Formation of gall stones occurs in all EXCEPT
i.e. (Jejunum resection): (1120-Bailey & Love 25th) (552-CSDT 13th) (1993-H17th)Predisposing factors for cholesterol and pigment gall stone formationCholesterol Stones1. Demographic / genetic factors - highest in north americans and lowest in Japan, familial disposition hereditary aspects2. Obesity : Normal bile acid pool and secretion but increased biliary secretion of cholesterol3. Weightloss : Mobilization of tissue cholesterol leads to increased biliary cholesterol secretion, while entero hepatic circulation of bile acids is decreased4. Female sex hormonesa. Estrogen stimulate hepatic lipoprotein receptors, increase uptake of dietary cholesterol and increased biliary cholesterol secretionb. Natural estrogens other estrogens and OCP leads to decreased bile salt secretion and decreased conversion of cholesterol to cholesteryl esters5. Increased age : increased biliary secretion of cholesterol decreased size of bile acid pool decreased secretion of bile salts6. Gall bladder hypo motility - leading to stasis and formation of sludgea. Prolong parenteral nutritionb. Fastingc. Pregnancyd. Drugs such as octreotide7. Clofibrate therapy : Increased biliary secretion of cholesterol8. Decreased bile acid secretiona. Primary biliary cirrhosisb. Genetic defect of the CYP7A1 gene9. Decreased phospholipid secretion. Genetic defect of the MOR3 gene10. Miscellaneousa. High caloric-High fat dietb. Spinal cord injuryPigment Stones1. Demographic / genetic factors. Asia rural setting2. Chronic hemolysis3. Alcoholic cirrhosis4. Pernicious anemia5. Cystic fibrosis6. Chronic biliary tract infections, parasitic infections (E.coli, A. lumbricoides. Clonorchis sinensis)1. Increasing age8. Ileal diease, ileal resection or by pass
OCP users
Ileal resection
Jejunum resection
Choletyramine therapy
Gall Bladder & Bile Ducts