Cholelithiasis ( Gall stone)

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Cholelithiasis are hard, stone like deposits inside the gallbladder. Cholelithiasis is the most common gastrointestinal disorder leading to surgical management. The size of the stone range from as small as a grain of sand to as large as a golf  ball.

What are the types of Cholelithiasis?

Gallstone is divided into following types:

1. Cholesterol Gallstone(80% of total gallstone) : It is radiolucent . Mainly contain cholesterol.
2. Pigment Gallstone(20% of total gallstone): It is radiopaque. Mainly contain calcium bilirubinate.

What is the pathogenesis of Cholelithiasis?

1. Cholesterol stones is formed when the ratio of cholesterol to phospholipids or bile salts is increased , bile salts is supersaturated with cholesterol results in crystallizes and forms a focus for stone formation .
2. Pigments stones is formed due to the crystallization of calcium bilirubinate.

What are the risks factor for cholelithiasis?

1. Female
2. More than 40 years
3. Obese individual
4. Pregnant women
5. Hemolytic anemia
6. Sickle cell anemia
7. Liver cirrhosis
8. Biliary tract infection
9. Diabetes
10. Eating high fat, high cholesterol , low fiber diet
11. Taking birth control pills
12. Taking drugs which contain estrogen.
13. Rapid weight loss
14. Fasting for long time
15. Long time intravenous feeding

What are the signs and symptoms cholelithiasis?

Many people (60%-80% )who have gallstones are asymptomatic( have never had signs and symptoms) . Symptoms commonly occur when stone blocks cystic or common bile duct , which includes:

1. Biliary colic ( Acute paroxysmal pain in upper right quadrant of the abdomen )
2. Pain spread to the back and right shoulder
3. Pain occur after fatty meal
4. Fever
5. Jaundice
6. Dyspepsia
7. Flatulence
8. Food intolerance
9. Nausea and vomiting
10. Abdominal fullness
11. Clay colored stools

What are the complications of cholelithiasis?

1. Acute Cholecystitis
2. Chronic Cholecystitis
3. Empyema of the gall bladder
4. Mucocele( dilation of the ball bladder with accumulated mucous secretion)
5. Mirizzi,s syndrome ( Mirizzi syndrome is a condition when common hepatic duct obstruction caused by compression from an impacted stone in the hartmann’s pouch or in cystic duct. )
6. Biliary obstruction
7. Acute Cholangitis
8. Acute Pancreatitis
9. Gallstone ileus ( Intestinal obstruction due to gall stone)
10. Gallbladder cancer

How is a cholelithiasis diagnosed ?

Diagnosis relies on history and physical examination and laboratory test with confirmatory radiological studies which includes:

1. Abdominal ultrasound ( 90% of gallstone are visible in USG)
2. Abdominal X-ray ( 10-15% of gallstone are diagnosed by x-ray
3. Abdominal CT and MRI scan
4. ERCP( endoscopic retrograde cholangiopancreatography)
5. HIDA scan(Hepatoiminodiacetic acid)
6. PTCA( Percutaneous transhepatic cholangiogram)
7. Laboratory tests includes Liver function tests, Serum lipase , Bilirubin and complete blood test.

How is a cholelithiasis managed ?

1. Asymptomatic Gallstones don’t required treatment. Cholecystectomy(open cholecystectomy and laparoscopic cholecystectomy) is being performed for those patients who developed symptoms or complications .Prophylactic cholecystectomy is considered in diabetes patients, congenital Hemolytic anemia , those due to undergo bariatric surgery. Other treatment for cholelithiasis includes:
2. ERCP( treat gallstones in the common bile duct)
3. Lithotripsy ( Lithotripsy is done for those who cant have surgery)
4. Medication which includes chenodeoxycholic acids (CDCA) or ursodeoxycholic acid (UCDA) are prescribed to dissolve cholesterol gallstones.

What is the prognosis of cholelithiasis?

Prognosis is excellent with early treatment.

References:

1. Sabiston textbook of surgery 18th edition
2. The Washington manual of surgery, 5th edition.
3. emedicine.medscape.com
4. http://www.medicinenet.com
5. http://en.wikipedia.org
6. http://www.uptodate.com
7. http://www.ncbi.nlm.nih.gov

Filed Under: General • Surgery

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