GALLBLADDER STONE | CHOLELITHIASIS

SURGERY

Gallbladder Stone | Cholelithiasis
One of the common problem affecting GI tract. Before adolescent men & women affected equally, there after the disease is more prominent in women.


Classification

There are 3 TYPES of gallstones.

  1. Mixed [Most Common]
  2. Cholesterol
  3. Pigmented

Pigmented stone is again of 2 TYPES –

  • Brown Stone
  • Black Stone [Most Common among Pigmented]

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Pic Says

The full circle depicts Mixed Variety of gallstone which is the most common. Geographical distribution of variety exists. Cholesterol variety is most common in USA & Africa. Pigmented variety is most common in INDIA. Among Black & Brown Stone, Black occupies the bigger portion, hence among pigmented variety Black is most common.


X-Ray Finding

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In X-Ray finding, 90% Gallstones are Radioluscent where only 10% are Radio-opaque. In Renal stone the finding is opposite, i.e. 90% are Radio-Opaque & only 10% are Radioluscent.

 

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In X-Ray finding, Gallstone appearance is either BiRadiate (Sea Gull Sign) or TriRadiate(Mercedez benz Sign) due to presence of GAS inside. Sometimes XRay gallbladder shows presence of toothpaste like material known as LIMEY GALLBLADDER.


Eitiology

ADMIRONS Triangle Hypothesis

Normal proportion of (Bile Salt+Lecithin) to Cholesterol is 25:1

In pathological condition it falls to 13:1 which leads to precipitation of cholesterol & eventually stone formation.

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Pic Says-

In Admiron’s Triangle, the Green Side depicts Bile Salt, Black side depicts Lecithin & Yellow depicts Cholesterol.

Decreased bile salt is due to-

  1. Liver Cirrhosis
  2. Ileal Disease & resection interfering Entero-Hepatic Circulation.

Decreased Lecithin is due to-

Convertion of Lecithin to Lysolecithin due to Pancreatic Reflux.

Increased Cholesterol is due to-

  1. Female Most Common
  2. Diabetes Mellitus
  3. Obesity
  4. Hypercholesterolemia
  5. 1stDegree Relative has 2 fold greater prevalence.
  6. Rapid Weight Loss
  7. Drug- CLOFIBRATE

Pathogenesis

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Pic Says-

Most common site for Black Stone lodging is gallbladder & for Brown stone it is biliary tree. Beta-Glucuronidase breaks down conjugated bilirubin(Soluble) to to Unconjugated Bilirubin(Insoluble) which combines with Calcium  to form Ca-Bilirubinate, later that combines with Ca-Palmitate & Ca-Stearate & Cholesterol to form Brown Pigment.

Ca-Bilirubinate + Ca- Palmitate + Ca-Stearate + Cholesterol = Brown Pigment

Brown Pigment his soft & mushy where Black is hard.


 

Effect on Biliary System

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Effect on GI System

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Mirrizi Syndrome

In Mirrizi Syndrome, stone gallstone impacts in gallbladder wall & compresses it causing pressure necrosis which further gets adherent to CHD or CBD wall then causes compression & occasionally leads to Cholecysto-Chole ductal Fistula. It occurs either from Hartman’s pouch into CHD or CBD[ most common] or from fundus of gallbladder to CBD.

Types-

  1. 10% – Extrinsic Compression of CHD or CBD Wall
  2. 40% – Stone has erodes <1/3rdCircumference forming a fistula
  • 45% [Most Common Type] – Eroded upto 2/3rd
  1. 5% – Eroded >2/3rd

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Differential Diagnosis

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