Flashcards in 71. Gallstones (cholelithiasis) Deck (25):
... all gallstones ( cholelithiasis)
high cholesterol an/or bilirubin , low bile salts or phospholipids (leithin ) and glabladder stasis
types - Mc
1. cholesterol stones (mc 80%)
2. pigmented stones
definition and types and radiolucent or radiopaque
cholelithiasisQ solide round stone in gallbladder
1. cholesterol stones --> raiolucent with 10-20% radiopaque due to calcifications
2. pigmented stones --> if black --> radiopaque ( Ca2+ bilirubinate, hemolysis), if brown (infection) --> radiolucent
cholelithiasis - cholesterol stones are associated with
1. estrogen (female, obesity, multiparity, estrogen therapy)
3. advanced age
4. rapid weight loss
5. native american origin
cholelithiasis - pigment stones are associated with
2. chronic hemolysis
3. alcoholic cirrhosis
4. advanced age
5. biliary infections ( ascaris lumbricoides, clonarchis, sinensis)
6. total parental nutrition
cholelithiasis- diagnosis and treatment
diagnosis : US
treat with cholecystectomy if symptomatic
uncomplicated cholelithiasis - manifests as ( mechanism )
Biliary colic neurohormonal activation (eg. by CCk after a fatty meal) --> contraction of gallbladder, forcing a stone into the cystic duct --> waxing and wanning tight quadrant pain ( may be asymptomatic eg. diabedics)
cholelithiasis - complication (which is the MC)
2. aute pancreatitis
3. ascending cholangitis
symptoms of cholangitis
2. fever (usually rigors)
3. RUG pain
• List the two types of gallstones.
Cholesterol stones and pigment stones
• A woman with a history of obesity, OCP use, and multiple pregnancies will likely have radiolucent or radiopaque kind of stones?
Radiolucent (the patient likely has cholesterol gallstones)
• Approximately what percentage of cholesterol stones are radiopaque?
10–20% (due to calcification)
• Why does Crohn disease predispose patients to gallstones?
Because of the inability of the diseased terminal ileum to absorb bile salts
• List at least four common risk factors for the formation of cholesterol stones.
Obesity, Crohn disease, cystic fibrosis, advanced age, clofibrate, estrogens, multiparity, rapid weight loss, Native American origin
• What percentage of gallstones are cholesterol stones?
• An alcoholic with a history of cirrhosis and biliary infections will most likely have what kind of gallstones (radiolucent or radiopaque)?
Radiopaque (the patient likely has pigment gallstones)
• A patient has RUQ pain, jaundice, and fever. Ultrasound shows gallstones, and labs show elevated white blood cells. What is the diagnosis?
Acute cholangitis (Charcot triad = RUQ pain, jaundice, and fever)
• List at least three common risk factors for pigment stones.
Chronic hemolysis, alcoholic cirrhosis, advanced age, biliary infection, total parenteral nutrition
• A 39-year-old overweight woman presents with jaundice and RUQ pain. How would you diagnosis her condition, and what is the treatment?
Ultrasound to identify a distended gallbladder with stones; cholecystectomy
• Name at least two major complications of gallstones.
Ascending cholangitis, acute pancreatitis, bile stasis, cholecystitis
• Define biliary colic.
Biliary contraction pain after eating due to neurohormones (e.g., CCK) forcing a gallstone into the cystic duct, causing visceral irritation
• Ultrasound shows an 8-mm stone in the cystic duct of a long-time diabetic man. Despite this, he had no complaint of significant pain. Why?
Diabetic patients might have neuropathy, which can reduce the sensation of pain from gallstones
• What radiographic finding is associated with obstruction of the ileocecal valve by a gallstone?
Air in the biliary tract (also known as pneumobilia or gallstone ileus)
• Name the 4 Fs associated with an increased risk of developing gallstones.
Female, Fat, Fertile (prgenancy), Forty (age)