Biliary Tract Disease

Cholelithiasis (Gallstones)

Epidemiology & pathogenesis (J Hepatol 2016;65:146; Gastro 2016;151:351)

  • Affects 10–20% of Western populations
  • Bile = bile salts, phospholipids, cholesterol; ↑ cholesterol saturation in bile + accelerated nucleation + gallbladder hypomotility → gallstones
  • Risk factors: ♀; South, Central, Native American; ↑ age (>40 y); obesity, TPN, rapid ↓ wt; dyslipidemia; preg., drugs (OCPs, estrogen, clofibrate, octreotide, Cftx); ileal dis., genetic
  • Statin use ↓ risk of sx gallstones & cholecystectomy (Hepatol Res 2015;45:942)

Types of gallstones (J Hepatol 2016;65:146)

  • Cholesterol (90%): 2 subtypes
    • mixed: contain >50% cholesterol; typically aller, multiple stones