One of most common gastrointestinal diseases worldwide
– Particularly common in Scandinavia, Chile
– In United States, estimated 10-20% of population have gallstones
• 2 main types: Cholesterol stones and pigment stones
Cholesterol stones
– > 80% of stones in developed nations
Pigment stones
– Black: Associated with hemolytic disorders, cirrhosis, TPN
– Brown: Associated with ascending cholangitis and biliary inflammation
Clinical Issues
• Most gallstones are clinically silent
May present with right upper quadrant pain, intolerance of fatty food
• 2-4 times more common in women than men
• Laparoscopic cholecystectomy is standard therapy
Imaging
• Ultrasound (diagnostic modality of choice) can detect stones > 3 mm in diameter
Macroscopic
• Cholesterol stones usually < 2 cm, multiple, and round or faceted
• Black pigment stones are 2-5 mm, shiny, irregular, multifaceted
• Brown pigment stones have softer texture and flaky appearance, often larger than black stones
• Stones are often associated with inflammation (cholecystitis)
Cholesterol Gallstones This gallbladder is filled with numerous smooth yellow mixed cholesterol stones. The gallbladder wall is mildly thickened and hyperemic, indicative of cholecystitis. (Courtesy G. F. Gray, MD.)
Black Pigment Gallstones This gallbladder contains numerous faceted black pigment stones that distend the gallbladder lumen. The gallbladder wall is thickened and edematous due to associated chronic cholecystitis. (Courtesy G. F. Gray, MD.)
Cholesterol Stone, Cut Surface The cut surface of this large gallstone shows a radial arrangement of cholesterol crystals around a central pigmented core.
Cholesterol Stones Lobulated cholesterol stones, some of which appear partially intramural, are seen within a hyperemic gallbladder. (Courtesy G. F. Gray, MD.)
TERMINOLOGY
Definitions
• Formation of stones in gallbladder
ETIOLOGY/PATHOGENESIS
Cholesterol Stone Formation
• > 80% of stones in developed nations are mixed cholesterol stones
• Bile supersaturation, destabilization plus gallbladder hypermotility
Only gold members can continue reading. Log In or Register to continue
