L11: Gall Stones Flashcards
Functions of Gall Bladder
- Reservoir or Bile
- Concentration of Bile
- Mucus Secretion
Resrvoir For Bile
Bile is excreted by …..
The liver
Bile is stored in …..
The gall bladder
Total of about 500 to 1000 ml per day
Release of Bile
Concentration of Bile
How much bile is water?
98%
How Much is bile concentrated?
Get concentrated 5-10 times
How is Bile Concentrated?
Results of Bile Concentration
Mucus Secretion by Gall Bladder
Amount of mucus by GB
Secretes about 20 ml of mucus per day
Surgical Importance of mucus secreted by GB
Obstruction to the cystic duct causes mucocele of the
Bile is formed of …..
pH of Bile
More Than 7
Amount Of Bile
500-1000 ml/day, 98% is water.
Capacity of GB
Gall bladder is 40-50 ml
Release of Bile
Fatty food stimulation releases cholecystokinin results in:
- Stimulates gall bladder to contract.
- At the same time, the sphincter of Oddi to relax.
Content of Bile
- Inorganic ions (more than plasma)
- Hence, severe electrolyte imbalance is seen in the biliary fistula
Fate of Bile
They are metabolized in the colon to deoxycholic acid & lithocholic acids.
Function of Bile
- Main function of bile acids in the bile is To maintain cholesterol in the solution
Another Name of Gall Stone Disease
Cholelithiasis
Etiology of Gall Stone Disease
Metabolic Causes of Gall Stone Disease
Conditions that increase cholesterol secretion & can results in stone formation:
- Obesity
- High-calorie diet
- Medications
Cholesterol
- Production
- Gives Rise to
- Execretion
Cholesterol is water insoluble so…
What maintains cholesterol in liquid form?
Mechanism of stone formations
Infections & Gallstones
The most common cause responsible for a gall stone in 80% of patients
Source of infections causing GSD
tonsils, tooth, bowel, etc.
Causative Organisms of GSD
Caused by organisms such as:
- E. coli
- Proteus
- Anaerobic organisms
- Streptococci
Route of Infection in GSD
Reach the gall bladder wall through the blood stream.
Effect of infections in GSD
Causes of Bile stasis
Types of stones in Bile stasis
They are prone to mixed stones as a result of bile stasis.
Causes of Decreased bile acid pool
Examples of Hemolytic Anemias Causing GSD
1) Hereditary spherocytosis
2) Sickle cell anemia
Mechanism of Hemolytic Anemias Causing GSD
Saint’s Triad
Parasitic Infestations Causing GSD
Causes of GSD due to abnormal mucus
Congenital cystic fibrosis
Mechanism of GSD due to abnormal mucus
Gallstones occur in these children due to impairment of bile flow.
Other Diseases associated with GSD
1) Diabetes mellitus.
2) Type IV hyperlipoproteinemia.
3) Cirrhosis of liver.
4) Fistulae on treatment with total parenteral nutrition.
5) Gastric surgery.
Different Types of GB Stones
- Mixed
- Cholesterol
- Pigment
- Brown Pigment
Incidence of Mixed Stones
They constitute about 80% of gall stones
Structure of Mixed Stones
Characters of Mixed Stones
Incidence of Cholesterol Stones
They constitute about 10% of gall stones
Cause of Cholesterol Stones
- Occur in patients with increased cholesterol levels.
- Occurs in aseptic bile
RF for Cholesterol Stones
- Fatty women are commonly affected
Structure of Cholesterol Stones
- Precipitation of cholesterol gives rise to stones.
- Pigment can also get precipitated along with cholesterol.
Characters of Cholesterol Stones
Symptoms of Cholesterol Stones
Such stones can be silent for many years.
Radiology of Cholesterol Stones
They are radio lucent
Incidence of Pigment Stones
They constitute about 5-10% of gall stones
Causes of Pigment Stones
Structure of Pigment Stones
Calcium bilirubinate stones.
Characters of Pigment Stones
Incidence of Brown Pigment Stones
Rare in gall bladder, occurs in bile duct
Cause of Brown Pigment Stones
Structure of Brown Pigment Stones
- Calcium bilirubinate - calcium palmitate - calcium stearate.
- Cholesterol.
Clinical features & complications of gall stones
Causes of Silent Gallstones
Usually in single, silent, cholesterol stone that is symptomless.
Dx of Silent Gallstones
TTT of Silent Gallstones
It can be left alone without treatment (This stone rarely causes obstructive jaundice)
Flatulent Dyspepsia in GSD
Cause of Gall Stone Colic
due to spasm of gall bladder
Site of Gall Stone Colic
Upper abdominal pain felt in the right hypochondrium
Nature of Gall Stone Colic
Severe colicky pain
Radiation of Gall Stone Colic
- May shoot to the back or between shoulder blades
- Pain may radiate to chest also.
PPT Factors for Gall Stone Colic
- At night in the supine position (The stone tends to block the cystic duct or neck of gallbladder)
Course of Gall Stone Colic
Continuous
Duration of Gall Stone Colic
Lasts for a few min to few hours
Associated Symptoms of Gall Stone Colic
1) Vomiting due to reflex pylorospasm.
2) Restlessness.
3) Sweating.
Tenderness in Gall Stone Colic
There is tenderness in the right hypochondrium.
