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in Case Study
Cholelithiasis

Cholelithiasis

These are images of different patients suffering from cholelithiasis (defined as the presence of calculi (gallstones) within the gallbladder). The gross picture shows several different types of gallstones found within the gallbladder, the yellow gallstones consists of cholesterol whereas the outer greenish-brown stones are composed of biliverdin and stercoilin. The ultrasound picture shows stones (Hyperechoic) indicated with white arrows.Gallstones are of two types, cholesterol stones and pigmented stones. Cholesterol stones are more common up to 80%, risk factors for them are the 5Fs: Fat, Female, Forty, Flatulent, Fertile, oral contraceptives, crohn's disease, and north American Indian ancestry. Pigmented stones are either black or brown in color, they are calcium based, risk factors for them are cirrhosis, biliary stasis (strictures, dilation, biliary infection), and chronic hemolysis. Gallstones are usually asymptomatic(80%) but if the symptoms are present they are composed of biliary colic, steady, severe dull pain in epigastrium or RUQ for minutes to hours, crescendo-decrescendo pattern, frequently after fatty meal or at night, nausea, and/or vomiting. Evaluation is by ultrasound which is the test of choice of gallstones disease, radiographs can differentiate between cholesterol stones which are radiolucent (Black) from the pigmented stones which are radiopaque (White).Treatment of gallstones is cholecystectomy (Removal of the gallbladder). Complications of cholelithiasis are cholecystitis, acute pancreatitis, gallbladder cancer, choledocolithiasis, and fistula.

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