6. Cholelithiasis (aetiology and complications) and pathology of the extrahepatic biliary tract

What is cholelithiasis?

Presence of gallstones in the gallbladder

What is choledoclithiasis?

Presence of gallstones in the common bile ducts

How common is gallstones?

10-20% of adults in the western countries are currently affected by gallstones, so very common

- commonly asymptomatic

How can gallstones be removed?

By ERCP

What is ERCP?

Endoscopic retrograde cholangiopancreatogram

Types of gallstones?

- Cholesterol stones

- Pigment stones

Which stone is the most common?

Cholesterol stones are most common

- account for 80% of gallstones in the west

Cholesterol stones are formed when?

Formed when the bile is supersaturated w/ cholesterol

- arise exclusively in the gallbladder and are yellow in color

Cholesterol stones? where

Arise exclusively in the gallbladder

Morphology of cholesterol stones?

Pigment stones are med of?

Made of bilirubin calcium salts

Pigment stones? where

May arise anywhere in the biliary tree

What does the pigment stones look like?

Risk factors for cholesterol stones?

6Fs

- Fat

- Female

- Fertile

- Forty

- Fair-skinned

- Family history

However 80% of people with gallstones dont have any identifiable risk factors

Risk factors for pigment stones?

- Chronic haemolytic anaemia

- Cirrhosis

Complications of gallstones?

- Cholecystitis

- Empyema

- Choledoclithiasis

- Ascending cholangitis

- Fistula formation

- Bile stone ileus

Cholecystitis?

Inflammation of the gallbladder

- chemical irritation due to obstruction of bile outflow lies in the background

- can be acute or chronic

When can empyema occur?

If there is a bacterial superinfection, causing the gallbladder to fill with pus

Chronic cholecystitis?

Cause the gallbladder to become fibrotic

- increase the risk for gallbladder carcinoma

What can choledocholithiasis lead to?

- Ascending cholangitis

- Pancreatitis

What is ascending cholangitis?

An infection of the biliary tract that may ascend into the liver

What type of tumors can occur in the biliary tree?

Cholangiocellular carcinoma

What is cholangiocellular carcinomas?

Tumor that can occur anywhere in the biliary tree, even in the gallbladder or in the liver

- arise from the cholangiocytes that line the bile ducts

What is a Klatskin tumor?

Cholangiocarcinoma occuring at the confluence of the hepatic ducts

Why are extrahepatic CCC better than intrahepatic?

The extrahepatic CCC cause obstruction of the bile ducts rather quickly, causing jaundice

- this allows diagnosis to be made early