1. THE BILIARY TRACT
Lecture 30
CHOLELITHIASIS

3. Cholelithiasis
Presence of stones in the
gallbladder is referred to as cholelithiasis
(from the Greek
chol- (bile) +
lith- (stone) +
iasis- (process).

4. CHOLELITHIASIS (GALLSTONES)
Epidemiology
• Gallstones afflict 10% to 20% of adult
populations in developed countries.
• It is estimated that more than 20 million persons
in the United States have gallstones, totaling some
25 to 50 tons in weight!
Over 95% of biliary tract disease is
attributable to
cholelithiasis (gallstones).

5. TYPES OF GALLSTONES
1.Cholesterol stones
20%
2.Pigment stones
5%
3.Mixed stones
75%

7. The risk factors most
commonly associated with the development of
cholesterol stones are:
1. Age and Sex.
2. Environmental Factors.
3. Acquired Disorders.
4. Hereditary Factors.

14. Cholesterol gallstone formation involves four
simultaneous conditions:
(1) The bile must be supersaturated with
cholesterol;
(2) hypomotility of the gallbladder promotes
nucleation;
(3) cholesterol nucleation in the bile is
accelerated;
(4) hypersecretion of mucus in the gallbladder
traps the nucleated crystals, leading to their
aggregation into stones.
Accretion within the gallbladder mucous layer.

15. The four contributing factors for cholelithiasis: supersaturation, gallbladder
hypomotility, crystal nucleation, and accretion within the gallbladder mucous layer.
A
micelle
is an
aggreg
ate of
surfact
ant
molec
ules
disper
sed in
a
liquid
colloid
1
2 3
4

22. Clinical features

23. Clinical features
• The vast majority of
gallstones (>80%) are
“silent,” and most
individuals remain free of
biliary pain or other
complications for

24. Symptoms
Symptoms commonly begin to appear
once the stones reach a certain size
(>8 mm).

27. Pain during inspiration with examiner’s hand on the
GB location.

33. "Is there any reward for good, other than
good?"