Gallstones are pieces of hard solid matter in the gallbladder. They form when the components of bile (especially cholesterol and bilirubin) precipitate out of solution and form crystals.
Pigment (bilirubin) gallstones are found most often in: Patients with severe liver disease and Patients with some blood disorders such as sickle cell anemia
Cholesterol gallstones are found most often in: Women over 20, especially pregnant women, and men over 60 years old; Overweight men and women; People on "crash diets" who lose a lot of weight quickly; Patients who use certain medications including birth control pills and cholesterol lowering agents; Native-Americans and Mexican-Americans
colicky pain, nausea and vomiting
epigastric or RUQ pain radiating to right scapula
steady pain which gradually builds up to plateau over 15-30 minutes
gradually disappearing over several hours
worse at night, worse rich or fatty foods
positive MurphyÕs sign - subcostal tenderness on deep inspiration
female:male = 2:1
70% in Southwestern Native American women
higher incidence with increasing age, multiple pregnancy
during pregnancy - 2nd & 3rd trimesters
associated with estrogen - BCP, ERT
mneumonic - Fair, Fat, Forty, Female, Fertile
Causes of gallstones include: production of bile supersaturated with cholesterol; Decrease in bile content of either phospholipids or bile acids; Biliary stasis; Hemolytic diseases; Biliary infection.
Risk Factors: Short gut syndrome; Inflammatory bowel disease; Multiparity; Long term total parenteral nutrition; Cirrhosis (for pigment stones); Hemolytic disorders - hereditary spherocytosis, sickle cell anemia; Prosthetic cardiac valves; Biliary parasites; Rapid weight loss; Childhood malignancy; Native American descent; Diabetes (for complications); Female gender
75% are cholesterol and mucin protein
25% are pigment bilirubin and calcium
abdominal ultrasound, oral cholecystogram (OCG), in which an X-ray of a dye-filled gallbladder is taken after the patient swallows dye-containing pills.
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