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?"