What percentage of the population has gallstones?
80% and of this only 1-2% will ever know that they have gallbladder disease.
So just because you see gallstones on an ultrasound, does it mean you should send a patient for gallbladder surgery?
NO. You must prove that they have cholecystitis, not just cholelithiasis.
Do stones in the fundus of the gallbladder cause problems?
Rarely :)
Do stones in the cystic or common bile duct require surgery?
YES. If patients get ascending cholangitis from infection, then they will need surgery + ERCP.
What are the common symptoms of biliary disease?
- nausea
- vomiting
- RUQ pain
- back/shoulder pain
- fatty food intolerance
- diarrhea (because if you can’t digest fatty foods due to lack of bile, the food will go right through you).
How do you diagnose biliary disease?
- ULTRASOUND= BEST; look for pericholecystic fluid (edema), thickened gallbladder wall (sign of chronicity), and gallstones.
- HIDA SCAN=nuclear medicine test; cholescintigraphy.
- ORAL CHOLECYSTOGRAM
- ERCP
- MRCP
If a patient is NPO, what does this do to the gallbladder?
dilates it. So DILATION only of the gallbladder on ultrasound doesn’t tell us much.
*** What should be next on your differential for gallbladder disease?
PUD of the duodenum.
If your HIDA scan is positive, are you going to surgery for a cholecystectomy?
YES
What is the only thing that makes laparoscopic surgery better than open surgery for cholecystectomy?
recovery time is faster.
Are gallbladder cystic duct anomalies common?
YES and this makes surgery challenging.
Why is ERCP better than MRCP?
because it can diagnose and treat, whereas MRCP can only diagnose.
*** Should you do ERCP before or after gallbladder surgery?
ERCP first ALWAYS!
What happens if you can’t remove common bile duct stones via ERCP and are forced to go to surgery?
- you can’t just close the common bile duct back up, because it will sclerose and close in on itself. So you must place a T-Tube (with a tube coming out of your side for 6 weeks, in order to let bile drain and ensure the duct doesn’t close on itself).
