Cholelithiasis is the presence or formation of gallstones in the gallbladder or bile ducts.
Majority of patients do not show any symptoms but when symptoms are available the first complaint is pain . The pain begins abruptly and occurs immediately after the consumption of a large fatty meal. The pain is generally located in the right upper and upper central epigastrium or middle abdomen. This pain can be intense and may spread into the back, scapula or shoulder and can last minutes to hours. In some cases the pain may be accompanied by nausea and vomiting as well as belching and bloating. The last two are not specific to cholelithiasis.
On physical examination, everything appears normal apart from the possible tenderness in the right abdomen . On rare occasions, an enlarged gallbladder may be felt when pressing the abdomen. Fever, tachycardia and hypotension may lead to complications such as the infection of biliary tree (cholangitis) or the inflammation of the gallbladder. Jaundice may be seen if the gallstones lead to obstruction of the common bile duct.
Plain radiographs, CT scans and abdominal sonograms are some of the diagnostic procedures often used as they have been able to pick up asymptomatic gallstone cases when focus was on diagnosis of other conditions.
Unless the gallstones are very large or there is a significant risk of complications, cholelithiasis doesn’t require any treatment. Some common medical treatments for gallstones that may be used alone or in combination include contact dissolution, extracorporeal shockwave lithotripsy and oral bile salt therapy (ursodeoxycholic acid) .
In most cases, the prognosis for cholelithiasis is very positive as 80% of patients do not develop any symptoms . Small stones generally find a way into the intestine and leave the body with stool.
Recurrence is often prevented with the aid of elective cholecystectomy, however chronic diarrhea may arise as a result of bile salts. Missed diagnosis or motility disorder may also lead to recurrent pain.
In many cases, cholelithiasis arises as a result of excess amounts of cholesterol in the bile which is stored in the gallbladder . The excess cholesterol hardens, forming stone-like substances. The rising levels of cholesterol in the bile can be attributed to increased body weight and older age. This is why this condition is seen mostly in older individuals, overweight people and women. Cholelithiasis may also develop as a result of the bile containing excess bilirubin.
Cholelithiasis is a common problem in most western cultures . As much as 3% of the population show symptoms of having this condition. In the United States for example, around 500,000 people show symptoms of gallstones that may lead to them needing a cholecystectomy. It is also responsible for the death of at least 10,000 people each year.
The incidence of cholelithiasis is far lower in other regions such as Asia and the African continent.
The first step to the development of gallstones is the formation of biliary sludge . The sludge is made up of Ca bilirubinate, mucin and cholesterol microcrystals. Sludge develops during gallbladder stasis as is seen in pregnant women. The gallstones leading to cholelithiasis are divided into three types.
The first is cholesterol stones which make up more than 85% of gallstone cases in the Western World.
The second is black pigment stones which are hard gallstones that are made up of Ca bilirubinate and inorganic Ca salts. The development of these stones is accelerated by alcoholic liver disease, chronic hemolysis and old age.
The third type of gallstones is brown pigment stones. These are soft and greasy and made of bilirubinate and fatty acids. They often form during infection, inflammation as well as parasitic infestation.
Gallstones generally grow at a pace of 1 to 2 mm/yr. Therefore is will take between 5 and 20 years for them to become large enough to become a medical concern. The first two forms of gallstones form within the gallbladder but brown pigment stones generally form in the ducts. Gallstones may end up migrating to the bile duct following a cholecystectomy and in the case of brown pigment stones they can develop behind strictures as a result of stasis and infection.
Common tips in the prevention of gallstones include :
Cholelithiasis is a medical disorder that signifies the presence of gallstones in the gallbladder . It is relatively common as around 10 to 20% of adults develop the condition in their life time.
The course cholelithiasis takes varies from one individual to the other but majority of those that develop it do not show any symptoms at all.
It is important for the condition to be treated as it can lead to serious problems such as tissue damage, tears in the gallbladder and infections that may spread to other parts of the body .
Gallstones or cholelithiasis refer to hardened deposits of digestive fluid which may form in the gallbladder. The gallbladder is a small organ on the right side of the abdomen and is located just below the liver. The gallbladder has a digestive fluid that that is known as bile which gets released into the small intestine of every human.
Gallstones often vary in size. They can be as a small as a grain of sand and in extreme cases , they may be as large as a golf ball. In some patients, only one gallstone is seen. In others, several gallstones may form.
The condition is relatively common in the western world. People who have gallstones often need a gallbladder surgery. Gallstones that don’t have any signs or symptoms generally do not need any treatment.