Ultrasound of CHOLELITHIASIS
Ultrasound is an essential
first-line investigation in suspected gallbladder and biliary duct disease. It
is highly sensitive, accurate
and comparatively cheap and is the imaging modality of choice.1
Gallbladder pathology is common and is
asymptomatic in over 13% of the population.
CHOLELITHIASIS
The most commonly and
reliably identified gallbladder pathology is that of gallstones (see
Table 3.1). More than 10% of the
population of the UK have gallstones. Many of these are asymptomatic, which is an important point
to remember. When Gallstones—clinical features Often asymptomatic
Biliary colic—RUQ pain,
fatty intolerance +ve ultrasound Murphy’s sign (if inflammation is
present) Recurring (RUQ) pain in
chronic cholecystitis Jaundice (depending on degree of obstruction) Fluctuating
fever (if infection is present RUQ=right upper
quadrant.
scanning a patient with
abdominal pain it should not automatically be assumed that, when
gallstones are present, they are
responsible for the pain. It is not uncommon to find further pathology in
the presence of gallstones and a
comprehensive upperabdominal survey should always be carried out. Gallstones are associated
with a number of conditions. They occur when the normal ratio of components making up the
bile is altered, most commonly when there is increased secretion of
cholesterol
in the bile. Conditions
which are associated with increased cholesterol secretion, and therefore the
formation of cholesterol stones, include obesity, diabetes, pregnancy and
oestrogen therapy. The incidence of stones also rises with age, probably because
the bile flow slows down. An increased secretion of bilirubin in the bile,
as in patients with cirrhosis
for example, is associated with pigment (black or brown) stones.
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