Gallstones Flashcards
What does Bile contain?
bile pigments (from Hb breakdown products), cholesterol and other lipids
How are gall stones usually classified?
cholesterol stones or pigment stones or mixed
what do cholesterol stones usually look like?
large and usually solitary
what are risk factors for cholesterol stones?
female, age and obesity
what do mixed stones usually look like?
usually multiple and irregularly shaped
What two categories can mixed stones be divided into?
brown and black
What are the differences between the two categories of mixed stones?
brown stones are softer and contain a mixture of pigment, cholesterol and calcium salts. black stones are much harder and made of pure pigment.
what are some risk factors for gallstones?
weight
family history
oestrogen
diet (high fat, low fibre)
what three factors are needed for the formation of cholesterol stones?
high concentration of cholesterol in the gallbladder
gallbladder stasis
products that promote crystallisation of cholesterol (some lipoproteins in bile do this)
when is formation of stones increased?
during fasting e.g. in IV nutrition - increases conc of cholesterol in the gallbladder relative to other solutes
when do cholesterol stones form?
when the concentration of micelles is not great enough to hold all the cholesterol in the micelles
what is the formation of ‘sludge’ inhibited by?
caffeine, NSAIDs and bile salts
what is the formation of ‘sludge’ exacerbated by?
Mucin, rapid weight loss, pregnancy, increased serum cholesterol, diabetes, high dietary fat, drugs (clofibrate, contraceptive pill)
what does clofibrate do?
it is a fibrate drug that lowers plasma cholesterol by increasing cholesterol secretion in bile
how long does it take for a stone to form from the beginning of the initial process?
8 years
