L30 gallstones student

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L30 gallstones student

  1. 1. THE BILIARY TRACTLecture 30CHOLELITHIASIS
  2. 2. CholelithiasisPresence of stones in thegallbladder is referred to as cholelithiasis(from the Greekchol- (bile) +lith- (stone) +iasis- (process).
  3. 3. CHOLELITHIASIS (GALLSTONES)Epidemiology• Gallstones afflict 10% to 20% of adultpopulations in developed countries.• It is estimated that more than 20 million personsin the United States have gallstones, totaling some25 to 50 tons in weight!Over 95% of biliary tract disease isattributable tocholelithiasis (gallstones).
  4. 4. TYPES OF GALLSTONES1.Cholesterol stones20%2.Pigment stones5%3.Mixed stones75%
  5. 5. The risk factors mostcommonly associated with the development ofcholesterol stones are:1. Age and Sex.2. Environmental Factors.3. Acquired Disorders.4. Hereditary Factors.
  6. 6. Cholesterol gallstone formation involves foursimultaneous conditions:(1) The bile must be supersaturated withcholesterol;(2) hypomotility of the gallbladder promotesnucleation;(3) cholesterol nucleation in the bile isaccelerated;(4) hypersecretion of mucus in the gallbladdertraps the nucleated crystals, leading to theiraggregation into stones.Accretion within the gallbladder mucous layer.
  7. 7. The four contributing factors for cholelithiasis: supersaturation, gallbladderhypomotility, crystal nucleation, and accretion within the gallbladder mucous layer.Amicelleis anaggregate ofsurfactantmoleculesdispersed inaliquidcolloid12 34
  8. 8. Clinical features
  9. 9. Clinical features• The vast majority ofgallstones (>80%) are“silent,” and mostindividuals remain free ofbiliary pain or othercomplications for
  10. 10. SymptomsSymptoms commonly begin to appearonce the stones reach a certain size(>8 mm).
  11. 11. Pain during inspiration with examiner’s hand on theGB location.
  12. 12. "Is there any reward for good, other thangood?"

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