GALLSTONES (CHOLELITHIASIS)
Gallstones are frequently
asymptomatic but can cause biliary colic (right upper quadrant pain due to
impacted stones). Diagnosis is by U/S; the majority of stones are not radiopaque.
Complications include cholecystitis, choledocholithiasis (calculi within the
biliary tract), biliary tract obstruction, pancreatitis, and cholangitis.
Cholesterol stones are composed mostly of
cholesterol monohydrate. The incidence increases with age. Risk
factors include female gender, obesity, pregnancy, oral con-traceptives, and
hormone replacement therapy. Native American Pima and Navajo Indians have an
increased incidence of cholesterol gallstones.
Pigmented bilirubinate stones are composed of calcium salts
and unconjugated bilirubin. Risk factors are
chronic hemolytic anemias, cirrhosis, bacterial infection, and parasites (Ascaris or Clonorchis [Opisthorchis]
sinensis).
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