overgrowth.

• Mucosa inflamed and cont to absorb water from bile and secrete mucous.

• People get cont. RUQ pain cholecystectomy.
  
  

Chronic Cholecystitis

• Essentially, chronic symptoms of acute attacks.

• GS on USS.

• GB thick fibrotic wall.

Category: Surgery Notes