Gallstones

Cholelithiasis
Accretion of bile constituents & mucus
Forms solid 'stones'
Within biliary tract

Epidemiology
20% western adults
Caucasian Male:Female  = 1:2
Up risk with age
>50% prevalence >80years

Symptoms & Signs
10-20% = Symptomatic
Depends upon location of stone
*RUQ pain
Severe/spasmodic (rhythmic contraction of gallbladder against the impacted stone aka biliary colic)

If in common bile duct
1) Cholestasis
2) Jaundice (conjugated hyperbilirubinaemia)
3) Pancreatitis
* Attack 30minutes after a bacon sandwich

Pathology
2 types of stone
 - cholesterol 80%
 - pigment 20%

Formed from:

• Bile supersaturation
• Gallbladder hypomobility
• Mucus hypersecretion

Cholesterol Stones
50% - 100% cholesterol monohydrate
Sm amounts of calcium salts +/- bilirubin

Aetiology
Obesity
Rapid weight loss
High oestrogen states (OCP, pregnancy)
FHx
Congenital errors of metabolism
Clofibrate Tx

Pigment Stones
Insoluble Ca salts of unconjugated bilirubin & inorganic molecules

Aetiology
Haemolysis
Severe ileal dysfunction
Bacterial contamination of biliary tract

Ix
Cholesterol Stones
Multiple
Sm, yellow surface
Lamellar cut surface
15% radio-opaque (if sufficient Ca carbonate)
Pigment
Multiple
Black, facetted surface
50-75% radio-opaque

Cx
*Cholecystitis - *indication for emergency cholecystectomy
Empyema
Perforation
Filstulae
Cholangitis
Cholestasis
Pancreatitis
Increased gallbladder carcinoma risk