gallstones 课件知识讲稿.pptVIP

;Gallstones are associated with a number of conditions. They occur when the normal ratio of components making up the bile is altered, most commonly when there is increased secretion of cho- lesterol in the bile. Conditions which are associated with increased cholesterol secretion, and therefore the formation of cholesterol stones, include obesity, diabetes, pregnancy and oestrogen therapy. ;The incidence of stones also rises with age, Probably because the bile flow slows down. An increased secretion of bilirubin in the bile, As in patients with cirrhosis for example, is Associated with pigment (black or brown) stones;Ultrasound appearances There are three classic acoustic properties associated with stones in the gallbladder; they are highly reflective, mobile and cast a distal acoustic shadow. In the majority of cases, all these properties are demonstrated (Figs 3.1–3.2);Figure 3.1 (A) Longitudinal section and (B) transverse section images of the gallbladder containing stones with strong distal acoustic shadowing. ;Figure 3.2 Multiple tiny stones combining to form a posterior band of shadow.;Choledocholithiasis Stones may pass from the gallbladder into the common duct, or may develop de novo within the common duct. Stones in the CBD may obstruct the drainage of bile from the liver, causing obstructive jaundice. ;Due to shadowing from the duodenum, ductal stones are often not demonstrated with ultrasound without considerable effort. Usually they are accom- panied by stones in the gallbladder and a degree of dilatation of the CBD. In these cases the operator can usually persevere and demonstrate the stone at the lower end of the duct. However, the duct may be dilated but empty, the stone having recently passed.;It is not unusual to demonstrate a stone in the CBD without stones in the gallbladder (Fig. 3.9). This may be due to a single calculus in the gallbladder having moved into the duct, or stone formation within the duc