Gallstones

Question 1

What are gallstones?

Answer 1

Gallstones (cholelithiasis) refers to the formation of hard stones in the gallbladder – a process which typically takes years to occur. It is a very common phenomenon which affects about 10-15% of the general population in the developed world.

Question 2

What is the second most common organ that requires surgery in the GI tract?

Answer 2

Gallbladder

Question 3

What does bile contain?

Answer 3

1. Bile pigments (from Hb breakdown products)
   2.Cholesterol
2. Other lipids

Question 4

What are the 3 types of gallstones?

Answer 4

1. Cholesterol stones
2. Pigment stones
3. Mix of both

Question 5

75% of which type of gallstones in the USA and Europe?

Answer 5

Cholesterol

Question 6

What are the clinical features of pure cholesterol stones?

Answer 6

1. Usually solitary and large
2. Risk factors = Female, age and obesity
   Stones of about 70% or more of cholesterol are usually smaller and more numerous. The rest of the stone is made up of calcium compounds and protein.

Question 7

What are the clinical features of mixed gallstones?

Answer 7

Usually multiple and irregular shaped

Question 8

What two categorises can pigment stones be categorised into?

Answer 8

1. Brown
2. Black

Question 9

What are brown mixed stones like?

Answer 9

Soft and contain a mixture of pigment, cholesterol and calcium salts

Question 10

What are black mixed stones like?

Answer 10

Black stones are hard and made up of pure pigment

Question 11

Why are females at greater risk of gallstones?

Answer 11

oestrogen and progesterone impair gallbladder emptying

Question 12

What causes the formation of cholesterol and mixed stones? (2)

Answer 12

1) stasis
2) supersaturation of cholesterol
3) Products that promote the crystallisation of cholesterol – some lipoproteins found in bile do this.

Question 13

What are black pigment stones comprised of? (3)

Answer 13

1) polymerised calcium bilirubinate
2) calcium phosphate
3) calcium carbonate

Question 14

Describe the appearance of black pigment stones (3):

Answer 14

1) small
2) hard
3) brittle

Question 15

What causes the formation of black pigment gallstones? (2)

Answer 15

1) stasis
2) supersaturation of bilirubin

Question 16

Give the five F risk factors for cholesterol stones:

Answer 16

1) female
2) forty plus
3) fair (white ethnicity)
4) fat
5) fertile

Question 17

When do cholesterol stones form?

Answer 17

Cholesterol stones form when the concentration of micelles is not great enough to hold all the cholesterol in the micelles.
Patients with cholesterol stones generally have a smaller bile pool, which circulates more often.

Question 18

What is cholesterol sludge?

Answer 18

Initially, cholesterol crystals will form in bile that is supersaturated with cholesterol. This results in the production of ‘sludge’

Question 19

How is the formation of ‘sludge’ inhibited?

Answer 19

1. Caffeine
2. NSAIDs
3. Bile salts

Question 20

How is the formation of sludge exacerbated?

Answer 20

1. Mucin
2. Rapid weight loss
3. pregnancy
4. Increased serum cholesterol
5. Reduced bile production

Question 21

Which two types of gallstone cannot be seen on X-ray?

Answer 21

1) cholesterol stone
2) brown pigment stone

Question 22

Give 5 conditions associated with the formation of black pigment gallstones:

Answer 22

1) sickle cell disease
2) thalassaemia
3) spherocytosis
4) malaria
5) hypersplenism
(all cause chronic haemolysis, leading to supersaturation of bilirubin)

Question 23

Where do brown pigment stones commonly form?

Answer 23

in bile ducts (rather than the gallbladder itself)

Question 24

Give three mild symptoms associated with uncomplicated gallstones:

Answer 24

1) upper abdominal pain
2) indigestion
3) nausea