causes, factors, features, diagnosis and treatment of gallstone as expectted for second year students

1. AMIRA ZULAIKHA
082012100065
NUR AMALINA
082012100067
GALL STONES

2. Objective
 To know what is gall stones, its causes and factors
favoring them
 To be able to understand the features of gall stones
 To be able to differentiate between the two types of
gall stones
 To know the diagnosis and treatment for gall stones

3. DEFINITION
 Presence of stones in gall bladder or bile duct
 A.K.A. cholelithiasis
 from the Greek words chol- (bile) + lith- (stone)
+ iasis- (process)

4. CAUSES
 When relative composition in bile changes, causing
precipitation of normal constituents
 Cholesterol level increase and bile acids level
decrease ( normal: 5% cholesterol, 80% bile acids,
15% phospholipids)
 May occur in severe ileal disease, obstruction to
biliary tract, hepatic dysfunction

5. Factors that favor Gall Stone formation
 Supersaturation of bile with cholesterol
 Nucletion factor  glycoprotein in gall bladder
mucous form the nucleus surrounding which gall
stones are formed
 Bile stasis decrease bile flow/ gall bladder
emptying

6. Types of Gall Stones
Mainly of two types:
 Cholesterol stones (85%) 
when ratio of bile cholesterol to bile salt falls
below 1:13.
Radiolucent (cannot be visualized on plain X-ray)
 Pigment stones (15%)
Mainly of calcium bilirubinate
Free bilirubin combines with calcium to form
calcium bilirubinate (highly insoluble in bile)

8. Commonly associated with 5 F:
 Female estrogen stimulates the liver to synthesise
more cholesterol
 Forty to fifty years old  body secrete more
cholesterol into bile
 Fair looking individuals melatonin inhibits
cholesterol secretion from the gall bladder
 Fertile ladies  excess estrogen increase cholesterol
levels in bile
 Fat peoplethe liver over-produces cholesterol

9. Features
 Usually silent stones (allow kidney to function
normally without pain)
 When gall stones come out of gall bladder and pass
the biliary duct, severe colicky or spasmodic
abdominal pain occur
 Chronic gall stones are present with acute
cholecystitis, bile stasis inducing inflammation of
gall bladder and obstructive jaundice

10. Diagnosis
 Ultrasound (cholecystography)
 Plain X-ray (pigment stones)

11. Treatment
 No effective medical treatment
 Cholesterol gall stones can sometimes be dissolved
by oral ursodeoxycholic acid
 Gall stones may occur when stop using drugs
 Treated surgically by removal of gall bladder
(cholecystectomy)
 Gall bladder not absolutely essential for digestion
 Only problem arise is steatorrhea if excess fatty
food is taken

12. Conclusion
Gall stones can be prevented by:
 advisable to avoid eating fatty foods with a high
cholesterol content
 A low-fat, high-fibre diet is recommended
 Control your weight by eating a healthy diet and
taking plenty of regular exercise.
 avoid low-calorie, rapid weight loss diets, they can
disrupt your bile chemistry and increase your risk
of developing gall stones

13. Reference
 Textbook of Medical Physiology, 2nd Edition, GK Pal
 Textbook of Physiology, 3rd Edition, AK Jain