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lelithiasis, is one of the most common surgical problems worldwide.

They are a frequent cause of abdominal


pain and dyspepsia.

Pathophysiology

Although gallstones can form anywhere in the biliary tree, the most common point of origin is within the
gallbladder. There are 3 types of gallstones, pure cholesterol, pure pigment, and mixed.
Under normal conditions, a delicate balance occurs among the levels of bile acids, cholesterol, and
phospholipids. A disparity in this balance, especially with the supersaturation of cholesterol, predisposes
patients to the formation of lithogenic bile and the subsequent development of cholesterol-type gallstones.
Pigmented gallstones are composed of calcium bilirubinate and appear in 2 major forms, black and brown.
Hemolysis and liver disease are associated with the black stones; the brown, earthy stones more frequently are
formed outside the gallbladder and often are associated with bacterial infections of the biliary tract.
Bile stasis predisposes to the formation of biliary sludge and eventual formation of gallstones and commonly is
seen in patients who are unable to take enteral nutrition. Infection of the biliary tree (especially with certain
beta-glucuronidase-producing bacteria, such as Escherichia coli and parasites) is associated with an increased
risk of ductal stone development. Intestinal resection is associated with an increased incidence of gallstones.
Contrary to expectation, these are mainly of the pigment variety.
Women are more likely to develop gallstones than men, with a ratio of 2:1. Classically, gallstones occur in
obese, middle-aged women leading to the popular mnemonic, fat, fertile, forties. Oral contraceptive pills with
high estrogen content increase the incidence of gallstones. The incidence increases with age

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patient has 21mm large calculus is noted in the neck of gallbladder. was reported during Ultra sound scan
reported by Radiologist. With mild prostatomegaly and fattyliver.Ask to do surgery looking for Altirior
Medicine to avoid surgery.
mahendra_khanted Saturday, July 30, 2011

can you please show pictures on how a gall stone look outside
rosariomoral Thursday, April 16, 2009
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Cholelithiasis
s Pathophysiology
s Clinical Features
s Investigations
s Treatment
CME Lessons
A Diagnostic approach to ProteinuriaA Focused approach to AnemiaAbdominal PainAbdominal pain in
womenAbnormal Vaginal BleedingAcid Peptic DiseaseAcute evaluation and management of ischemic
stroke-1Acute Respiratory infections in ChildrenAcute sinusitisAdult immunizationsAmbulatory
Management of BurnsAn Introduction to Biomedical EthicsAnorectal ExaminationApproach to Breast
LumpsApproach to the Somatizing PatientApproach to VaginitisCannot Miss DiagnosisCervical
CancerChest PainChildhood EpilepsyCholelithiasisCommon Bed Side
ProceduresConjunctivitisConstipation in ChildrenDermatologicDiagnosis and Management of Alcohol
ProblemsDiarrhea in ChildrenEmergency Thora CentesisEndometriosisEvaluation of headacheFebrile
SeizuresFever in ChildrenHead Ache in ChildrenHeamorrhoidsHematuriaImmunization in
ChildrenIncision and Drainage of abscessInfective EndocarditisIntraosseous Fluid InfusionIntroduction
to DermatologyLaboratory Evaluation of the patient with jaundiceLeprosyLeukocytosisLow Back
PainMalariaManagement of Heart FailureManaging Pshychiatric disorders in Primary CareMeningitis
in ChildrenObstructed Femoral HerniaOverview of the risk factors for cardiovascular
diseasePerforated Peptic UlcerPericardio CentesisPhimosisPremenstrual syndromePreoperative
medical evaluation of the healthy patientPressure UlcersPrimary DysmenorrheaRecurrent Abdominal
PainSchool Problems and the Family PhysicianSkin InfectionsSomatoform DisordersStroke-IThe
Crying Infant Pleural EffusionTuberculosis in ChildrenUrinary Incontinence in WomenUrinary tract
infectionUrinary Tract Infection in the Paediatric Patient
4
Family Medicine Comments
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AlendronateAmitriptylineCelecoxibClonazepamDanazolDiphenhydramineEpinephrineFerrous
SulphateGlibenclamideHydroxyzineLoperamideMetforminOmeprazoleOxybutyninOctreotide
AcetatePioglitazone HydrochloridPropranololRanitidineRosiglitazone MaleateSilver
sulfadiazineSucralfateSumatriptanValproic AcidAcarboseSpironolactone
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