Gallstone diseases

Question 1

Define cholelithiasis

Answer 1

Gallstones in gallbladder

Question 2

Define biliary colic

Answer 2

Intermittent obstruction of cystic duct that is symptomatic

Question 3

Define cholecystitis

Answer 3

Gallstone obstruction in cystic duct causing inflammation of gallbladder

Question 4

Define choledocholithiasis

Answer 4

Gallstone obstruction in the common bile duct (without infection)

Question 5

Define cholangitis

Answer 5

Infection and inflammation of common bile duct, usually due to choledocholithiasis

Question 6

What are the two types of gallstones

Answer 6

1. Cholesterol

2. Pigmented stone

Question 7

What are the risk factors for cholesterol gallstones?

Answer 7

5Fs: Female, fair (scandinavian), fat, fertile (pregnancy), FHx

Increased age
Rapid/cyclic weight loss
Drugs: ceftriaxone, post-menopause estrogen
Gallbladder dysmotility (starvation, TPN, diabetes)
High triglyceride, low HDL

Question 8

Risk factors for pigmented stone

Answer 8

Cirrhosis
Chronic hemolytic states
Bile stasis (stricture or biliary infection)

Question 9

Percentage of gallstones that are cholesterol vs. pigmented

Answer 9

80% are cholesterol

20% are pigmented

Question 10

What is the pathophys of gallstone formation

Answer 10

Cholesterol super saturation + impaired gallbladder/cystic duct + cholesterol crystal nucleation = cholesterol precipitation and formation of stones