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GALLSTONE

Mario M. Y. I.
(03011177)

DEFINITION

Gallstones are stones that form in the gall


(bile) within the gallbladder. (The
gallbladder is a pear-shaped organ just below
the liver that stores the bile secreted by the
liver.)
The common types of gallstones
arecholesterol, black pigment, and brown
pigment.

ETIOLOGY

Cholesterol gallstones
Pigment gallstones

EPIDIMIOLOGY

Gallstones are common; they occur in approximately 20% of women


in the US, Canada and Europe, but there is a large variation
inprevalenceamong ethnic groups. For example, gallstones occur 1
to 2 times more commonly in Scandinavians and MexicanAmericans. Among American Indians, gallstone prevalence reaches
more than 80%. These differences probably are accounted for
bygenetic(hereditary) factors.
First-degree relatives (parents, siblings, and children) of individuals
with gallstones are 1 times more likely to have gallstones than if
they did not have a first-degree relative with gallstones.
Further support comes from twin studies that show that genetic
factors are important in determining who develops gallstones.
Among non-identical pair of twins (who share 50% of theirgeneswith
each other), both individuals in a pair have gallstones 8% of the time.
Among identical pair of twins (who share 100% of their genes with
each other), both individuals in a pair have gallstones 23% of the
time.

PATHOLOGY

Cholesterol gallstones
The first is an abnormally rapid formation and growth of cholesterol particles into gallstones.
Thus, with the same concentrations of cholesterol, bile acids and lecithin in their bile, patients
with gallstones form particles of cholesterol more rapidly than individuals without gallstones.
The second process that promotes the formation and growth of gallstones is reduced contraction
and emptying of the gallbladder that allows bile to stay in the gallbladder longer than normal so
that there is more time for cholesterol particles to form and grow.

Pigment gallstones
Black pigment gallstones
If there is too much bilirubin in bile, the bilirubin combines with other constituents in bile, for
example,calcium, to form pigment (so-called because it is dark brown in color). Pigment
dissolves poorly in bile and, like cholesterol, it sticks together and forms particles that grow in
size and eventually form gallstones. The pigment gallstones that form in this manner are called
black pigment gallstones because they are black and hard.
Brown

pigment gallstones
If there is reduced contraction of the gallbladder or obstruction to the flow of bile through the
ducts, bacteria may ascend from theduodenuminto the bile ducts and gallbladder. The bacteria
alter the bilirubin in the ducts and gallbladder, and the altered bilirubin then combines with
calcium to form pigment. The pigment then combines with fats in bile (cholesterol andfatty
acids from lecithin) to form particles that grow into gallstones. This type of gallstone is called a
brown pigment gallstone because it is more brown than black. It also is softer than black pigment
gallstones.

SYMPTOMATHOLGY

Biliary colic
Constant pain
15 minutes to 4-5 hours
Nausea

DIAGNOSIS

General checkup and X-ray are commonly performed


on chest, and the gallbladder section is not taken most
of the time. Also, you should know that X-ray does not
usually indicate the presence of gallstone as it is
mostly composed of lipid cholesterol.
If you keep or leave the bile at your body temperature,
it will form crystallized cholesterol and will grow
bigger overtime forming gallstones. This kind of
gallstone can't be shown in X-ray.
There are other kinds of gallstone, too, depending on
the patients. Some of them can be seen in X-ray.
To check the presence of gallstone, regardless of its
type and size, echocardiogram is usually being utilized.

TREATMENT

Cholecystectomy
Oral dissolution therapy

CONCLUSION

It does not mean that all of us will be


affected by gallstone. There are some who
never had any symptoms in their lifetime.
We call this silent gallstone, and
occasionally, they disappear on their own.
Although we do not have any definite
records, we believe that nearly 70% of us
never notice or never experience such
symptoms.