Gallstone disease

Question 1

What is the make up of bile solutions

Answer 1

Bilirubin
Bile salts (Pigments)
Phospholipids
Cholesterol

Question 2

What are the different types of gall stones

Answer 2

Cholesterol stones
Mixed stones
Pigment stones

Question 3

Explain the 3 phases of cholesterol stone formation

Answer 3

Phase 1: Supersaturation mostly due to oversecretion
Phase 2: When vesicles become supersaturated they become unstable and nucleate cholesterol crystals
Phase 3: Cholesterol dense zones develop and stones can grow by fusion of crystals

Question 4

Explain the formation of pigment stones

Answer 4

Black:
- Usually due to haemolytic disorders formed by supersaturation of bilirubinate, carbonate and phosphate
- It forms in the gallbladder due to increased unconjugated bilirubin in bile

Brown stones:
- Secondary to bacterial infection caused by bile stasis

Question 5

What are the complications of gallstones disease

Answer 5

Acute cholecystitis
Mirizzi syndrome
Bouverette syndrome

Question 6

What are the investigations for cholangitis

Answer 6

WCC, Platelets, CRP, Alb, ALP, GGT, AST, ALT, Ur/Cr, INR, ABG

U/S of liver and biliary tree