18 Gallstones

  • bilirubin for heme elimination
  • bile salts for fat absorption
  • cholesterol for cholesterol elimination
  • all 3 needed in balance to not have stones
  • also need phosphatidylcholine

Cholesterol Stones

  • gallbladder cancer

  • either increased levels of cholesterol or decreased levels of bile acids and phosphatidylcholine

Risks

Bilirubin Stones

  • infections: convert to unconjugated, less soluble
  • hemolysis/liver disease: black

Gallbladder Symptoms

  • removal of gallbladder main way to treat stones

Biliary Colic

Acute Cholecystitis

  • US: wall of gallbladder thickened

  • fever/WBC: inflammation

Choledocolithiasis

Gallstone Pancreatitis

Chronic Cholecystitis

  • inflammation > Ca deposition > porcelain gallbladder

Acalculous cholecystitis

Bile Duct Symptoms

AIDS Cholangiopathy

Ascending

  • clonorchis: looks like cholangitis but with eosinophilia. Recently ate sushi/fish

  • take picture and extract stones

Gallstone Ileus

  • fistula between gallbladder and intestine
  • nl: never air in biliary tree

Gallbladder Carcinoma