GALLSTONES Flashcards
What are the three main components of bile?
Bilirubin, bile salts, cholesterol
An elderly patient with gallstones symptoms should flag which diagnosis? Explain why
Gallbladder cancer
Gallstones are rare in this patient demographic (most classically occurs in people in their 40s)
Excess oestrogen increases risk of gallstones. Explain which type of gallstone specifically and give a reason why
Cholesterol gallstones
Oestrogen promotes synthesis of cholesterol
Why does pregnancy and multiparity increase the risk of gallstones?
Oestrogen plus progesterone slow gallbladder emptying
Why does rapid weight loss increase the risk of cholesterol gallstones?
Causes increased cholesterol mobilisation in body → more cholesterol in bile
What happens to around 95% of bile salts produced in the liver?
what happens if this does not occur?
Reabsorbed in terminal ileum and recycled
→ underproduction of bile salts or poor reabsorption through ileum both increase risk of cholesterol gallstones (this is because cholesterol will not stay dissolved in bile without salts)
Why are people with Crohn’s disease at increased risk of cholesterol gallstones?
Often involves inflammation of the ileum causing abnormal resorption of bile salts
Why are people with cirrhosis at increased risk of cholesterol and pigment gallstones respectively?
Cholesterol: Decrease production of bile salts
Pigment: Impaired bilirubin conjugation
Why are patients with cystic fibrosis more likely to develop cholesterol gallstones?
Pancreatic insufficiency → fat malabsorption → loss of more bile acids in stool
Which type of gallstones can be seen on x-ray (radio opaque)?
what is the general principle that causes these types of gallstones?
Pigment stones (bilirubin)
→ any process that leads to rise in unconjugated (insoluble) bilirubin
Why are patients who suffer from recurrent biliary tree infections at risk of pigment stones?
Bacteria have enzymes called glucuronidases → convert conjugated bilirubin from liver back into unconjugated insoluble state → precipitates out and forms stones
Which drug is sometimes used for cholesterol gallstones in patients that don’t want surgery? How does it work?
Ursodeoxycholic acid
secondary bile acid → may dissolve gallstones
What stimulates the gallbladder to contract when a fatty meal is consumed?
Cholecystokinin
What is wrong with the gallbladder?
What are these people at a high risk of?
What is the treatment?
Porcelain gallbladder → calcification caused by long-standing, untreated cholecystitis
Increased risk of gallbladder carcinoma
Treatment → surgery
Somebody presenting with fever, abdominal pain, jaundice plus confusion and low blood pressure are most likely to have which diagnosis?
what is this most commonly caused by?
Reynolds pentad
- Indicate sepsis and shock from ascending cholangitis
- Gram-negative GI bacteria e.g. E. coli, klebsiella, Enterobacter
What would cause air in the biliary tree on x-ray?
Fistula between tree and small intentine → gallstone ileus
Chronic infection with which bacteria increases a persons risk of gallbladder carcinoma?
Salmonella typhi (colonises in gallbladder)
seen in areas where typhoid is endemic and up to 4% of people may be carriers
