{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 27, Ep 1 of 4: Gallstones and Acute Cholecystitis","html":"","width":"100%","height":180,"duration":1042,"description":"Episode one of the Biliary Tract Disease chapter starts with the stone, because the phenotype tells you what biochemical environment produced it, and that environment is really the risk-factor list seen from the mechanism side. Cholesterol stones come from supersaturation, dysmotility, or nucleation; black pigment stones from excess unconjugated bilirubin; brown pigment stones form new in the duct under stasis plus bacterial deconjugation. Asymptomatic stones are observed because the math favors it, unless a cancer or surgical-emergency configuration shifts the calculus, and true biliary colic tips a fit patient toward cholecystectomy. When persistent obstruction converts colic into acute cholecystitis, the Tokyo grade dictates how aggressively to operate, with the friable ischemic wall of the acalculous and emphysematous variants pushing drainage back toward the percutaneous route.\n \nTopics covered\n\nCholesterol stones and the three lithogenic pathways\nGallstone risk factors mapped to mechanism\nBlack pigment stones and chronic hemolysis\nBrown pigment stones and the two-year rule\nObservation versus surgery for asymptomatic stones\nProphylactic cholecystectomy indications\nTokyo diagnosis and grading of cholecystitis\nDrainage options for the poor surgical candidate\nAcalculous and emphysematous variants\n \n \nKey decisions\n\nAsymptomatic gallstones are observed because progression to symptomatic disease runs only one to four percent per year, which does not exceed the perioperative mortality of elective cholecystectomy.\nProphylactic cholecystectomy is offered for a discrete list of cancer or emergency configurations: patchy porcelain gallbladder, stones three centimeters or larger, coexisting polyps, Native American women with stones, and pancreaticobiliary maljunction with cysts.\nIn uncomplicated cholecystitis liver chemistries stay normal or under twice normal, so a marked bilirubin or transaminase elevation signals concurrent duct stones or Mirizzi syndrome and should...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}