Gallstones Flashcards

1
Q

What are gallstones?

A

Gallstones (cholelithiasis) refers to the formation of hard stones in the gallbladder – a process which typically takes years to occur. It is a very common phenomenon which affects about 10-15% of the general population in the developed world.

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2
Q

What is the second most common organ that requires surgery in the GI tract?

A

Gallbladder

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3
Q

What does bile contain?

A
  1. Bile pigments (from Hb breakdown products)
  2. Cholesterol
  3. Other lipids
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4
Q

What are the 3 types of gallstones?

A
  1. Cholesterol stones
  2. Pigment stones
  3. Mix of both
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5
Q

75% of which type of gallstones in the USA and Europe?

A

Cholesterol

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6
Q

What are the clinical features of pure cholesterol stones?

A
  1. Usually solitary and large
  2. Risk factors = Female, age and obesity
    Stones of about 70% or more of cholesterol are usually smaller and more numerous. The rest of the stone is made up of calcium compounds and protein.
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7
Q

What are the clinical features of mixed gallstones?

A

Usually multiple and irregular shaped

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8
Q

What two categorises can pigment stones be categorised into?

A
  1. Brown
  2. Black
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9
Q

What are brown mixed stones like?

A

Soft and contain a mixture of pigment, cholesterol and calcium salts

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10
Q

What are black mixed stones like?

A

Black stones are hard and made up of pure pigment

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11
Q

Why are females at greater risk of gallstones?

A

oestrogen and progesterone impair gallbladder emptying

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12
Q

What causes the formation of cholesterol and mixed stones? (2)

A

1) stasis
2) supersaturation of cholesterol

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13
Q

What are black pigment stones comprised of? (3)

A

1) polymerised calcium bilirubinate
2) calcium phosphate
3) calcium carbonate

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14
Q

Describe the appearance of black pigment stones (3):

A

1) small
2) hard
3) brittle

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15
Q

What causes the formation of black pigment gallstones? (2)

A

1) stasis
2) supersaturation of bilirubin

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16
Q

Give the five F risk factors for cholesterol stones:

A

1) female
2) forty plus
3) fair (white ethnicity)
4) fat
5) fertile

17
Q

When do cholesterol stones form?

A

Cholesterol stones form when the concentration of micelles is not great enough to hold all the cholesterol in the micelles.
Patients with cholesterol stones generally have a smaller bile pool, which circulates more often.

18
Q

What is cholesterol sludge?

A

Initially, cholesterol crystals will form in bile that is supersaturated with cholesterol. This results in the production of ‘sludge’

19
Q

How is the formation of ‘sludge’ inhibited?

A
  1. Caffeine
  2. NSAIDs
  3. Bile salts
20
Q

How is the formation of sludge exacerbated?

A
  1. Mucin
  2. Rapid weight loss
  3. pregnancy
  4. Increased serum cholesterol
  5. Reduced bile production
21
Q

Which two types of gallstone cannot be seen on X-ray?

A

1) cholesterol stone
2) brown pigment stone

22
Q

Give 5 conditions associated with the formation of black pigment gallstones:

A

1) sickle cell disease
2) thalassaemia
3) spherocytosis
4) malaria
5) hypersplenism
(all cause chronic haemolysis, leading to supersaturation of bilirubin)

23
Q

Where do brown pigment stones commonly form?

A

in bile ducts (rather than the gallbladder itself)

24
Q

Give three mild symptoms associated with uncomplicated gallstones:

A

1) upper abdominal pain
2) indigestion
3) nausea