Cholelithiasis(Gallstones)

Done by :- Hamad Emad Thuhayr

Supervisor by :- Dr. Osman Habeeb Bashir

2st BGM SOEPLE 1

Contents

SOEPEL Anatomy Introduction of Cholelithiasis

Characteristics and composition Clinical features Pathophysiology Diagnosis and investigations Treatment References

SOEPEL

Subject :

Mr. B is a middle age. He has abdominal pain in right upper quadrant after a fatty meal. Also the pain radiating to the R scapula and causes nausea. additionally, it come suddenly.

SOEPEL

Object: General examination & Abdominal examination

Evaluation (DD): Biliary disease, Inflamed or perforated duodenal ulcer, Hepatitis and Cholelithiasis.

Plan: Hematology ;- Cbc, Lft, Rft, Blood sugars f/pp or random, Coagulation profile. Radiology ;- USG abdomen.

Elaboration: Cholecystectomy.

Learning goals: Cholelithiasis (Gallstones).

Anatomy

Fundus

The Gall Bladder and Bile Ducts

INTRODUCTION

Definition. CHOLELITHIASIS refers to presence or formation of gallstones in the gallbladder

or bile ducts. Gallstones are the most common biliary stones. Overall prevalence of gallstones of 7.9% in men and 16.6% in women In Acute Cholecystitis gallstones are present in about 95% of cases -calculous cholecystitis. The exact incidence of acute Cholecystitis among patients who harbor gallstones is not known

but in about 20% of patients who enter a hospital for biliary tract disease have acute cholecystitis.

Characteristics and composition

1. CHOLESTEROL STONES –- . Cholesterol gallstones usually contain >50% cholesterol monohydrate plus an admixture of calcium salts, bile pigments, and proteins

2. PIGMENT STONES Composed almost entirely of calcium bilirubinate. They are mostly small,

black and multiple. Some are hard and coral like, others are soft and really concretions of sludge rather than stones.Two types Hemolysis and liver disease are associated with the black stones; the brown, earthy stones more frequently are formed outside the gallbladder and

often are associated with bacterial infections of the biliary tract

Cont….

3. MIXED STONESCholesterol is the major component. Other components includes calcium bilirubinate, calcium palmitate, calcium carbonate, calcium phosphate and proteins. They are usually multiple and often they are faceted.

.

Clinical features

Gallstones may cause no signs or symptoms. If a gallstone lodges in a duct and causes a blockage, signs and symptoms may result, such as:

Sudden and rapidly intensifying pain in the upper right portion of your abdomen

Sudden and rapidly intensifying pain in the center of your abdomen, just below your breastbone

Back pain between your shoulder blades

Pain in your right shoulder

Pathophysiology

• Cholesterol gallstones develop when bile contains too much cholesterol and not enough bile salts.

• ncomplete and infrequent emptying of the gallbladder may cause the bile to become overconcentrated and contribute to gallstone formation.

• the presence of proteins in the liver and bile that either promote or inhibit cholesterol crystallization into gallstones.

• increased levels of the hormone estrogen.

Diagnosis and investigations

UltrasoundMost sensitive and specific test for gallstones

Computerized tomography (CT) scanMay show gallstones or complications, such as infection and rupture of GB or bile ducts

Cholescintigraphy (HIDA scan)Used to diagnose abnormal contraction of gallbladder or obstruction of bile ducts

Endoscopic retrograde cholangiopancreatography (ERCP)Used to locate and remove stones in bile ducts

Blood testsPerformed to look for signs of infection, obstruction, pancreatitis, or jaundice

Treatment

• Nonsurgical treatment:• Only in special situations

• When a patient has a serious medical condition preventing surgery• Only for cholesterol stones

• Oral dissolution therapy• Ursodeoxycholic acid - to dissolve cholesterol gallstones• Months or years of treatment may be necessary before all stones dissolve

• Contact dissolution therapy• Experimental procedure• Involves injecting a drug directly into the gallbladder to dissolve cholesterol stones

Cont….

• Surgery: Cholecystectomy (gallbladder removal)laparoscopic cholecystectomy has become the "gold standard" for treating symptomatic

cholelithiasis

Cont….

• Cholendoscopic removal of gallstones

Cont….

• Biliary lithotripsy

Conclusion

The bile play a major role in the excretion of cholesterol & absorption of fat sol Vit.

Alteration of bile composition lead to the formation of GS .

Finally GB hypomotility & bile stasis promote GS formation .

Refferences

• Oxford Handbook of Clinical Medicine• www.wikipedia.org• www.emedicinehealth.com