Cholelithiasis Flashcards
What is the definition of cholelithiasis?
-the formation of gallstones in the gallbladder
What age does it usually occur?
-40 years
Why is it more prevalent in females than males?
-increased incidence of oestrogen
What are the 3 types of gallstones?
- cholesterol stones
- black stones
- brown stones
What is the pathophysiology of the formation of gallstones?
- hypersaturation of cholesterol,calcium carbonate, bile salts and bilirubin
- biliary stasis
- decreased gallbladder emptying(pregnancy, bowel obstruction or prolonged parenteral feeding) which leads to cholestasis
What are the 6 F’s?
- fat
- female
- famiy history
- fair skinned
- forty
- fertile
What are the risk factors for cholesterol stone formation?
- family history
- obese
- female
- above 40
- drugs-fibrates, oral contraceptives
- pregnancy
- malabsorption(crohns disease, ileal resection)
What is the pathophysiology of cholesterol stone formation?
- increased concentration of cholesterol in the bile
- decreased bile salts and lecithin which leads to the bile being hypersaturated
- the cholesterol and he calcium carbonate precipitates out and forms cholesterol stones or mixed stones
How do the black stones form?
- They occur 10% of the time
- caused by increased haemolysis which leads to increased unconjugated bilirubin and conjugated bilirubin uptake and the formation of black stones
- they are soft and crumble easily
How do the brown/mixed stones form?
-They occur 10% of the time
What are the risk factors for black stones?
- chronic haemolytic anaemias(sickle cell disease, hereditary spherocytosis)
- cirrhosis
What are the clinical features of patients with gallstones?
- usually asymptomatic
- if they have pain: biliary colic dull RUQ pain that lasts <6 hours
- if it is referred then it goes to the epigastrium, right shoulder and the back
- usually post-prandially (right after eating)
What are the diagnostic tests we can do for cholilithiasis?
- RUQ ultrasound is the best
- MRCP(magnetic resonance cholangiopancreatography) or EUS(endoscopic ultrasound)
- labs will be normal if uncomplicated(WBC, amlase and bilirubin)
Why do we not use X-ray?
- most stones are radiolucent(cholesterol stones)
- whereas 10-15% are radio-opaque
What is the difference between ERCP and MRCP?
-ERCP is used for interventions like stoe removal
MRCP-is only used for diagnostics and does not use contrast but we can view the intrahepatic and extrahepatic as well as the pancreatic duct
What conservative Rx can we give he patient?
- dietary changes
- spasmolytics
- analgesia
What is the Rx for cholelithiasis?
-laparoscopic cholecystecomy
-indicated when you have symptomatic cholelithiasis
or asymptomatic but at risk for gallbladder cancer
What are the complications for cholelithiasis?
- choledocholiathis
- cholangitis
- cholecystitis
- mirizzi syndrome
What is the alternative for patients with cholelithiasis that do not want to get surgery?
- They can medical management called medical/oral litholysis
- for 6 months
- You can consume bile salts
How is cholesterol and food items taken into the bile acid?
-bile salts and phospholipids are amphiphatic(both have hydrophillic and hydrophoic elements) that help keep the cholesterol in he vesicles and don’t forge into stones
What age do cholesterol stones develop in?
- older
- obese
- rapid weight loss
- developed countries
What age do pigment/black stones develop in?
-younger patients
How long does biliary colic occur for if we are dealing with symptomatic choleliathis?
-minutes to 2 hours
-
What triggers the biliary colic?
- fried oily foods
- after meals
