Cholelithiasis

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Cholelithiasis
Diagnosis in short

Yellow gallstones. (WC)
Subtypes cholesterol stones, pigment stones, mixed cholesterol/pigment stones
Gross yellow, black/brown or mixed (dependent on subtype)
Grossing notes gallbladder grossing
Site gallbladder

Associated Dx choledocholithiasis, (gallstone) pancreatitis, acute cholecystitis (esp. if in gallbladder neck), chronic cholecystitis
Prevalence very common
Prognosis benign

Cholelithiasis is the formation of stones (gallstones) in the gallbladder.

General

  • Often accompanies cholecystitis/contributes and/or causes cholecystitis.
  • The gallbladder is removed following biliary pancreatitis (gallstone pancreatitis) to reduce recurrence risk.[1][2]
  • Rarely, gallstones may compress the common bile duct - known as Mirizzi syndrome.[3]
    • Can be associated with jaundice.[4]

The two types of gallstones:

  • Cholesterol stones.
  • Pigment stones.

Note:

  • Most stones technically speaking are a mix, i.e. cholesterol and pigment. Many call yellow stones that are a mix "cholesterol stones".

Epidemiology

Classic risk factors for gallstones - 4 Fs:[5]

  • Female.
  • Fat.
  • Forty.
  • Fertile.

Additional:

  • Family history.

Cholesterol stones

  • More common than pigment stone.

Appearance:

  • Clear or yellow.
  • Opaque or translucent.
  • Sometimes shinny.

Image

Pigment stones

Appearance:

  • Black - key feature.
  • Dull.

Microscopic

  • Not routinely done on gallstones.

Images

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Gallbladder, Cholecystectomy:
- Cholelithiasis. 
- Gallbladder with minimal chronic inflammation.

Block letters

GALLBLADDER CHOLECYSTECTOMY:
- CHOLELITHIASIS.
- MILD CHRONIC CHOLECYSTITIS.

Micro

The sections show gallbladder wall and cystic duct with scattered lymphocytes. There is no significant nuclear atypia. Neutrophils are not readily apparent. No definite entrapped epithelial crypts are identified within the gallbladder wall. The gallbladder wall is not significantly thickened.

See also

References

  1. Bouwense, SA.; Besselink, MG.; van Brunschot, S.; Bakker, OJ.; van Santvoort, HC.; Schepers, NJ.; Boermeester, MA.; Bollen, TL. et al. (2012). "Pancreatitis of biliary origin, optimal timing of cholecystectomy (PONCHO trial): study protocol for a randomized controlled trial.". Trials 13: 225. doi:10.1186/1745-6215-13-225. PMID 23181667.
  2. van Baal, MC.; Besselink, MG.; Bakker, OJ.; van Santvoort, HC.; Schaapherder, AF.; Nieuwenhuijs, VB.; Gooszen, HG.; van Ramshorst, B. et al. (May 2012). "Timing of cholecystectomy after mild biliary pancreatitis: a systematic review.". Ann Surg 255 (5): 860-6. doi:10.1097/SLA.0b013e3182507646. PMID 22470079.
  3. Khalid, S.; Bhatti, AA.. "Mirizzi's syndrome: an interesting on table finding.". J Ayub Med Coll Abbottabad 26 (4): 621-4. PMID 25672201.
  4. Elhanafy, E.; Atef, E.; El Nakeeb, A.; Hamdy, E.; Elhemaly, M.; Sultan, AM.. "Mirizzi Syndrome: How it could be a challenge.". Hepatogastroenterology 61 (133): 1182-6. PMID 25513064.
  5. Szwed, Z.; Zyciński, P. (2007). "[4F's--still up to date risk factors of cholelithiasis].". Wiad Lek 60 (11-12): 570-3. PMID 18540184.
  6. URL: http://www.rxmed.com/b.main/b2.pharmaceutical/b2.1.monographs/CPS-%20Monographs/CPS-%20%28General%20Monographs-%20U%29/URSOFALK.html. Accessed on: 29 October 2011.