Discuss the causes, symptoms and dietary management of gallstones.

1. 1 · Open in two lines. Gallstones are solid deposits formed from bile in the gall bladder. Diet aims to prevent painful attacks and new stones.
2. 2 · Draw the biliary system. [Sketch: liver, gall bladder with stones, cystic duct, common bile duct, duodenum]
3. 3 · Types and risk factors.
   • Cholesterol, pigment, mixed stones.
   • 5 Fs, crash diets, fasting, diabetes, high-fat low-fibre diet.
4. 4 · Symptoms and complications. Biliary colic after fatty meals, nausea, bloating; cholecystitis, jaundice, pancreatitis.
5. 5 · Diet principles. Acute: NPO then fat-free fluids. Chronic: low fat, high fibre, normal protein, slow weight loss, small regular meals.
6. 6 · Foods and menu. Include and avoid lists; a one-day low-fat menu.
7. 7 · Close in one line. A low-fat, high-fibre diet with slow weight loss prevents most attacks.

Scoring tip: Explain why fat hurts (CCK makes the gall bladder contract); one line of reasoning lifts the answer.