Cholelithiasis

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.
• Rarely, gallstones may compress the common bile duct - known as Mirizzi syndrome.
  • Can be associated with jaundice.

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:

• Female.
• Fat.
• Forty.
• Fertile.

Additional:

• Family history.

Cholesterol stones

• More common than pigment stone.

Appearance:

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

Image

• 

  Yellow gallstones. (WC)

Pigment stones

• Due to high RBC turnover, e.g. sickle cell disease, thalassemia.
• Radio-opaque.

Appearance:

• Black - key feature.
• Dull.

Microscopic

• Not routinely done on gallstones.

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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

• Gallbladder.
• Kidney stones.