do bile acid sequestrants increase gall stones or not?

[voicesinmyhead]

UW says no, some sources say yes.

Any consensus?

---

Members don't see this ad.

 

[worldbeater]

Gallstones are increased by cholesterol, and decreased by bile salts and lecithin (Virchow's triangle). I don't think any other factors affect it and I am not sure if bile acid sequestrants help bile salts. If World says no, go with that, it's usually the most up to date.

 

[slz1900]

Uworld explains why they don't increase gallstones even though it seems like they should. Basically they stimulate cholesterol conversion to bile acids and increase gall bladder motility as well, so the loss of bile acids by the bile acid sequestrants is cancelled out and there is no change in risk of stones.

 

[LaurenMD]

Pathoma says that they do increase gallstones. Bile acids act to solubilize cholesterol. When bile acid sequestrants inhibit the recycling of bile acids, cholesterol solubility is decreased which leads to the formation of cholesterol stones.

 

[GoPelicans]

I kinda have a dumb question regarding gallstones too. I read somewhere recently that cholelithiasis and cholecystitis do not typically cause jaundice. Anyone know why this is? I thought conjugated bilirubin was stored in the gallbladder along with cholesterol and bile salts, so a blockage should cause jaundice, no?

 

[Jabbed]

I kinda have a dumb question regarding gallstones too. I read somewhere recently that cholelithiasis and cholecystitis do not typically cause jaundice. Anyone know why this is? I thought conjugated bilirubin was stored in the gallbladder along with cholesterol and bile salts, so a blockage should cause jaundice, no?

Stored in the gallbladder, but made in the liver. Cholelithiasis will only produce jaundice if it obstructs the common bile duct (aka choledocholithiasis). Cystic duct obstruction still allows bile to be secreted from the liver directly into the common bile duct.

Normal flow of bile: Liver → common hepatic duct → cystic duct → gallbladder (until secretion) → cystic duct → common bile duct

 

[GoPelicans]

Awesome explanation, thanks!

 

[Dr.serotonin]

they do, even goljan says so. you decrease the conc: of bile salts but inhibiting enterohepatic circulation of bile salts thus precipitating cholesterol stones. Period

 

[slz1900]

they do, even goljan says so. you decrease the conc: of bile salts but inhibiting enterohepatic circulation of bile salts thus precipitating cholesterol stones. Period

Except gallstones are not listed as a side effect on bile acid sequestrant packets in real life... and they're not listed as a side effect in FA or uworld. Seems like in this case the intuitive physiological explanation may not be correct.

 

[voicesinmyhead]

but Uworld?

 

[Dr.serotonin]

ok. I Agree. thanks for changing my concept

 

[voicesinmyhead]

So lets stick to uworld concept then? thanks!