Gallstones Flashcards
Specific population of people with high incidence of gallstones.
Pima Indian Women
about 70% develop stones
Most common type of gallstone.
Cholesterol stones (85%)
Why are the elderly prone to cholesterol stones?
Cholesterol is converted to bile salts by 7-alpha-hydroxylase. This enzyme decreases with age and the lower activity leads to calculus formation.
Main phospholipid that helps bile salts solubilize cholesterol.
Lecithin (95%)
Name the two general mechanisms that lead to gallstone formation.
- Excess cholesterol
2. Depleted bile salts
Most important factor that leads to gallstone formation.
Gallbladder Stasis
Which stones occur in a sterile environment and as a result of hemolysis pathology?
Black stones
-hemoglobinopathies, occur in GB
Which stones occur due to infection and are most likely located in the bile ducts.
Brown Stones
What is the Reynold Pentad?
Indicates emergent suppurative cholangitis.
Charcot Triad (RUQ pain, fever, jaundice) + shock + encephalopathy
What is Mirizzi Syndrome?
When a gallstone becomes impacted in the cystic duct or neck of the gallbladder causing compression of the common bile duct (CBD) or common hepatic duct, resulting in obstruction and jaundice.
What is the treatment for acute cholescytitis?
Laparoscopic or Conventional cholecystectomy
Name 4 treatments for Symptomatic Chronic Calculous Cholecystitis.
- Surgery
- Lithotripsy
- Methyl tert-butyl ether (MTBE) dissolution: dissolves the stones but since it’s also used as a component in gasoline it has health risks.
- UDCA (bile salt dissolution)
Name 2 treatments for cholangitis.
- ERCP
2. Cholecystectomy + bile duct exploration + T-tube
Treatment for severe and mild/moderate Gallstone Pancreatitis.
Severe: ERCP w/ sphincterotomy and stone removal
M/M: ERCP or cholecystectomy
Treatment for Mirizzi Syndrome
Cholecystectomy
What is the major condition on a differential if a patient persists with RUQ pain even after a cholecystectomy?
Peptic Ulcer Disease
Treatment of Sphincter of Oddi (choledochal sphincter) dysfunction.
ERCP w/ sphincterotomy
How does a HIDA scan work?
Hepatobiliary Iminodiacetic Acid (HIDA) is an irradiated form of unconjugated bile that is taken up by the liver, conjugated and released into the biliary system. It will show up with nuclear imaging and can assess the function of the liver, gallbladder, and biliary tree.
AKA: cholescintigraphy
Where do choledochal cysts form?
In the biliary tree, most commonly in the common bile duct.
Choledochal means biliary tree
What is Caroli Syndrome?
Ectasia (dilation of vessels) of intrahepatic bile ducts linked with portal hypertension and congenital hepatic fibrosis.
Often patients also have renal cysts or hepatic stones.
How effective is lithotripsy?
Very effective in breaking up the stones, however, the stones are not the primary problem. The gallbladder is the issue and the stones will often reappear so patients must be kept on UDCA to prevent relapse.
Etiology and Tx for Biliary disease in pregnancy.
Caused by cholesterol supersaturation and gallbladder stasis.
Tx: Cholecystectomy in 2nd trimester or later
ERCP in 2nd or 3rd trimester
Radiation for CT Dx is fine once 2nd trimester is reached
