cholelithiasis Flashcards
Cholelithiasis def and epi? is it symptomatic?
- The presence of Gallstones.
- It Affects 10-20% western population in northern hemisphere.
types of Cholelithiasis?
- 80% cholesterol stones
- When cholesterol concentrations get supersaturated, it starts to form solid crystals – aka stones
- High cholesterol, low lecithin, low bile salt - 20% pigment stones (bilirubin calcium salts)
- excess unconjugated bilirubin in the biliary tree.
- haemolytic anaemia,
- biliary tree infections
Risk factors for Cholelithiasis development : 5Fs
- Fair (Caucasian)
- Female (gender, sex hormone (COP))
- Fat (elevated BMI, rapid weight reduction)
- Fertile (> 1 child)
- Forty (age > 40)
- gallbladder stasis
- chronic haemolytic syndromes
- biliary infections
- Other causes (acalculous cholecystitis)
- post major surgery
- severe trauma/burns; sepsis
- vasculitis; drugs e.g.
- chemotherapy
- Fistula
Complications of Cholelithiasis:
- 70-80% asymptomatic and Remainder becomes symptomatic
- Cholecystitis
- Empyema: when the obstructed gallbladder fills w/ mucus.
- Perforation
- Ascending
- cholangitis
- Obstructive cholestasis
- Pancreatitis
- Gallstone ileus: gallstone enters the GIT via a cholecystenteric fistula and becomes impacted most commonly in the terminal ileum. AXR: shows air in the CBD
- Merize’s syn.: when the stone in the GB presses on the CB, causing jaundice.
- Carcinoma
- Vasculitis
Bile duct stricture (benign) causes
- Post- operative causes
Primary biliary surgery :
- Laparoscopic/Open cholecystectomy
- CBD exploration
- Biliary enteric anastomosis
- Cyst excision
- Liver transplant
Other operative procedure:
- Hepatic resection
- Portacaval shunt
Gastric resection
- Inflammatory causes
- Chronic pancreatitis
- Cholelithiasis
- Choledocholithiasis
- Chron’s disease
- Ascending/ primary sclerosing cholangitis
- Pancreatic pseudocysts
- Viral infections
- Duodenal ulcer disease
- Hydrate cysts disease
- Liver abscess
- Post-radiation therapy
Others
- Trauma
- Penetrating
- Ischemia
- Sphincter of Oddi stenosis
Biliary Atresia
Neonatal cholestasis
▪ 1 in 10,000-15,000 live births
▪ Obliteration or discontinuity of the extrahepatic biliary system
▪ Unknown aetiology
▪ a/w trisomy 18 and 21
▪ 20% have extrahepatic congenital anomalies (cardiac, GIT, spleen)
Clinical triad:
- jaundice >14d
- dark urine + pale stools
- hepatomegaly
▪ Fatal by 2yo if untreated
▪ Rx: Hepatoportoenterostomy (Kasai procedure) or transplant
Bile duct stricture (malignant)
primary tumors:
- Cholangiocarcinoma
- pancreatic adenocarcinoma
- Gallbladder cancer
- Ampullary, gastric carcinoma
- Hepatoma
Metastic tumors:
- Pancreatic, colon, breast, Ovarian adenocarcinoma
- Lung carcinoma
- Melanoma
Courvoisier’s Law
- In a pt with painless jaundice + an enlarged gallbladder/RUQ mass, the cause is unlikely to be gallstones
- Thus, the cause could be an obstructing pancreatic/biliary neoplasm until proven otherwise.
