Cholelithiasis

• Stones in the Gallbladder
• Epidemiology:

  – 10-20% of adult population

  – >80%: “Silent”; individuals remain free of biliary pain or other complications for a long period of time

  – Two main types:

  • 90%: Cholesterol stones; containing more than 50% of crystaline cholesterol monohydrate
  • 10%: Pigment stones; composed predominantly of bilirubin calcium salts
• Risk Factors for Gallstones

  – Cholesterol Stones

  • Female gender
  • Oral contraceptives and Pregnancy
  • Obesity and metabolic syndromes
  • Gallbladder stasis
  • Hyperlipidaemia syndromes
• Risk Factors for Gallstones

  – Pigment Stones

  • Chronic haemolytic syndromes
  • Infection of the biliary tree
  • Crohn disease
• Clinical Features:

  • Biliary pain : Constant or “colicky” (spasmodic)
• Complications:

  • Cholecystitis and Empyema
  • Perforation
  • Fistulas
  • Inflammation of the biliary tree (Cholangitis)
  • Obstructive cholestasis
  • Pancreatitis