GALL STONE DISEASE

INTRODUCTION
10 to 20% of all people will have GBS during
their life.
One third will have symptoms.
Complications are rare in asymptomatic.
Incidence and complications increase with age.
Surgery is indicated in symptomatic persons.
US can show GBS in 98% of fasting patients
with GBS ( highly sensitive )
TYPES OF GBS
Cholesterol: the commonest
solitaire & mixed
Pigmented:
black: infection
brown: hemolysis
CLINICAL PRESENTATION
Asymptomatic ( incidental ): most common.
Acute biliary pain ( biliary colic ): most common
symptomatic.
Acute cholecystitis.
Obstructive jaundice.
Cholangitis.
Acute pancreatitis.
Gall bladder cancer ??
Mucocele.

ASYMTOMATIC GBS
No need for surgery in general.
2% became symptomatic each year.
Calcified ( porsaline ) gall bladder has higher
risk of malignancy and is an indication for
surgery.
ACUTE BILIARY PAIN
Known as biliary colic ( misnomer ).
Usually recurrent.
Continuous pain not colicky.
Less than 6 hours.
due to contraction against obstruction ( stone )
at the neck of GB.
ACUTE CHOLECYSTITIS
Continuous pain more than 6 hours.
Epigastric ( visceral ) and RUQ ( somatic ) pain.
Radiated to the back ( inter costal nerve
irritation ).
Referred to right shoulder ( phrenic nerve
irritation which originated from the cervical
spine same as the supraclavicular nerve ).
ACUTE CHOLECYSTITIS
RUQ tenderness.
Murphy sign.
May be fever and leukocytosis.
Ultrasound is 85% sensitive.
Treatment: urgent surgery is the best
other option: antibiotic then elective surgery.
OBSTRUCTIVE JAUNDICE
Usually painful.
May lead to cholangitis.
Itching, dark urine and clay stool.
Elevated alkaline phosphatase and gama GT with
direct hyperbilirubinemia.
Diagnosis by US and more sensitive MRCP.
US can show CBD stone in only 20% of cases but
usually show biliary tree dilatation.
Treatment by ERCP, if failed surgery.

ACUTE CHOLANGITIS
Dangerous.
Charcot triad: RUQ pain, fever and jaundice.
May lead to septic shock.
Needs decompressiom by ERCP or surgery, with
antibiotics.
Defenitive treatment by cholecystectomy.
ACUTE PANCREATITIS
Mostly due to passage of a stone throgh the
ampulla of Vater.
GBS is the commonest cause of acute
pancreatitis in our region.
Conservative management then early
cholecystectomy.
MUCOCELE
Due to a stone obstructing the cystic duct.
Mucous collected in the GB without bile.
Painless or discomfort.
Cholecystectomy.
GALL BLADDER CANCER
Associated with GBS but may be not the cause.
Very bad prognosis.
Porsaline (calcified wall )GB has 5 to 10 % risk.
CHOLECYSTECTOMY
Better laparoscopic than open
less pain and earlier discharge home and
return to work.
Possible complications include biliary tree injury
presented early mainly by bile leak and late as
jaundice and biliary stricture



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