Gallstones

Q: A 50-year-old obese female presents with intermittent RUQ pain after fatty meals. Ultrasound shows gallstones but no evidence of inflammation. What is the most appropriate management?

Pain management and dietary advice. For asymptomatic or mildly symptomatic gallstones, observation with dietary advice and pain management is often appropriate. Elective cholecystectomy is considered for symptomatic patients or those with specific risk factors, but immediate surgery for uncomplicated biliary colic is not always necessary. ---

Q: A patient with a gallstone blocking the common bile duct will likely have difficulty digesting:

Fats. Bile is required for fat emulsification; without it, lipase cannot efficiently digest fats, leading to steatorrhea.

Courvoisier's law states that a palpable, non-tender gallbladder with jaundice is unlikely to be due to gallstones, and points to a malignant obstruction such as carcinoma of the head of the pancreas.

What our notes say

Courvoisier's law states that a palpable, non-tender gallbladder with jaundice is unlikely to be due to gallstones, and points to a malignant obstruction such as carcinoma of the head of the pancreas. (Surgery Question Bank: 12 Clinical MCQs)
| Gallbladder | Larger, empties slowly; cholestasis is almost physiological | Gallstones and intrahepatic cholestasis of pregnancy | (Physiological changes in pregnancy)
The gallbladder is opened to reveal ten multifaceted 0.5 to 1 cm diameter dark, greenish-black gallstones. (Gastrointestinal and liver — Past Paper Questions & Answers)
Gallbladder hypotonia and more lithogenic bile raise the risk of gallstones and cholestasis. (Reproductive Health 1 End of Trimester CAT: November 2018)
Topics tested: HIV and the gut, diarrhoea (infectious and non-infectious), alcoholic liver disease, hepatitis A, B and C, cirrhosis, liver tumours, cholera, shigella, gallstones and pancreatitis. (Internal Medicine CAT 1 (MBIM 6112), 2019/2020: gastroenterology and hepatology,)
Gallstone ileus (fistula into the bowel) and Mirizzi syndrome. (Internal Medicine CAT 1 (MBIM 6112), 2019/2020: gastroenterology and hepatology,)

Study material on Gallstones

Practice questions on Gallstones

A 50-year-old obese female presents with intermittent RUQ pain after fatty meals. Ultrasound shows gallstones but no evidence of inflammation. What is the most appropriate management?

Immediate cholecystectomy
Ursodeoxycholic acid therapy
Pain management and dietary advice
Laparoscopic cholecystectomy once symptomatic episode resolves

Answer: C. For asymptomatic or mildly symptomatic gallstones, observation with dietary advice and pain management is often appropriate. Elective cholecystectomy is considered for symptomatic patients or those with specific risk factors, but immediate surgery for uncomplicated biliary colic is not always necessary. ---

A patient with a gallstone blocking the common bile duct will likely have difficulty digesting:

Starches
Proteins
Fats
Simple sugars

Answer: C. Bile is required for fat emulsification; without it, lipase cannot efficiently digest fats, leading to steatorrhea.