L11: Gall Stones Flashcards
(75 cards)
1
Q
Functions of Gall Bladder
A
- Reservoir or Bile
- Concentration of Bile
- Mucus Secretion
2
Q
Resrvoir For Bile
A
3
Q
Bile is excreted by …..
A
The liver
4
Q
Bile is stored in …..
A
The gall bladder
Total of about 500 to 1000 ml per day
5
Q
Release of Bile
A
6
Q
Concentration of Bile
A
7
Q
How much bile is water?
A
98%
8
Q
How Much is bile concentrated?
A
Get concentrated 5-10 times
9
Q
How is Bile Concentrated?
A
10
Q
Results of Bile Concentration
A
11
Q
Mucus Secretion by Gall Bladder
A
12
Q
Amount of mucus by GB
A
Secretes about 20 ml of mucus per day
13
Q
Surgical Importance of mucus secreted by GB
A
Obstruction to the cystic duct causes mucocele of the
14
Q
Bile is formed of …..
A
15
Q
pH of Bile
A
More Than 7
16
Q
Amount Of Bile
A
500-1000 ml/day, 98% is water.
17
Q
Capacity of GB
A
Gall bladder is 40-50 ml
18
Q
Release of Bile
A
Fatty food stimulation releases cholecystokinin results in:
- Stimulates gall bladder to contract.
- At the same time, the sphincter of Oddi to relax.
19
Q
Content of Bile
A
- Inorganic ions (more than plasma)
- Hence, severe electrolyte imbalance is seen in the biliary fistula
20
Q
Fate of Bile
A
They are metabolized in the colon to deoxycholic acid & lithocholic acids.
21
Q
Function of Bile
A
- Main function of bile acids in the bile is To maintain cholesterol in the solution
22
Q
Another Name of Gall Stone Disease
A
Cholelithiasis
23
Q
Etiology of Gall Stone Disease
A
24
Q
Metabolic Causes of Gall Stone Disease
A
Conditions that increase cholesterol secretion & can results in stone formation:
- Obesity
- High-calorie diet
- Medications
25
Cholesterol
- Production
- Gives Rise to
- Execretion
26
Cholesterol is water insoluble so...
27
What maintains cholesterol in liquid form?
28
Mechanism of stone formations
29
Infections & Gallstones
The most common cause responsible for a gall stone in 80% of patients
30
Source of infections causing **GSD**
tonsils, tooth, bowel, etc.
31
Causative Organisms of **GSD**
Caused by organisms such as:
1. E. coli
2. Proteus
3. Anaerobic organisms
4. Streptococci
32
Route of Infection in **GSD**
Reach the gall bladder wall through the blood stream.
33
Effect of infections in **GSD**
34
Causes of **Bile stasis**
35
Types of stones in Bile stasis
They are prone to mixed stones as a result of bile stasis.
36
Causes of **Decreased bile acid pool**
37
Examples of Hemolytic Anemias Causing **GSD**
1) Hereditary spherocytosis
2) Sickle cell anemia
38
Mechanism of Hemolytic Anemias Causing **GSD**
39
Saint's Triad
40
Parasitic Infestations Causing **GSD**
41
Causes of **GSD** due to abnormal mucus
Congenital cystic fibrosis
42
Mechanism of **GSD** due to abnormal mucus
Gallstones occur in these children due to impairment of bile flow.
43
Other Diseases associated with **GSD**
1) Diabetes mellitus.
2) Type IV hyperlipoproteinemia.
3) Cirrhosis of liver.
4) Fistulae on treatment with total parenteral nutrition.
5) Gastric surgery.
44
Different Types of GB Stones
- Mixed
- Cholesterol
- Pigment
- Brown Pigment
45
Incidence of **Mixed Stones**
They constitute about 80% of gall stones
46
Structure of **Mixed Stones**
47
Characters of **Mixed Stones**
48
Incidence of **Cholesterol Stones**
They constitute about 10% of gall stones
49
Cause of **Cholesterol Stones**
- Occur in patients with increased cholesterol levels.
- Occurs in aseptic bile
50
RF for **Cholesterol Stones**
- Fatty women are commonly affected
51
Structure of **Cholesterol Stones**
- Precipitation of cholesterol gives rise to stones.
- Pigment can also get precipitated along with cholesterol.
52
Characters of **Cholesterol Stones**
53
Symptoms of **Cholesterol Stones**
Such stones can be silent for many years.
54
Radiology of **Cholesterol Stones**
They are radio lucent
55
Incidence of **Pigment Stones**
They constitute about 5-10% of gall stones
56
Causes of **Pigment Stones**
57
Structure of **Pigment Stones**
Calcium bilirubinate stones.
58
Characters of **Pigment Stones**
59
Incidence of ****Brown Pigment Stones****
Rare in gall bladder, occurs in bile duct
60
Cause of **Brown Pigment Stones**
61
Structure of **Brown Pigment Stones**
- Calcium bilirubinate - calcium palmitate - calcium stearate.
- Cholesterol.
62
Clinical features & complications of gall stones
63
Causes of **Silent Gallstones**
Usually in single, silent, cholesterol stone that is symptomless.
64
Dx of **Silent Gallstones**
65
TTT of **Silent Gallstones**
It can be left alone without treatment (This stone rarely causes obstructive jaundice)
66
**Flatulent Dyspepsia** in GSD
67
Cause of Gall Stone Colic
due to spasm of gall bladder
68
Site of **Gall Stone Colic**
Upper abdominal pain felt in the right hypochondrium
69
Nature of **Gall Stone Colic**
Severe colicky pain
70
Radiation of **Gall Stone Colic**
- May shoot to the back or between shoulder blades
- Pain may radiate to chest also.
71
PPT Factors for Gall Stone Colic
- At night in the supine position (The stone tends to block the cystic duct or neck of gallbladder)
72
Course of **Gall Stone Colic**
Continuous
73
Duration of Gall Stone Colic
Lasts for a few min to few hours
74
Associated Symptoms of Gall Stone Colic
1) Vomiting due to reflex pylorospasm.
2) Restlessness.
3) Sweating.
75
Tenderness in Gall Stone Colic
There is tenderness in the right hypochondrium.
