7.0 Cholelithiasis/ gallstones

cholelithiasis

the formation of gallstones in the gallbladder or biliary ducts

the gallbladder

a small pear shaped organ located beneath the liver which stores bile and digestive fluid produced by the liver which helps the digestion of fats

gall stones

solid participles that form from the components of bile, most commonly cholesterol or bilirubin

gallstones can vary in size from a grain of sand to the size of a large golf ball

some individuals with gallstones may never experience symptoms while others may suffer from significant discomfort, pain and complications

types of gallstones

• cholesterol gallstones

• pigment gallstones

cholesterol gallstones, most common type 80%

form when there’s too much cholesterol in the bile leading to the precipitation of solid cholesterol crystals that eventually grow into stones

pigment gallstones

form from excess bilirubin in the bile, associated with conditions that cause the breakdown of red blood cells leading to increased bilirubin levels

risk factors for gallstones 

age + gender

obesity

rapid weight loss

pregnancy

family history/genetics

medical conditions

medications

age + gender

most common in women over 40, especially during reproductive years due to the influence of oestrogen which increases cholesterol saturation in bile

obesity

increases cholesterol production which raises risk 

rapid weight loss

particularly from crash diets or bariatric surgery, can cause an imbalance in bile composition increasing likelihood

pregnancy

associated with high oestrogen levels which increases cholesterol levels in bile.

progesterone, another pregnancy hormone,

slows gall bladder motility leading to stasis of bile

family history and genetics

play a role in gallstone formation, family history increases likelihood

medical conditions

diabetes

liver cirrhosis

haemolytic anaemia

crohn’s disease- impar bile salt recycling increasing risk of pigment stones

haemolytic anaemia

premature destruction of red blood cells before their typical lifespan of 120 days.

bone marrow unable to sufficiently compensate for the loss of red blood cells

leading to a fall in RBC count and haemoglobin concentrations

medications

oral contraceptives/hormones replacement therapy increase risk due to influence on bile composition

gallstone symptoms

typically asymptomatic however there are symptoms that occur from obstruction of the bile ducts

symptoms

biliary colic

nausea + vomiting

jaundice

dark urine + pale stool

biliary colic, most common symptom of gallstones

characterised by a sudden intense pain in the upper right/center of the abdomen just before the breastbone

the pain may radiate to the right shoulder or the back and typically occurs after eating a fatty meal

the pain lasts from minutes-hours then subsides as the stone passes or moves

nausea + vomiting

acompanies biliary colic, related to the disruption of normal bile flow and digestion

jaundice

may occur if a gallstone blocks the common bile ducts, bile becomes backed up into the liver

dark urine + pale stool

occurs if the bile pigments cannot reach the intestines due to duct blockage