Development and Composition of Gallstones (Nursing)

00:00 When I first learned about gallstones and how horrific they can be sometimes, I wanted to know what causes gallstones cuz I absolutely don't ever want to experience this.

00:14 Well, there's three answers, but really, it's better to call them theories because we're not exactly sure what the absolute causes are.

00:23 We know that one possible answer could be the bile has too much cholesterol in it.

00:29 80% of gallstones are made of cholesterol.

00:32 The second reason is the gallbladder can't empty efficiently.

00:38 Remember, if the gallbladder doesn't empty completely, the remaining particles like cholesterol or calcium salts can start to thicken and overly concentrate then it becomes this biliary sludge which over time in the gallbladder, the sludge will likely become stones.

00:55 So, first theory is we think that the bile has too much cholesterol in it because we know that 80% of the gallstones are made of cholesterol.

01:04 They can be made of other things, but a large majority of them are cholesterol.

01:08 Second theory is the gallbladder can't empty efficiently, it starts to thicken, it gets sludgy, and then you end up with stones.

01:17 The third theory is patient with cirrhosis or sickle cell anemia also have a risk in gallstones.

01:24 Yeah. I don't really have an in-depth explanation for you on that.

01:29 We just know right now that is what we see.

01:33 So, those are three possible theories or answers, whichever you prefer, for how gallstones develop.

01:40 Sometimes it's hard to visualize what we're talking about, so I've got some actual pictures here of gallstones that were removed from real humans.

01:51 Okay, take a look at these. Look at the cholesterol one.

01:54 That's the one in box A, farthest on the left. Yeah, look how big that is.

01:59 You're looking about a range of 2 cm.

02:01 Take a look at the next one, the brown pigment one. That's pretty pointy.

02:07 Can you imagine trying to pass that through your hepatobiliary system? And if that wasn't bad enough, look at the black pigment one.

02:15 That is all kinds of things poking out that would not feel comfortable when they pass.

02:21 I wanted you to see pictures of these to get an idea of some size.

02:26 These are pretty impressive ones if you ask me.

02:28 We're ranging about 1-2 cm trying to move through a hepatobiliary tract that is much smaller than that.

02:35 That's why these patients required intervention because gallstones, which is cholelithiasis, happens, right? When this liquid bile that's mostly just flow right on through becomes solid particles like the stones you see here or even a thick enough sludge that can obstruct the flow.

02:55 Now, we do think that sludge eventually becomes stones, but even a thick sludge before it becomes a stone can stop up the flow.

03:03 I title this note 'too much of a good thing' because I want you to keep in mind that if someone has a high bilirubin or high cholesterol level in their bile, we've noticed that they have an increased risk of gallstones.

03:18 So, if the patient has high level of bilirubin or a high level of cholesterol in their bile, we know they have an increased risk to develop gallstones.

03:29 So, I'm gonna break that down a little bit, not just leave you hanging with a little bit of information.

03:34 We know if a patient has high cholesterol, cholesterol is the most common type of gallstones.

03:40 Now, the stones are kind of yellowish to white-ish that you see in that picture.

03:44 Cholesterol gallstones are caused by the liver making more cholesterol than the liver can dissolve.

03:51 Now, cholesterol can come from sources like dietary or even your genetics.

03:56 Some people who eat very healthy, low fat, and exercise can still have elevated cholesterol levels.

04:04 So, we think these stones come from when the liver is making more cholesterol than the liver can actually dissolve.

04:11 Now, high bilirubin or like these other two types of stones we've looked at.

04:15 This is more common to people with certain conditions such as cirrhosis, sickle cell anemia, or who have higher bilirubin levels.

04:23 The stones are called pigment stones.

04:26 Pigment gallstones are from when your gallbladder can't break down the excess bilirubin.

04:31 These are really hard stones and are often dark brown or black.

04:36 So, pigment stones are gonna come from bilirubin and that's why they are darker.

04:40 Cholesterol stones are going to be a lot lighter.

04:43 Think of fat and that'll be easy for you to remember.

04:47 So, we know that cholelithiasis is the presence of these stones.

04:50 We've played the game already where you see the stones in the gallbladder, you see them in the neck of the cystic duct, you see them travelling down the common bile duct, and on this one, we can't see where it is close to the pancreas, but you've got a good feel of what cholelithiasis looks like.

05:06 You know that patient pain can range from silent where they don't even know that they have the stones, to excruciating when the stones start to block the ducts.