Epidemiology

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Etiology

Cholesterol stones

• Risk factors
  • Obesity, insulin resistance, dyslipidemia
  • Female sex
    • Especially during reproductive years due to increased levels of estrogen and progesterone
    • Increased estrogen levels cause increased secretion of bile rich in cholesterol, (lithogenic bile), which can result in the formation of cholesterol gallstones.
    • Increased progesterone levels cause smooth muscle relaxation, decreased gallbladder contraction, and subsequent bile stasis with formation of gallstones.
  • Multiparity or pregnancy
  • Age (> 40 years of age)
  • European, Native American, or Hispanic ancestry
  • Family history
  • Drugs: fibrates (inhibition of cholesterol 7-α hydroxylase), estrogen therapy, oral contraceptives
  • Malabsorption (e.g., Crohn disease, ileal resection, cystic fibrosis)
  • Rapid weight loss (e.g., after bariatric surgery)

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Pathophysiology

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Clinical features

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Diagnostics

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Treatment

Nonoperative management of cholelithiasis

Indications

• Patients at high risk of complications due to surgery or anesthesia (e.g., recent myocardial infarction)
• Patients unwilling to undergo surgery

Oral bile acid dissolution therapy

• May be useful in dissolving pure cholesterol stones (i.e., radiolucent stones) that are &lt 0.5 cm
• Ursodeoxycholic acid
• Duration of therapy: 6–24 months [17][33]

Extracorporeal shock wave lithotripsy (ESWL)

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