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Gallstones


Description

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



Signs

commonly asymptomatic

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



Symptoms

fever

positive MurphyÕs sign - subcostal tenderness on deep inspiration



Epidemiology

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

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



Cholelithiasis

75% are cholesterol and mucin protein

25% are pigment bilirubin and calcium

Conventional Labs

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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