Gallstones and Billiary Tree: Mechanical Cholestasis Flashcards
What is cholestasis
Anything that interferes with billiary secretion
Five components of Bile?
- Bile Acids- (solubilize cholesterol) must have for fat absorption
- Phospholipid- (solubilize cholesterol)
- IgA and IgM- Bacteriostasis
- Mucus- prevent bacterial adhesion
- Glutathione- Induces bile flow
What are the two most important components of bile?
- Bile Acids
- Phospholipid
Both of these components are necessary for fat absorption
Bile Acids and Phospholipids are important for what?
Solubilizing cholesterol
Know stone types
ok
Cholesterol metabolism slide
know it
Cholesterol stones have what appearance
They are usually yellowish white and rarely seen on x-ray (radiolucent). This is the most common type of stone.
Black stones
Hemolysis
Brown stones
Infection
Pigment stones (those that are black or brown are visible on x ray or not?
Visible (radioopaque)
What are some conditions that are related to stone formation (cholesterol)
- Female
- Fat
- Forty
- Fertile (pregnant)
More expansive list is Crohn’s disease, obesity, Cystic Fibrosis, advanced age, estrogens, multiparity, rapid weight loss and advanvced age.
What is cholecystitis?
Inflammation of the gallbladder usually due to a stone…
When does cholecystitis become serious ?
When the common bile duct becomes involved…this can lead to ascending cholangitis.
So cholecystits occurs when a stone exists in the cystic duct leading off of the gallbladder. If there is an obstruction in the common bile duct, things get real because this can lead to ascending cholangitis
MOST SIGNIFICANT IMPACT ON STONE FORMATION
High Cholesterol
What is the major enzyme that is responsible for incorporating cholesterol into bile salts? This enzyme decreases with age
Cholesterol 7alpha hydroxylase
Obesity impacts cholesterol metabolism how?
Enhances the conversion of acetate to cholesterol through increased HMG coA activity
The only real way to get rid of free cholesterol is:
To secrete it in the bile
Estrogens have what impact on cholesterol metabolism?
Increase the uptake of Serum lipoproteins into the liver. Bascially increase cholesterol uptake from serum
Progesterones/ oral contraceptives
More free cholesterol due to decreased conversion to cholesterol ester stores
Charcot’s triad of cholangitis?
Jaundice
Fever
Right Upper Quadrant pain (MUST HAVE PAIN)
Bile acids are reabsorbed and enter into the enterohepatic circulation in which part of the small intestins
Terminal Illeum
In patients with gallstones, gallbladder emptying is very slow (hypomotility). This is potentially related to ?
Increased mucin
What is Biliary Colic?
Occurs when you have a stone that is blocking the cystic duct. Associated with pain, nausea, vomiting, but no fever, chills, or signs of gallbladder inflammation. The pain will disappear as soon as the stone either passes or moves back into the gallbladder
What do you do for someone with Biliary colic?
Send them home and tell them they need to speak to someone about having their gallbladder removed
Acute Cholecystits presentation>?
usually a woman over 40. She will present with abdominal pain that has been there for hours (unlike simple biliary colic). She will also have a fever and chills (unlike colic). WHite count may be high and the gallbladder walls will be inflammed because this stone has been stuck in the cystic duct for a while.
She needs to be admitted and probably sent to surgery
Choledocholithiasis
This occurs when a gallstone has made it out of the cystic duct but gets trapped in the common bile duct. The pt will present with fever, chills, abdominal pain, and JAUNDICE.
What is choledocolithiasis with cholangitis?
Cholangitis occurs when you get inflammation inside the bile ducts of the liver due to a stone blocking the common bile duct. This is very bad news and the mortality is extremely high
What is biliary pancreatitis
occurs when a stone blocks the common bile duct below where the pancreatic duct comes in. Not only do you get choledocolithisasis, but you will get pancreatitis. Tests will show high pancreatic enzymes. Pt will have pian and persistent nausea and vomitting
Emphysematous cholecystits
gallbladder full of gas
