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10:04 PM | Posted by Unknown

Gallstones : rapid review

# How are the gallstones formed :-

* Bile help the body to digest fat , it is made in the liver , stored in the gallbladder until the body need it.

* Cholesterol secreted from the liver into the bile, it's held in solution forming micellar complexes with bile acids & phospholipids .

* Gallstones : are small pebble-like substances develop in the gall bladder [Cholelithiasis: stones in the gall bladder or in the bile duct, cholidocholilethiasis: obstruction of the common bile duct]

* When cholesterol level increase (secreted more than which can be emulsified ) it precipitates forming gallstones .

* Gallstones may be as small as a grain of sand or as large as a golf ball & may be one or hundred or combination of 2 .

* Gallstones can block the flow of the bile if lodged in any of the ducts present (types of ducts are hepatic duct: carry the bile out of the liver, cystic duct: carry bile to & from gallbladder, common bile duct: takes bile from cystic & hepatic to the small intestine)

# Types :-

* Gallstones are of 2 types :

1- cholesterol stones 80% .

2- pigment stones (of bilirubin).

# Causes :-

* Causes of gallstone formation:

1-too much cholesterol or bilirubin .

2-not enough bile salts .

3-gallbladder doesn't empty completely often enough .

# Risk factors :-

* People at risk for gallstones include :-

• women—especially women who are pregnant, use hormone replacement therapy, or take birth control pills .

• people over age 60 .

• overweight or obese men and women .

• people who fast or lose a lot of weight quickly .

• people with a family history of gallstones .

• people with diabetes .
• people who take cholesterol-lowering drugs .

# Symptoms :-

* Symptoms: (start to appear when stone become more than 8mm)

1-Steady pain in the upper abdomen .

2-pain in the right shoulder.
3-nausea .

4-fever.

5-jaundice .

* The symptoms appear suddenly so ,it's called gallbladder attack & usually follow fatty meals & may be during night .

* Silent stones: with no symptoms & no need for treatment.

# Diagnosis :-

* All stones are of mixed content to some extent (cholesterol 30-70%) + ca salts . so because of their calcium content they can be diagnosed radiologically. (ultrasound & ct) .

* blood test also needed to look for infection, obstruction & pancrititis .

# Treatment :-

-drug therapy play a subordinate role compared with surgical therapy (as with drug , gallstones may recur again after stoppage of the drug) therapy .

-administrating more bile acids [ursodeoxycholic acid (ursofalk) ® or chenodeoxycholic acid] decrease gallstones because they emulsify cholesterol and prevent its precipitation .

* Conditions must be provided to attain adv of bile acid administration :
- Gallstones volume less than 15mm, gall bladder with normal function, no liver disease , normal body weight, long term administration of bile acids.

*references: color atlas of pharmacology, drugs.com, wikepedia, medicine.net, master of Egypt's drugs, master of Sadie's drugs .

*prepared by : Dr. Mostafa Abd eltawab .
*all rights are reserved for pharmacist development group .
=============================================================================

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