Cholelithiasis ( Gallstone)

Question 1

Choleycysitis :
Can you explain the words ?

Answer 1

Chole: bile
Cyst:bladder
itis :inflamtion

Question 2

Bile
Function :
Enterohepatic circulastion :
Componets :

Answer 2

1- Digestion + absorbtion &fat soluble Vitamine A D EK
2-Enterhepatic circulation : Bile acids are released from the liver into the duodenum, and reabsorbed at
the terminal ileum, and transported back to the liver via the portal vein.
Components : Water 90% - elctrolyte &organic solute 10%

Question 3

Cholesterol Gallstones 80%:
X-ray
Risk factor
AGE
Ethicus factors

Answer 3

Cholesterol Gallstones 80%:
• Usually not visible on x-ray (radiolucent)
• Mixed (75%): small size, multiple / Pure cholesterol (10%) : large & solitary
• Risk factors:
- ↑ cholesterol :
• Excess Estrogen  ↑ fat synthesis  ↑ cholestrol ( Sex distribution—twice as common in women . Pregnancy,
multiparity : estrogen + progesterone which slow GB emptying) • Altered lipid metabolism  ↑cholesterol in bile ( obesity ↑ TBC , rapid Wt. loss ↑ cholesterol mobilization
- ↓ bile salts ( produced in liver & secreted in bile & 95% reabsorbed in terminal ilium. keep cholesterol emulsified )
• underproduction :, children with cystic fibrosis ( loss of bile salt in stool due to malabsorption ). Drugs (Colifibrate: inhibit
bile acid synthesis). • Poor absorption from terminal ilium: Crohn’s disease involving TI or Ileal atrophy from TPN
-AGE: classically occurs in 40 yr olds / rare in children & elderly ( think of Ca. )

Question 4

Pigment (15%) = bilirubin stones
Black pigment
Brown pigment

Answer 4

Black pigment:
Cirrhosis :imparide bilirubin conjugastion
Chronic hemolytic state
Brown pigment
Biliary infection
Convereted conjected to un cojecated
More common biliary than GB
Contain Ca &chlestrol

Question 5

Gallbladder
Blood supply :

Answer 5

cystic artery (usually a branch of the right
hepatic artery).
And CCK