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- Symptoms arise when gallstones pass through the cystic or common bile ducts leading to impedance of normal bile flow and gallbladder spasm.
- Biliary dyskinesia produces symptoms identical to biliary colic in the absence of stones.
- Choledocholithiasis (common bile duct stones), may lead to prolonged pain, elevated LFTs and bilirubin, and to more complications like cholangitis or pancreatitis.
- Cholesterol stones:
- Most common type of gallstone
- Form when solubility exceeded
- Pigment stones:
- Composed of calcium bilirubinate
- Associated with clinical conditions such as hemolytic anemias that lead to increased concentration of unconjugated bilirubin
- Incidence increases with age and favors females to males 2:1. Other risk factors include Hispanic ethnicity, obesity, pregnancy, rapid weight loss, and drugs that induce biliary stasis (e.g., ceftriaxone and oral contraceptives).
- Gallstones are exceedingly rare in childhood and are most commonly associated with sickle cell disease, hereditary spherocytosis, or other hemolytic anemias that result in pigment stone formation.
- Biliary sludge:
- Nonstone, crystalline, granular matrix
- Associated with rapid weight loss, pregnancy, ceftriaxone or octreotide therapy, and organ transplantation
- May develop symptoms identical to cholelithiasis and its complications
- “Porcelain gallbladder” from mucosal precipitation of calcium salts owing to recurrent obstruction of cystic duct.
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