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Medical Lecture Notes - Gallstones

Gallstones notes

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28 views3 pages

Medical Lecture Notes - Gallstones

Gallstones notes

Uploaded by

Zoya
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Medical Lecture Notes: Gallstones

Introduction to Gallstones

Definition: Gallstones, also known as choleliths, are solid particles that form in the gallbladder,
a small organ located under the liver. They are composed mainly of cholesterol, bilirubin, and
bile salts.

Types:

1. Cholesterol Gallstones: The most common type, comprising about 80% of gallstones.
They form when there is too much cholesterol in the bile.
2. Pigment Gallstones: Made up of bilirubin, these stones are smaller and darker. They
can occur in conditions that lead to increased breakdown of red blood cells, such as
hemolytic anemias.
3. Mixed Gallstones: Contain both cholesterol and calcium salts of bilirubin.

Pathophysiology

Formation Mechanisms:

1. Supersaturation of Bile with Cholesterol: When the liver excretes more cholesterol
than can be dissolved by the bile salts, it precipitates out as solid crystals.
2. Biliary Stasis: Slowed or reduced gallbladder motility, often associated with pregnancy,
fasting, or certain medications, can lead to stone formation.
3. Hyperbilirubinemia: Conditions causing increased breakdown of red blood cells, such
as sickle cell anemia or cirrhosis, can lead to the formation of pigment stones.

Risk Factors:

● Non-Modifiable:
○ Age (more common in people over 40)
○ Female gender (higher incidence in women)
○ Ethnicity (higher prevalence in Native Americans and Hispanics)
● Modifiable:
○ Obesity
○ Rapid weight loss
○ High-fat diet
○ Certain medications (e.g., oral contraceptives, hormone replacement therapy)
○ Diabetes
○ Hyperlipidemia

Clinical Presentation

Asymptomatic Gallstones:
● Many individuals with gallstones are asymptomatic and the stones are often discovered
incidentally.

Symptomatic Gallstones:

● Biliary Colic: Intermittent and severe pain, usually in the right upper quadrant (RUQ) or
epigastric region, often radiating to the right shoulder or back. Typically triggered by fatty
meals.
● Acute Cholecystitis: Persistent RUQ pain, fever, nausea, vomiting, and positive
Murphy’s sign (pain on palpation of the RUQ during inspiration).
● Choledocholithiasis: Stones in the common bile duct causing jaundice, dark urine, pale
stools, and biliary colic.
● Cholangitis: Infection of the biliary tree presenting with Charcot's triad (fever, jaundice,
and RUQ pain) and potentially Reynold's pentad (Charcot's triad plus hypotension and
altered mental status) indicating severe infection.

Diagnosis

Laboratory Tests:

● Liver function tests (LFTs): Elevated bilirubin, alkaline phosphatase, and transaminases.
● Complete blood count (CBC): Leukocytosis in cholecystitis or cholangitis.

Imaging:

● Ultrasound: First-line imaging modality, highly sensitive for gallstones and acute
cholecystitis.
● CT Scan: Useful for complications such as perforation or pancreatitis.
● HIDA Scan (Hepatobiliary Iminodiacetic Acid Scan): Used to assess gallbladder
function and cystic duct patency.
● MRCP (Magnetic Resonance Cholangiopancreatography): Non-invasive imaging of
the biliary and pancreatic ducts.
● ERCP (Endoscopic Retrograde Cholangiopancreatography): Diagnostic and
therapeutic, allows stone removal from the common bile duct.

Management

Asymptomatic Gallstones:

● Typically no treatment unless the patient is at high risk for complications (e.g., diabetics,
patients with a calcified gallbladder).

Symptomatic Gallstones:

● Medical Therapy:
○ Pain management with NSAIDs or opioids.
○ Antibiotics for cholecystitis or cholangitis (e.g., ceftriaxone, metronidazole).
○ Ursodeoxycholic acid for cholesterol stones (limited efficacy).

Surgical Therapy:

● Cholecystectomy:
○ Laparoscopic Cholecystectomy: Gold standard treatment for symptomatic
gallstones and acute cholecystitis. Minimally invasive with quicker recovery.
○ Open Cholecystectomy: Reserved for complicated cases or when laparoscopic
surgery is contraindicated.

Non-Surgical Therapy:

● ERCP: For choledocholithiasis and cholangitis to remove stones from the common bile
duct.
● Percutaneous Cholecystostomy: Temporary measure in critically ill patients who are
not surgical candidates.

Complications

● Acute Cholecystitis: Inflammation of the gallbladder, potentially leading to perforation,


abscess formation, or gangrene.
● Chronic Cholecystitis: Repeated episodes of acute inflammation leading to fibrosis and
loss of gallbladder function.
● Choledocholithiasis: Stones in the common bile duct causing biliary obstruction.
● Cholangitis: Infection of the biliary tract, a medical emergency requiring prompt
treatment.
● Gallstone Pancreatitis: Stones obstructing the pancreatic duct, leading to inflammation
of the pancreas.

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