1 / 13

GALLSTONES

GALLSTONES. Tanja Čujić Mentor: A. Žmegač Horvat. Anatomy of gallbladder and extrahepatic biliary tree. Bile H elps the body digest fats M ade in the liver S tored in the gallbladder until the body needs it Contains: Water Cholesterol Bile pigments Phospholipids Bicarbonate

tacita
Download Presentation

GALLSTONES

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. GALLSTONES Tanja Čujić Mentor: A. Žmegač Horvat

  2. Anatomy of gallbladder and extrahepatic biliary tree • Bile • Helps the body digest fats • Made in the liver • Stored in the gallbladder until the body needs it • Contains: • Water • Cholesterol • Bile pigments • Phospholipids • Bicarbonate • Anions of the bile acids • Concentrations vary - different kinds of stones may be formed

  3. What are gallstones? • Small, pebble-like substances • Multiple or solitary • May occur anywhere within the biliary tree • Havedifferent appearance - depending on their contents

  4. Pigment stones • Small • Friable • Irregular • Dark • Made of bilirubin and calcium salts • Less than 20% of cholesterol • Risk factors: • Haemolysis • Liver cirrhosis • Biliary tract infections • Ileal resection

  5. Cholesterol stones • Large • Often solitary • Yellow, white or green • Made primarily of cholesterol (>70%) • Risk factors: • 4 “F” : • Female • Forty • Fertile • Fat • Fair (5th “F” - more prevalent in Caucasians) • Family history (6th “F”)

  6. Mixed stones • Multiple • Faceted • Consist of: • Calcium salts • Pigment • Cholesterol (30% - 70%) • 80% - associated with chronic cholecystitis

  7. Gallstone prevalence • 8% of people over 40 yrs. • 90% “silent stones” • Risk factors for becoming symptomatic: • Smoking • Parity

  8. Complications of gallstones • In the GB: • Biliary colic • Acute and chronic cholecystitis • Empyema • Mucocoele • Carcinoma • In the bile ducts: • Obstructive jaundice • Pancreatitis • Cholangitis • In the gut: • Gallstone ileus

  9. Symptoms • Pain in the RUQ • Most common and typical symptom • May last for a few minutes to several hours • Mostly felt after eating a heavy and high-fat meal • Pain under right shoulder when lifting up arms • Fever, nausea and vomiting • Jaundice (obstruction of the bile duct passage) • Acute pancreatitis (gallstone enters the duct leading to pancreas and blocksit)

  10. Diagnosis • Ultrasound • Most sensitive and specific test for gallstones • Computerized tomography (CT) scan • May show gallstones or complications, such as infection and rupture of GB or bile ducts • Cholescintigraphy (HIDA scan) • Used to diagnose abnormal contraction of gallbladder or obstruction of bile ducts • Endoscopic retrograde cholangiopancreatography (ERCP) • Used to locate and remove stones in bile ducts • Blood tests • Performed to look for signs of infection, obstruction, pancreatitis, or jaundice

  11. Treatment • Surgery: Cholecystectomy (gallbladder removal) • 5 - 40% ofpatients develop postcholecystectomy syndrome (gastrointestinal distress and persistent pain in the RUQ) • 20% of patients develop chronic diarrhea • Two surgical options • Open cholecystectomy • Laparoscopic cholecystectomy

  12. Nonsurgical treatment: • Only in special situations • When a patient has a serious medical condition preventing surgery • Only for cholesterol stones • Oral dissolution therapy • Ursodeoxycholic acid- to dissolve cholesterol gallstones • Months or years of treatment may be necessary before all stones dissolve • Contact dissolution therapy • Experimental procedure • Involves injecting a drug directly into the gallbladder to dissolve cholesterol stones

  13. References: • Oxford Handbook of Clinical Medicine • www.wikipedia.org • www.emedicinehealth.com • Tufts OCW

More Related