Post on 29-Jun-2015
THE BILIARY TRACT
Lecture 30
CHOLELITHIASIS
CholelithiasisPresence of stones in the gallbladder is
referred to as cholelithiasis (from the Greek chol- (bile) + lith- (stone) + iasis- (process).
CHOLELITHIASIS (GALLSTONES) Epidemiology
• Gallstones afflict 10% to 20% of adult populations in developed countries.
• It is estimated that more than 20 million persons in the United States have gallstones, totaling some
25 to 50 tons in weight!
Over 95% of biliary tract disease is attributable to cholelithiasis (gallstones).
TYPES OF GALLSTONES
1.Cholesterol stones 20%2.Pigment stones 5%3.Mixed stones 75%
The risk factors most commonly associated with the development of
cholesterol stones are:
1. Age and Sex. 2. Environmental Factors. 3. Acquired Disorders. 4. Hereditary Factors.
Cholesterol gallstone formation involves four simultaneous conditions:
(1) The bile must be supersaturated with cholesterol;
(2) hypomotility of the gallbladder promotes nucleation;
(3) cholesterol nucleation in the bile is accelerated;
(4) hypersecretion of mucus in the gallbladder traps the nucleated crystals, leading to their aggregation into stones.
Accretion within the gallbladder mucous layer.
The four contributing factors for cholelithiasis: supersaturation, gallbladder hypomotility, crystal nucleation, and accretion within the gallbladder mucous layer.
A micelle is an aggregate of surfactant molecules dispersed in a liquid colloid
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Clinical features
Clinical features
• The vast majority of gallstones
(>80%) are “silent,” and most individuals remain free of biliary pain or other
complications for decades.
Symptoms Symptoms commonly begin to appear once
the stones reach a certain size
(>8 mm).
Pain during inspiration with examiner’s hand on the GB location.
"Is there any reward for good, other than good?"