Cholelithiasis
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Basics
Description
- Symptoms arise due to transient gallstone obstruction of cystic duct
- Biliary dyskinesia can produce symptoms similar 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
Etiology
- Cholesterol stones:
- Most common type of gallstone (>90% in the U.S. and Europe)
- Form due to disturbance of cholesterol disposal
- Pigment stones:
- Much less common
- Composed of calcium bilirubinate
- Associated with clinical conditions such as hemolytic diseases, cirrhosis, cystic fibrosis that lead to increased concentration of unconjugated bilirubin
- Incidence increases with age and favors females to males 2:1 (4:1 during reproductive years). Other risk factors include Hispanic ethnicity, obesity, pregnancy, rapid weight loss, and drugs that induce biliary stasis (e.g., ceftriaxone and oral contraceptives), family history of gallstones
- Gallstones are exceedingly rare in childhood and are most commonly associated with sickle cell disease, hereditary spherocytosis, or other hemolytic diseases 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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Basics
Description
- Symptoms arise due to transient gallstone obstruction of cystic duct
- Biliary dyskinesia can produce symptoms similar 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
Etiology
- Cholesterol stones:
- Most common type of gallstone (>90% in the U.S. and Europe)
- Form due to disturbance of cholesterol disposal
- Pigment stones:
- Much less common
- Composed of calcium bilirubinate
- Associated with clinical conditions such as hemolytic diseases, cirrhosis, cystic fibrosis that lead to increased concentration of unconjugated bilirubin
- Incidence increases with age and favors females to males 2:1 (4:1 during reproductive years). Other risk factors include Hispanic ethnicity, obesity, pregnancy, rapid weight loss, and drugs that induce biliary stasis (e.g., ceftriaxone and oral contraceptives), family history of gallstones
- Gallstones are exceedingly rare in childhood and are most commonly associated with sickle cell disease, hereditary spherocytosis, or other hemolytic diseases 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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