18 Gallstones

• bilirubin for heme elimination

• bile salts for fat absorption

• cholesterol for cholesterol elimination

• all 3 needed in balance to not have stones

• also need phosphatidylcholine

Cholesterol Stones

• gallbladder cancer

• either increased levels of cholesterol or decreased levels of bile acids and phosphatidylcholine

Risks

Bilirubin Stones

• infections: convert to unconjugated, less soluble

• hemolysis/liver disease: black

Gallbladder Symptoms

• removal of gallbladder main way to treat stones

Biliary Colic

Acute Cholecystitis

• US: wall of gallbladder thickened

• fever/WBC: inflammation

Choledocolithiasis

Gallstone Pancreatitis

Chronic Cholecystitis

• inflammation > Ca deposition > porcelain gallbladder

Acalculous cholecystitis

Bile Duct Symptoms

AIDS Cholangiopathy

Ascending

• clonorchis: looks like cholangitis but with eosinophilia. Recently ate sushi/fish

• take picture and extract stones

Gallstone Ileus

• fistula between gallbladder and intestine

• nl: never air in biliary tree

Gallbladder Carcinoma