Gall Stones

(Cholelithiasis, Choledocolithiasis)

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Definition

-  Stone formation (cholesterol, pigment or mixed) in gallbladder

 

Features

-  90% pop > 60 yrs

-  Often incidental finding on Abdo US or AXR

-  70-80% asymptomatic

-  1-3% present w S/S per yr

-  Cholesterol stones most common in developed world

-  Pigment stones most common in third world

 

Causes

-  Pigment Stones

-  Haemolysis

-  Haemolytic aneamia

-  Malaria

-  Hyperbilirubinaemia

-  Biliary infection

-  GIT disorders (CF, IBD..)

-  Cholesterol Stones

-  Female, fat, fourty, fair, fertile

-  Rapid weight loss

-  Hyperlipidaemia

-  Mixed Stones

-  Ca, cholesterol, pigment

 

Associated S/S

-  Biliary colic

-  Stone caught in neck on contraction

-  Sporadic & unpredictable epigastric or RUQ pain

-  Increases over 1-20 min then fades

-  +/- nausea, vomiting

 

Complications

-  Cholecystitis

-  Cholestasis

-  Ascending Cholangitis

-  Pancreatitis: acute or chronic

-  Gall Stone ileus

-  Gall bladder Ca

 

Ix

-  LFTs: cholestatic: elevated ALP, GGT

-  Abdo US: stones, sludge, duct dilation

-  AXR

-  Mixed stones 10-20% radio-opaque

-  Cholesterol & pigment stones radio-lucent

 

Mx

-  Depending on complications

-  Cholecystectomy: laparascopic or laparatomy