6/24/2010 | Posted by Unknown

Gallstones : rapid review

  •  How gallstones are formed.
  •  Types.
  •  Causes.
  •  Risk factors.
  •  Symptoms.
  •  Diagnosis.
  •  Treatment.

How gallstones are 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. mmm                   

  • 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.

- Prepared by: Dr. Mustafa Abdel Tawab (pharmacist).
- Resources:  -  Color atlas of pharmacology.  -  Drugs.com.  -  Master of Egyptian drugs. -  Wikipedia.   -  Master of Saudi drugs.
- Copyrights: All rights are reserved for pharmacist development group 2009 - 2011.

Posted by Unknown on 6/24/2010. Filed under , , . You can subscribe to the site updates through the RSS 2.0 or by Email