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Cholelithiasis - Cholelithiasis Vic Vernenkar D.O...

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Cholelithiasis Vic Vernenkar, D.O. Department of Surgery St. Barnabas Hospital
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A Cause For Pain
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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.
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Anatomy
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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.
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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.
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Harvest Time
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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.
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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.
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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.
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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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