Gall stones

1. Gall stones
Hossam GHONEIM, MD

2. Risk factors
• Age
• Sex
• Pregnancy
• Oral contraceptives and estrogen replacement therapy
• Family history and genetics
• Obesity
• Rapid weight loss
• Diabetes mellitus
• Serum lipids
• Serum bilirubin
• Cirrhosis
• Gallbladder stasis
• Other drugs
• Decreased physical activity
• Crohn's disease
• Hemolysis

3. Clinical presentation
• Typical
– Severe pain, Intermittent and recurrent upper abd
mainly rt hypochondrium, refered to Rt shoulder
and/or back
– Nausea, vomiting, fever
• Atypical
– NCCP, epigastric pain, reflux and Heart burn
• Murphy’s sign on clinical examination

4. Diagnosis
• Ultrasound
• MRCP
• Lab
– CBC
– CRP
– Bilirubin, ALT,AST

9. FAQ
• Inflammation or no Inflammation (silent
stones)?
• Type of stones or number and size?
• CBD stones, MRCP or ERCP?
• GS pancreatitis
• Non calcular cholecystitis
• GB polyps
• GB dyskinesia

10. GS ilieus