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Gall Bladder Pathology

--low bile salt concentration
--low lecithin
--high cholesterol

THE FIVE F's: who is most likely to present with gall bladder concerns
--fertile (has had children)
--the sixth F: feathers or first nation (natives)

SAD causes of gall stones:
--stasis, acids, diet
--stasis increases concentration & lithogenicity of bild, mbdt preg, fasting, pareneteral nutrit, spinal cord injury, pritikin diet
--acids: ileal resection or bypass, Crohn's dz, decrease bile acid levels, if low or absent dt bile salts reabsorbed in terminal ileum, if not lost then chol precipitates ??? this not make sense yet
--diet: high caloric intake, refined carbs, high sat: unsat fat ratio, decreased frequency of meals, low fiber-->decreased bile production, increase conversion to deoxycholic acid, decrease removal of deoxycholic acid in stool

--vegetarian diet protective? debatable.
--food allergy theory per Breneman 1948: avoid pork, onions & eggs to avoid attacks of biliary pain
--PATHOGENESIS: supersaturated bile (high chol) precipitates cholesterol monohydrate slude, gravel & stones
----pure chol stones are oval/round and pale yellow, more common in the west
----stones mixed with calcium carbonate, phosphate and bilirubin get gray-white to black stone
----pigment stones made of calcium bilirubinate more in Asian pops
----more stones jammed in there they get facets from rubbing on each other
--SX: 70-80% ASx for decades, if Sx then bilicary "colic" pain, severe or excrutiating spasmodic or continuous in upper abdomen, pain in episodes, months/years apart
--Tx: allopathic: laparoscopic cholecystectomy
--COMPLICations: rare: empyema, perforation, fistula, cholangitis, extrahepatic cholestasis, pancreatitis, "gallstone ileus", hydrops or mucocele of the gallbladder
--Dx: HIDA scan, get gall bladder ejection fraction

----chronic hemolysis
----GI dz-->unconj in GB (Crohn, cystic fibrosis
----ileal bypass/resection
----biliary infx
----statis from TPN
----periampullary diverticula (ampulla of vater)
----Giardia, H. Pylori
----if GB sterile, stones black, multiple, crumbly
----if ducts infected, stone brown, soft, greasy

--inflam of the GB
--types: acute calculus and acute acalculus (w/ & w/o stones)
--measure wall thickness with US
--PATHOGENESIS: stone obstruction-->stasis-->mucosal phosphlipases hydrolyze lecithin to lysolecithin (toxic), mucus layer disrupted, bile salts and prostaglandins induce inflam of mucosa
--variable onset and course
--Sx: RUQ or epigastric pain, lowgrade fever, anorexia, tachycardia, diaphoresis, N = V.
--LABS: leukocytosis, increased ALP
--PROG: usu resolves in 1-7 days w/o intervention
--COMPLIC: empyema, gangrenous cholecystitis (esp w/ DM), sepsis, perforation and abscess, rupture and peritonitis, fistula to bowel
--ACALCULUS ETIO same as gastritis: ischemic compromise to GB from surgery, trauma, burns, sepsis, prolonged TPN, postpartum, multi-organ failure, multi-transfusions. Acalc mb just sludge, gangrene and perforation are more common, 50% fatality rate in critically ill pts.

--ETIO: usu stones
--Rokitansky-Ashoff sinuses = diverticuli of GB
--porcelain gallbladder dt extensive calcification, risk factor for CA (5th mc GI CA, ASx)
--hydrops with chronic obstruction (edema)

--stone in common bile duct
--clinical signs mb jaundice only
--if ascending cholangitis (infx) then fever, chills, abdom pain and jaundice

--carcinoma = 5th mc GA CA, most in women 60-70
--ETIO: carcinogenic bile, chronic cholecystitis
--MORPH: porcelain GB, late dx, mets to liver at Dx, also ducts, local nodes, peritoneum, GI tract and lungs
--Sx: Asx or like cholecystitis
--1% 5 year survival

--2 TSP olive oil, clove garlic and juice of one lemon, blend with a touch of cayenne, drink


( 4 comments — Leave a comment )
Mar. 5th, 2009 12:19 am (UTC)
I got mine out a year ago today.

Female, fat (5'2" 150), fertile, fair. My mother and grandmother had theirs out in the last 5 years.

TBH, I have had pains since I was in my teens. I had no idea what they were until much later. It is so nice to be pain free. I had a handful of nuts about six weeks before the surgery that dropped me. I then had to admit to myself that it had to go!

No stones, though.
Mar. 5th, 2009 01:13 am (UTC)
Really! Happy anniversary. So yours was "acalculous". I think mine is inflamed right now....definitely limits my desire to EAT. Going in for ultrasound in 2 weeks. Maybe mine will also get removed.... So questions: Have you had trouble with fatty foods since you had it out? Diarrhea? Did you change your diet?
Mar. 5th, 2009 03:38 am (UTC)
My ultrasound was negative. They gave me some kind of (expensive)test to make it contract and it just didn't do much of anything. Except hurt. I just don't think it ever worked well. I was a skinny little thing in my teens. (What thyroid issues? Me? LOL.) I did have some diarrhea related to fat intake soon after, but it was gone in a couple of months. I was more careful about fat intake for a while. It wasn't horrible. I don't think I have changed my diet. I had to be very careful for a few months before I had it out.

Dark leafy greens with fat was a big trigger for me before. Spinach salad with dressing was the worst!

No one wants to eat when it causes them pain!

Hey, I have a question for you. Do you mind if I ask?
Mar. 5th, 2009 06:20 am (UTC)
Of course you can ask! I'm all the time asking YOU questions. Thanks for being so willing to tell your story.

I had a HIDA scan (the one where the GB is supposed to contract) a couple of years ago and they told me my GB was fine. Something in my upper right quadrant was bothering me then. I never got a diagnosis, other than "you probably have an ulcer". I wonder why spinach bothered your GB?
( 4 comments — Leave a comment )



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