Gallstone Disease

Definitions Acute calculous cholecystitis = occlusion of the cystic duct by gallstone leading to gallbladder inflammation Chronic calculous cholecystitis = recurrent episodes of cystic duct obstruction leading to chronic inflammation

Bile Bile Bile salts Phospholipids Cholesterol

Types of Gallstones Mixed (80%) Pure cholesterol (10%) Pigmented (10%) Black stones (associated with cirrhosis and hemolysis)

Gallstone Pathogenesis (1) cholesterol supersaturation in bile (2) Reduced bile salts-illeal resection (3) Increased hemolysis ,

Gallstone Risk Factors “Female, Fat, Forty, Fertile” Obesity Fatty diet DM Ileal resection Hemolytic states Cirrhosis Bile duct stasis Hyperlipidemia

Gallstone Complications Gallstone ileus gallstone pancreatitis Acute cholecystitis GB gangrene GB perforation GB empyema (pus in the GB) Choledochohlithiasis Cirrhosis Cholangitis Pancreatitis

Diagnostic Criteria for Acute Cholecystitis, According to Tokyo Guidelines Table 1. Diagnostic Criteria for Acute Cholecystitis, According to Tokyo Guidelines. Strasberg S. N Engl J Med 2008;358:2804-2811

Cholecystitis: Management NPO, IVF, IV antibiotics Non-operative Operative: cholecystectomy