Cholelithiasis
Background
Presence of gallstones in the gallbladder.
Spectrum ranges from asymptomatic, colic, cholangitis, choledocholithiasis, cholecystitis
Colic is a temporary blockage, cholecystitis is inflammation from obstruction of CBD or cystic duct, cholangitis is infection of the biliary tree.
Anatomy
Pathophysiology
Three types of stones, cholesterol, pigment, mixed.
Formation of each types is caused by crystallization of bile.
Cholesterol stones most common.
Bile consists of lethicin, bile acids, phospholipids in a fine balance.
Impaired motility can predispose to stones.
Pathophysiology
Sludge is crystals without stones. It may be a first step in stones, or be independent of it.
Pigment stones (15%) are from calcium bilirubinate. Diseases that increase RBC destruction will cause these. Also in cirrhotic patients, parasitic infections.
Harvest Time
Frequency
US: affected by race, ethnicity, sex, medical conditions, fertility. 20 million have GS. Every year 1-2% of people develop them. Hispanics are at increased risk.
Internationally: 20% of women, 14% of men. Patients over 60 prevalence was 12.9% for men, 22.4% for women.
Morbidity/Mortality
Every year 1-3% of patients develop symptoms.
Asymptomatic GS are not associated with fatalities.
Morbidity and mortality is associated only with symptomatic stones.
Race
Highest in fair skinned people of northern European descent and in Hispanic populations.
High in Pima Indians (75% of elderly). In addition Asians with stones are more likely to have pigmented stones than other populations.
African descent with Sickle Cell Anemia.
Sex
More common in women. Etiology may be secondary to variations in estrogen causing increased cholesterol secretion, and progesterone causing bile stasis.
Pregnant women more likely to have symptoms.
Women with multiple pregnancies at higher risk
Oral contraceptives, estrogen replacement tx.
Age
It is uncommon for children to have gallstones. If they do, its more
Presence of gallstones in the gallbladder.
Spectrum ranges from asymptomatic, colic, cholangitis, choledocholithiasis, cholecystitis
Colic is a temporary blockage, cholecystitis is inflammation from obstruction of CBD or cystic duct, cholangitis is infection of the biliary tree.
Anatomy
Pathophysiology
Three types of stones, cholesterol, pigment, mixed.
Formation of each types is caused by crystallization of bile.
Cholesterol stones most common.
Bile consists of lethicin, bile acids, phospholipids in a fine balance.
Impaired motility can predispose to stones.
Pathophysiology
Sludge is crystals without stones. It may be a first step in stones, or be independent of it.
Pigment stones (15%) are from calcium bilirubinate. Diseases that increase RBC destruction will cause these. Also in cirrhotic patients, parasitic infections.
Harvest Time
Frequency
US: affected by race, ethnicity, sex, medical conditions, fertility. 20 million have GS. Every year 1-2% of people develop them. Hispanics are at increased risk.
Internationally: 20% of women, 14% of men. Patients over 60 prevalence was 12.9% for men, 22.4% for women.
Morbidity/Mortality
Every year 1-3% of patients develop symptoms.
Asymptomatic GS are not associated with fatalities.
Morbidity and mortality is associated only with symptomatic stones.
Race
Highest in fair skinned people of northern European descent and in Hispanic populations.
High in Pima Indians (75% of elderly). In addition Asians with stones are more likely to have pigmented stones than other populations.
African descent with Sickle Cell Anemia.
Sex
More common in women. Etiology may be secondary to variations in estrogen causing increased cholesterol secretion, and progesterone causing bile stasis.
Pregnant women more likely to have symptoms.
Women with multiple pregnancies at higher risk
Oral contraceptives, estrogen replacement tx.
Age
It is uncommon for children to have gallstones. If they do, its more