recent posts

CHOLELITHIASIS

 

 

image
Pathogenesis

 

  1. imbalance of cholesterol and its solubilizing agents, bile salts and lecithin concentrations
  2. if hepatic cholesterol secretion is excessive then bile salts and lecithin are overloaded, supersaturated cholesterol precipitates and can form gallstones

Types of Stones

 

Cholesterol (80%) = mixed (> 70% cholesterol by weight)


Risk factors

  1. female, fat, fertile, forties
  2. North American Indians highest incidence
  3. prolonged fasting + total parenteral nutrition (TPN; usually results in acute acalculous cholecystitis)
  4. rapid weight loss
  5. terminal ileal resection or disease (e.g. inflammatory bowel disease)

 

Pigment stones (20%)

 

  1. smooth green/black to brown: composed of unconjugated bilirubin, calcium, bile acids
  2. black pigment stones :associated with cirrhosis, chronic hemolytic states
  3. calcium bilirubinate stones : associated with bile stasis, (biliary strictures, dilatation and biliary infection (Clonorchis sinensis))

Natural History

 

  1. 80% are asymptomatic
  2. 18% develop symptoms over 15 years


Clinical Presentation (in severity of increasing order)

 

  1. asymptomatic stones
    • most asymptomatic gallstones do NOT require treatment
    • consider operating if calcified "porcelain" gallbladder(15-20% associated cancer), diabetes, history of biliary pancreatitis
  2. biliary colic
  3. cholecystitis - acute and chronic
  4. complications of cholecystitis c
  5. holedocholithiasis (CBD stones)

 

CHOLELITHIASIS CHOLELITHIASIS Reviewed by Radiology Madeeasy on August 31, 2010 Rating: 5
Powered by Blogger.