Cholelithiasis

Question 1

What is Cholelithiasis?

Answer 1

precipitation of bile content leading to stone formation

Question 2

Etiology of Cholelithiasis

Answer 2

• genetic predisposition: some are more genetically susceptible
• altered bile composition–> composition of bile changes and form precipitation and give rise to stones
• bile stasis –> an obstruction in the pathway (ducts) could lead to stasis of bile allowing component of bile to settle and precipitate to form stones (bile can have normal component)

Question 3

Flow of the Bile (5)

Answer 3

bile flows from gallbladder—> cystic ducts —> common bile duct —> sphincter of Oddi —> duodenum

Question 4

Composition of Bile and function (5)

Answer 4

1. NaHCO2 = neutralize chyme
2. bile salts = breakdown fats
3. lecithin = transport fat
4. cholesterol = for excretion
5. bilirubin = waste product of heme breakdown (must be excreted)

Question 5

What is Cholethiasis also known as?

Answer 5

gallstones

Question 6

When does issues arises?

Answer 6

gallbladder can be almost entirely be filled with stones with no complications BUT issues arises when stones migrate out of gallbladder

Question 7

Patho Cholelithiasis

Answer 7

nuclei forms–> precipitate around nuclei–> stones develop:

• A nucleus is a particle such as inflammatory debris or a small fragment
• It is produced by bacteria eg E. Coli or Strep. Fecalis
• nuclei forms and precipitates out and other components will attach to it and build a stone

Question 8

What are the 3 types of gallstones? %?

Answer 8

1. cholesterol stones - 80%
2. pigment stones - 20%
3. mixed stones

Question 9

What are cholesterol stones? (3)

Answer 9

• bile and xs cholesterol
• most abundant
• develop when there are xs of cholesterol in body

Question 10

What are pigment stones? (3)

Answer 10

• bilirubin and calcium salts
• calcium salts are a component of bile
• pigment d/t the coloration of bilirubin

Question 11

What are mixed stones? 2 interpretations

Answer 11

1. Different type of stone in gallbladder (cholesterol stone and pigment stone)
2. Stone with various component such as Ca, phosphate, and cholesterol

(more component than pigment stones)

Question 12

Manifestations of cholelithiasis

Answer 12

obstruction of stones when migrated out of gallbladder can lead to:

• colicky pain = radiating pain from flank, groin, and chest; describe to be wave-like spasmodic pain (d/t stone path of migration) –> “biliary colic”
• N/V d/t severe pain

Question 13

Diagnostics

Answer 13

• hx and px

- CT and US: shows the stones and obstructions

Question 14

Treatment (4)

Answer 14

• analgesics: dealt with right away (in ER setting)
• dissolving agents: Synthesized from bile acid to dissolve the stone eg actigall (made from bile acid)
• sx: to remove stones or gallbladder
• complex

Question 15

What surgery is used to remove gallbladder?

Answer 15

retrograde endoscopy

Question 16

complication

Answer 16

• pancreatitis = causes bile to back up and activate the dig enzymes released by pancreas resulting in auto-digestion and pancreatic inflm
• perforation = obstruction near the gallbladder causes increase in pressure when gallbladder contracts to release bile which results in perforation (and chemical peritonitis)
• cholecystitis = inflm of gallbladder if there is large number of stones