3.15. Liver + Biliary Tree Disease - Cholestasis (Gallstones) Flashcards
What are the 2 Types of Cholestasis (Gallstones) which occur?
- Cholesterol Gallstones
2. Bile Pigmented Stones
Which if the 2 types of Gallstones are more common?
Cholesterol Gallstones - 80%
Bile Pigmented Stones - 20%
What are the Risk Factors for developing Cholesterol Gallstones?
- Increasing Age
- Being Female
- Rapid Weight Loss
- High Fat, Low Fibre Diet
- Alcoholism
- Predisposing Conditions
- Certain Medications
- Ileal Disease / Resection
At what age do Gallstones appear more frequently?
After the age of 30
How much more common are Gallstones in Females?
2-3 times, especially in those who have had many Children
Why can Rapid Weight Loss cause Cholesterol Gallstones?
Due to elevated Leptin levels, which are associated with the formation of Cholesterol Gallstones
What Predisposing Conditions are there?
- Diabetes Mellitus
- Obesity (+/- Metabolic Syndrome)
- Liver Cirrhosis
- Viral Hepatitis
- Acromegaly
What is an example of medication which can put you at risk of getting Cholesterol Gallstones?
The Oral Contraceptive Pill
Why can Ileal Disease or an Ileal Resection cause Cholesterol Gallstones?
Due to the resulting Bile Loss (Lack of Bile Reabsorption)
What are the Risk Factors for developing Bile Pigmented Stones?
- Haemolytic Conditions (e.g. Sickle Cell Anaemia, Hereditary Spherocytosis)
- Infection in the Biliary Tree
What forms the Cholesterol Gallstones?
The formation of Cholesterol Gallstones is due to Cholesterol Crystallization from Gallbladder Bile
What is the Cholesterol Crystallization from Gallbladder Bile (forming Cholesterol Gallstones) dependent on?
- Cholesterol Supersaturation in the Bile
- Crystallizing Promoting Factors within the Bile
- The Motility of the Gallbladder
How is Cholesterol Crystallization dependent on Cholesterol Supersaturation in the Bile?
- Cholesterol is formed and co-secreted with Phospholipids in the Biliary Canaliculus
- Supersaturation can occur due to:
a) Excess Cholesterol Secretion into the Bile
b) A decrease of Bile Salt Content, which can occur due to Bile Salt Loss (e.g. Ileal Resection, Crohn’s Disease)
Is everyone who has Cholesterol Supersaturation guaranteed to have Cholesterol Gallstones?
No, Many people who have this will never develop Gallstones
What are the Crystallizing Promoting Factors, within the Bile?
- There are a number of Lipoproteins which have been reported as Putative Crystallizing Factors
- There is Evidence to suggest a Genetic Factor is prevalent (After being ected on by an Environmental Factor)
How is Cholesterol Crystallization dependent on Gallbladder Motility?
A decrease in Gallbladder Motility, leads to Bile Stasis, which lead to Cholesterol Crystallization
What are the 2 Types of Bile Pigmented Stones?
- Black Pigmented Stones
2. Brown Pigmented Stones
What are Black Pigmented Stones comprised of?
- Calcium Bilirubinate
- A Network of Mucin Glycoproteins, which interlace with salts, such as:
a) Calcium Carbonate
b) Calcium Phosphate
What are Brown Pigmented Stones comprised of?
- Calcium Salts
- Fatty Acids
- Calcium Bilirubinate
What is the Pathology of Black Pigmented Gallstones?
- Bile Salt loss in the Colon (Due to Ileal Resection / Crohn’s) promotes Colic Reabsorption of Bilirubin
- This enhances the Enterohepatic Circulation of Bilirubin which leads to the formation of Gallstones
When are Brown Pigmented Gallstones found?
- In the presence of Bile Stasis / Biliary Infection
2. In the Intrahepatic Ducts in circumstances of Duct Disease (e.g. Primary Sclerosing Cholangitis)
What are Brown Pigmented Gallstones a common cause of?
Recurrent Bile Duct Stones following a Cholecystectomy
What are Black Pigmented Gallstones related to?
Bacterial Colonization of the Biliary Tree
What do All Types of Gallstones produce?
A Blockage / Obstruction of the Biliary Pathway, leading to a Backlog of Bile within the Hepatocytes
