introduction,types,chemistry,riskfactor,cure

1. CHOLELITHIASIS
Gallstones
Dn. mouazama hanif

2. No of content
◦ Anatomy of gallbladder and biliary tract
◦ Bile and its regulation
◦ Gall stone
◦ Epidemiology
◦ Types
◦ Etiology

3. Causes/insertion
BILE
•IF BILE CONTAINS TOO MUCH CHOLESTEROL, IT
CAN HARDEN INTO GALLSTONES.
5% PHOSPHOLIPIDS
5%PROTEIN
10%CHOLESTEROL
70%BILE SALTS+ACIDS
1% BILIRUBIN
CHOLESTEROL STONE
PIGMENTED STONE
MIXED STONE

9. Types of stone
◦ Cholesterol stone
◦ Multiple layers of cholesterol
◦ Most cholesterol stone contain calcium and
bile pigment.
◦ If excessive production of cholesterol or
insufficient bile secreted bile become
supersaturated, and precipitate out as
cholesterol and stone.
◦ The incident increase with age,mostely
common in women.
◦ Pigmented stone
◦ Two types black and brown stone.
◦ Black formed in sterile bile where as brown
stone are formed in infected intrahepatic are
extra hepatic ducts,
◦ Black stones
◦ Increased production of unconjugated
bilirubin, wherein it is composed of a pigment
polymer usually unconjugated bilirubin
calcium, phosphate calcium and calcium
carbonate.

10. Types of stone and how formed?
◦ Brown stone
◦ Basically because of bacteria hydrolysis of
conjugated to unconjugated bilirubin.
◦ It consist of calcium bilirubin, calcium soaps of
fatty acids, cholesterol.
◦ Stasis enhance the precipitation by
combination of the above content
◦ Black stone
◦ Stasis enhance the precipitation by
combination of the above content
◦ Mucin is also increase the precipitation

11. Morphology
◦ Cholesterol stone
◦ Smooth
◦ Rough
◦ Morular
◦ Cholesterol stone usually single and large,2-4cm
very in size, when multiple they are faceted.
◦ Firm hard
◦ Radiolucent (combination of caco3 and calcium
phosphate, it can be radio –opaque)
◦ Pure cholesterol stone are radiolucent
◦ Black stone
◦ Multiple (more in number)
◦ Smaller in size (varies from 0.2-1.5cm)crumble on
touch
◦ Radio-opaque(lots of quantity of calcium
carbonate.
◦ Brown stone
◦ Brown in color ,multiple,soft,size varies from 0.2-
1.5cm,not as fragile as black, easily crushed.

12. ◦ Clinical manifestation
◦ Majority are asymptomatic
◦ Functional spasm around the obstructed duct resulting in
pain this pain refer to as biliary colic (episodic and sever pain.
◦ Some Risk factors for gallstones
◦ •Gender: Women 2x as likely; excess estrogen from
pregnancy, BC
◦ pills, HRT all may increase cholesterol levels
◦ •Weight: even moderate obesity
◦ •Diet: high fat, low fiber diet increases level of cholesterol in
bile
◦ • Rapid weight loss: crash diets as body tries to metabolize
fat
◦ •Age.>60: body secretes more cholesterol into bile
◦ Complications
◦ Acute cholecystitis
◦ Hydrops gallbladder (high fluid content)
◦ Mucocele of gallbladder (entire filled with mucous)
◦ Empyema of gallbladder (prolonged inflammation)
◦ Perforation (peritoneal inflammation)

13. Vitamin deficiency
◦ Obstruction of bile flow also interference with absorption of the fat soluble vitamins like A,K,E,D.
◦ NUTRITIONAL THERAPY
◦ Limit fat
◦ Skimmed dairy products like yogurt milk.
◦ Lean meat mashed potatoes, alkaline fruits.
◦ Avoid egg cream,meat,cheese ,gas for mining vegetables,