gallstones Flashcards
who is more likely to get men or women
women
what are the 2 types
- cholesterol (more common)
- pigment
what are pigment stones composed of
calcium bilirubinate
what is most common type of stone
cholesterol gallstone
what is cholesterol stone formation due to
cholesterol crystallisation from gall bladder bile
what is cholesterol crystallisation dependent on
- cholesterol supersaturation of bile
- crystallisation promoting factors in bile
- motility of gall bladder
where is most cholesterol derived from
hepatic uptake form dietary sources
what is the rate limiting step of cholesterol synthesis
HMG-CoA reductase
when does the cholesterol crystallise into stones
when the bile is supersaturated with cholesterol
what is a highly selective intestinal cholesterol absorption inhibitor
ezetimibe
how do statins work
competitive inhibition of HMG-CoA reductase
what does leptin do
increase cholesterol secretion into bile
what does gall bladder stasis lead to
cholesterol crystallisation mediated by hyper secretion of mucin
risk factors fo cholesterol gallstones
- increasing age
- female
- family history
- rapid weight loss
- diet
- drugs (contraceptive pill)
- cirrhosis
- diabetes
what are the 2 types of pigment stones
- brown
- black
what are black pigment stones composed of
calcium bilirubinate
what do black pigment stones look like on cross section
glass-like
what are black stones associated with
haemolytic anaemias e.g. sickle cell disease
- malaria
- hepatic cirrhosis
- foot trauma
what disease causes an increased prevalence of black pigment gallstones
Gilbert syndrome
what are brown stones composed of
calcium salts of fatty acids
what causes brown stones
bile stasis
or
biliary infection
what is biliary colic
pain associated with temporary obstruction of the cystic or common bile duct by stone that has migrated from the gall bladder
symptoms
- abdominal pain that can radiate to right shoulder
- nausea
- vomiting
- fever
- rigors
what is the most useful investigation
ultrasound
differential diagnosis
- IBS
- carcinoma of the right colon
- peptic ulcer
- renal colic
- pancreatitis
what is the treatment of choice
cholecystectomy
when is cholecystectomy done
when symptoms are present
treatment of acute cholecystitis
- IV fluids
- opiate analgesia
- IV antibiotics
what bacteria are associated with cholecystitis
- e.coli
- klebsiella
- enterococcus
- pseudomonas
complications of cholecystectomy
- biliary leak
- injury to bile duct
what is another method to treat cholesterol stones
solubilisation by increasing the bile salt content of bile
how is stone dissolution done
orally with urseodeoxycholic acid
symptoms of common bile duct stones
- biliary colic
- fever
- jaundice
what is bilirubin levels of gallstones
raised bilirubin
