Gall blader stone formation in influenced by AJE -
- Clofibrate therapy
- Hyperalimentation
- Primary biliary cirrhosis
- Hypercholesterolemia
Hyper alimentation - decreases gall bladder motility, promotes stasis
Primary biliary cirrhosis - decreases bile salt secretion into bile
Clofibrate therapy - increases biliary cholesterol
thus these factors predispose to cholesterol stone formation.
Predisposing factors for cholesterol gall stone formation are
- Demographic/genetic factors
Prevalence highest in North American Indians, Chilean Indians and Chilean Hispanics, greater in Northern Europe and North America than in Asia, lowest in Japan; familial disposition; hereditary aspects.
2. Obesity
Normal bile acid pool and secretion but increased biliary secretion of cholesterol
3. Weight loss
Mobilization of tissue cholesterol leads to increased biliary cholesterol secretion while enterohepatic circulation of bile acid is increased
4. Female sex hormones
Estrogens stimulate hepatic lipoprotein receptors, increases uptake of dietary cholesterol, and increase biliary cholesterol secretion
Natural estrogens, other estrogens, and oral contraceptives lead to decreased bile salt secretion and decreased conversion of cholesterol to cholesteryl esters.
5. Increasing age
Increased biliary secretion of cholesterol, decreased size of bile acid pool, decreased secretion of bile salts.
6. Gallbladder hypomotility leading to stasis and formation of sludge
Prolonged parenteral nutrition
Fasting
Pregnancy
Drugs such as octreotide
7. Clofibrate therapy
Increased biliary secretion of cholesterol
8. Decreased bile acid secretion
Primary biliary cirrhosis
Genetic defect of the CYP7A1 gene
9. Decreased phospholipid secretion
Genetic defect of the MDR3 gene
10. Miscellaneous
High-calorie, high fat diet
Spinal cord injury