Cholelithiasis - Cholelithiasis Vic Vernenkar, D.O....

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Unformatted text preview: Cholelithiasis Vic Vernenkar, D.O. Department of Surgery St. Barnabas Hospital A Cause For Pain Background ♦ Presence of gallstones in the gallbladder. ♦ Spectrum ranges from asymptomatic, colic, cholangitis, choledocholithiasis, cholecystitis ♦ Colic is a temporary blockage, cholecystitis is inflammation from obstruction of CBD or cystic duct, cholangitis is infection of the biliary tree. Anatomy Pathophysiology ♦ Three types of stones, cholesterol, pigment, mixed. ♦ Formation of each types is caused by crystallization of bile. ♦ Cholesterol stones most common. ♦ Bile consists of lethicin, bile acids, phospholipids in a fine balance. ♦ Impaired motility can predispose to stones. Pathophysiology ♦ Sludge is crystals without stones. It may be a first step in stones, or be independent of it. ♦ Pigment stones (15%) are from calcium bilirubinate. Diseases that increase RBC destruction will cause these. Also in cirrhotic patients, parasitic infections. Harvest Time Frequency ♦ US: affected by race, ethnicity, sex, medical conditions, fertility. 20 million have GS. Every year 1-2% of people develop them. Hispanics are at increased risk. ♦ Internationally: 20% of women, 14% of men. Patients over 60 prevalence was 12.9% for men, 22.4% for women. Morbidity/Mortality ♦ Every year 1-3% of patients develop symptoms. ♦ Asymptomatic GS are not associated with fatalities. ♦ Morbidity and mortality is associated only with symptomatic stones. Race ♦ Highest in fair skinned people of northern European descent and in Hispanic populations. ♦ High in Pima Indians (75% of elderly). In addition Asians with stones are more likely to have pigmented stones than other populations. ♦ African descent with Sickle Cell Anemia. Sex ♦ More common in women. Etiology may be secondary to variations in estrogen causing increased cholesterol secretion, and progesterone causing bile stasis....
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This note was uploaded on 12/27/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Cholelithiasis - Cholelithiasis Vic Vernenkar, D.O....

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