BATU EMPEDU

Incidence of gallstones
 fourth decade of life, especially in women of
obese constitution with high cholesterol level.
 Also women under contraceptive pills,
sedentary lifestyle, multi-para women, and
people suffering from chronic ulcerative colitis
are major victims.
 The increased dietary intake of fast foods,
pastries(kue kering, kripik), oily, spicy foods
can cause gallstones more.
 Gallstones .

• Size of the stone - varies from 5 mm to 2

cm
• Shape varies from round, oval to
irregular
• Number of stones may vary from single
or solitary to tiny 100s
• Types - aseptic stones and septic stones.
 Risk factors for the formation of cholesterol gallstones

• female gender, 
• being overweight,
• losing a lot of weight quickly on a "crash"
or starvation diet, or
• taking certain medications such as birth
control pills or cholesterol lowering drugs
.
ERCP
Endoscopic Retrograde Cholangio-
 
                                  

 
Pancreatography
Diagnostic

                                 

 
• The 2 main substances
• Cholesterol gallstones
• More than 80% of gallstones in the United
States contain cholesterol as their major
component.
• Calcium, bilirubin, and pigment gallstones
• Mixed gallstones
• Cholesterol gallstones may become colonized
with bacteria and can elicit gallbladder
mucosal inflammation..
• In the United States, about 20 million people
(10-20% of adults) have gallstones.
• Every year 1-3% of people develop gallstones
• Each year, in the United States, approximately
500,000 people develop symptoms or
complications of gallstones requiring
cholecystectomy.
• Gallstone disease is responsible for about 10,000
deaths per year in the United States.
• About 7000 deaths are attributable to acute
gallstone complications, such as acute pancreatitis.
• About 2000-3000 deaths are caused by
gallbladder cancers (80% of which occur in the
setting
of gallstone disease
with chronic
cholecystitis). 
• Women are more likely to develop
cholesterol gallstones than men,
• especially during their reproductive
years
• when the incidence of gallstones in
women is
2-3 times that
in men.
• Patient Education
Alarm symptoms include persistent
epigastric pain lasting for greater
than 20 minutes, especially if
accompanied by nausea, vomiting, or
fever.
If pain is severe or persists for more
than an hour, the patient should
seek immediate medical attention.
Anatomi Sistem Saluran Empedu
SEKIAN
 The relative risk of gallbladder carcinoma is
2.4 if gallbladder stones are 2.0–2.9 cm in
diameter, and greater with larger stones
 Factors in Cholesterol Stone Formation
 Genetics
 In an American family study, around 29%
of the chance of having symptomatic
gallstones was inherited.
 Lifestyle
 Lack of physical activity is also an
association.
 Obesity
 Obesity is associated with increased cholesterol
synthesis. Fifty per cent of markedly obese
patients have gallstones at surgery.
 Dietary Factors
 Epidemiological studies show that chronic
over-nutrition with refined carbohydrates and
triglycerides increases the risk
 In Western countries, gallstones have been linked
to dietary fibre deficiency and a longer intestinal
transit time .
 Vegetarians get fewer gallstones irrespective of
their tendency to be slim
 Age, By age 75, around 20% of men and 35% of
women in some Western countries have
gallstones. Clinical problems present most
frequently between the ages of 50 and 70.
 Sex and Oestrogens
 Gallstones are twice as common in women
as in men, and this is particularly so before
the age of 50.
 The incidence is higher in multiparous than
in nulliparous women. Incomplete emptying
of the gallbladder in late pregnancy leaves a
large residual volume and thus retention of
cholesterol crystals.
 Hati yang Gembira
 Istirahat yang Cukup
 Diet yang Seimbang
 Udara yang Bersih
 Pengendalian Diri
 Sinar Matahari yang Cukup
 Enerjik Berolahraga
 Hubungan Sosial yang Baik
 Air Jernih yang Cukup
 Tuhan yang Terutama
• Causes of gallstones - Mainly, stagnation of bile in the gall bladder or duct for a prolonged time evokes stone
formation as the outcome of precipitation or sediment. It may also be due to variation in concentration ratio of
cholesterol with bile salts (normal it is 1:20-1:30) in the bile. In general, routine causes are
• Functionless gall bladder i.e. thick walled gall bladder with no contraction at all
• Untimely, unconditioned diet and starvation often. Also reduced food intake can reduce the secretion of bile
acids from the liver. This causes difference in composition ratio of bile salts and cholesterol, which finally
results in cholesterol stones.
• Prolonged use of drips, by avoiding oral foods in case of hospital stay
• Fatty, flabby belly and pregnancy can relax the gall bladder and thus cause stones
• Malfunctioning of liver which secretes less bile with less bile salts
• Infection of gall bladder (acute or chronic cholecystitis)
• Injury in the gall bladder area which causes inflammation of gall bladder
• Taking non-veg foods, fast foods, pastry, oily and spicy foods often.
• Increased blood cholesterol level
• Diseases of the intestines - for example, ulcerative colitis, crohn’s disease, irritable bowel syndrome, etc. Here,
absorption of bile salts from the intestine or recycling of bile salts is interrupted, so the liver secretes bile
containing very low bile salts. These lowered bile salts can’t maintain the cholesterol in solution, forming
cholesterol gallstones.
•  
• The two main types of gallstones are:
• Cholesterol stones: Usually yellow-green in
color, approximately 80% of gallstones are
cholesterol stones.
• Pigment stones: These stones are smaller and
darker and are made up of bilirubin.
• Factors that may increase your risk of gallstones include:
• Being female
• Being age 60 or older
• Being an American Indian
• Being a Mexican-American
• Being overweight or obese
• Being pregnant
• Eating a high-fat diet
• Eating a high-cholesterol diet
• Eating a low-fiber diet
• Having a family history of gallstones
• Having diabetes
• Losing weight very quickly
• Taking some cholesterol-lowering medications
• Taking medications that contain estrogen, such as hormone therapy drugs
• What Causes Gallstones?
• Several factors may come together to create gallstones, including:
• Genetics
• Body weight
• Decreased motility (movement) of the gallbladder
• Diet
• Gallstones can form when there is an imbalance in the substances that make up bile. For
instance, cholesterol stones may develop as a result of too much cholesterol in the bile.
Another cause may be the inability of the gallbladder to empty properly.
• Pigment stones are more common in people with certain medical conditions, such as
cirrhosis (a liver disease in which scar tissue replaces healthy liver tissue) or blood diseases
such as sickle cell anemia.
• What Are the Risk Factors for Gallstones?
• Risk factors for getting gallstones include:
• Genetics. If other people in your family have had gallstones, you are at increased risk of
developing gallstones.
• Obesity. This is one of the biggest risk factors. Obesity can cause a rise in cholesterol and can
also keep the gallbladder from emptying completely.
• Estrogen. Estrogen can increase cholesterol and reduce gallbladder motility. Women who are pregnant or who take
birth control pills or hormone replacement therapy have higher levels of estrogen and may be more likely to develop
gallstones.
• Ethnic background. Certain ethnic groups, including Native Americans and Mexican-Americans, are more likely to
develop gallstones.
• Gender and age. Gallstones are more common among women and older people.
• Cholesterol drugs. Some cholesterol-lowering drugs increase the amount of cholesterol in bile, which may increase
the chances of developing cholesterol stones.
• Diabetes. People with diabetes tend to have higher levels of triglycerides (a type of blood fat), which is a risk factor
for gallstones.
• Rapid weight loss. If a person loses weight too quickly, his or her liver secretes extra cholesterol, which may lead to
gallstones. Also, fasting may cause the gallbladder to contract less.
• What Are the Symptoms of Gallstones?
• Gallstones often don't cause symptoms. Those that don't are called "silent stones." A person usually learns he or she
has gallstones while being examined for another illness.
• When symptoms do appear, they may include:
• Pain in the upper abdomen and upper back. The pain may last for several hours.
• Nausea
• Vomiting
• Other gastrointestinal problems, including bloating, indigestion and heartburn, and gas
• Etiology
• Cholesterol gallstones, black pigment gallstones, and brown pigment
gallstones have different pathogeneses and different risk factors.
• Cholesterol gallstones
• Cholesterol gallstones are associated with female sex, European or
Native American ancestry, and increasing age. Other risk factors
include the following:
• Obesity
• Pregnancy
• Gallbladder stasis
• Drugs
• Heredity
• Taking non-veg foods, fast foods, pastry, oily and spicy foods often.
• Increased blood cholesterol level