Chapter 155 Gallbladder and Bile Ducts Flashcards
Learn Diseases of the GB and BD
Prevalence of gallstones in American and European adults
10 to 15%, with women affected twice as often as men
How common is cholesterol gallstones in younger individuals?
Cholesterol gallstones are uncommon in individuals younger than 20 years, but a sharp increase is noted with each decade up to about age 70 years, particularly in women. By age 60, about 20% of women and 10% of men have gallstones. So, about 12% of Americans have gallstones.
Prevalence of stones in Mexican American, white, African American, and Native American women.
26% - Mexican American
17% - White
14% - African American
Extremely high in Native American, especially women. In Chileans and Bolivian of Indian ancestry, stones are common, and stone-assoc cancer is most common GI cancer in these countries.
Why pregancy may contribute to predominance of cholesterol stones in younger women?
It is assoc with progesterone-induced impaired gallbladder emptying and esteogen-mediated increased cholesterol saturation of bile.
Nulliparous vs multiparous GB stones prevalance
1.3% in nulliparous vs. 13% in multiparous
Meds assoc with increased incidence of GB stones
HRT Oral contraceptives Somatostatin analogues Ceftriaxone Clofibrate
Diseases assoc with stones
Obesity (biliary cholesterol > bile acid, lecithin)
Rapid weight loss
Diminished ileal absorption of bile acids (Sx resection or bypass)
Chron’s dse
Prevalence of cholesterol vs black pigment stones?
70-80% - Cholesterol
20-30% - Black pigment
Remaining - Brown pigment
Most common complication of gallstone dse
Acute cholecystitis. Stone lodged at GB-cystic duct junction, where it impairs gb flow and drainage. In severe cases, it leads to ischemia and necrosis of gb. More often, stone spontaneously dislodges and inflammation resolves. Half has secondary bacteriobilia with E. coli mostly.
Ratio of gallstone-affected Asian populations of brown pigment gallstone
30-90%
Nonmodifiable risk factors r/t to gallstone formation
Increasing age
Female gender
Ethnicity
Genetics, family history
Modifiable risk factors assoc with gallstone formation
Pregnancy and parity Obesity Low-fiber, high calorie diet Prolonged fasting Meds: clofibrate, estogens, octreotide Low-level physical activity Rapid weight loss Hypertriglyceridemia, low HDL Metabolic syndrome Gallbladder stasis Terminal ileal disease or resection TPN, fasting state
Clinical manifestation of cholelithiasis
Asymptomatic. Eventually RUQ or epigastric pain that is constant, frequently radiates to the back and right scapula. 50% of patients, pain occurs and 1 hour after fatty meal. Pain is 1-5 hours but can persist up to 24 hours. Pain more than 24 hours suggests acute inflammation or cholecystitis. In 60-70% of cases, nausea and vomiting in each episode. 50% with bloating and belching. Fever and jaundice less frequent if simple. Alternative cause if pain is continuous, in the back or LUQ although some may have gallstones.
Clinical manifestation of acute calculous cholecystitis.
Similar to cholelithiasis but pain usually unremitting, lasts several days, often with nausea, emesis, anorexia, and fever. PE with low-grade fever, RUQ tenderness and guarding. Murphy sign. RUQ mass in a third of patients. Mild jaundice (bilirubin < 6 mg/dL) may be present. Significant jaundice in commkn bile duct stones, cholangitis, common hepatic duct obstruction. High fever in ascending cholangitis with bacterial infection. May coexist with choledocholitiasis, acute cholangitis and gallstone pancreatitis
Cholescintigraphy
Technetium Tc99m-labeled iminodiacetic acid derivatives are injected IV, taken up by the liver, excreted into bile. This hepatobiliary iminodiacetix acid (HIDA) scans provide functional information about liver ability to excrete radiolabeled substance into nonobstructed biliary tree.
