GALL STONES : Introduction

on 30.12.07 with 0 comments


  • Prevalence 10%

  • F>M (2:1)

  • Incidence increases with age

“ Female, fat, fertile, fifty, fare”- kind of true.


  1. Cholesterol supersaturation.

    • Cholesterol normally dissolved in lecithin-bile acid.

    • If the concentration of cholesterol increases, no more can dissolve ie supersaturated.

    • Supersaturation occur in:

* High oestrogen states= Obesity, pregnancy, Pill.

*Decreased bile acid pool = terminal ileum disease/resection.

Therefore, enterohepatic circulation disrupted.

  1. Stasis.

  • Fasting: no food stimulus for GB emptying.

  • TPN: As above

  • Truncal vagotomy: No neural stimulus to GB

  1. Increased Bilirubin secretion in bile or deconjugation.

  • Bilirubin is kept soluble in bile by conjugation with glucuronide.

  • Pigment stones occur when:

      1. Increased breakdown of RBC: Haemolytic anaemias, Spherocytosis, SCD.

      2. Failure of conjugation: Hepatocyte insufficiency to form glucuronide or XS glucuronidase. Increased bacteria as cause or effect?

Category: Surgery Notes



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