Edit concept Question Editor Create issue ticket

Cholelithiasis

Cholelithiases

Cholelithiasis is the presence or formation of gallstones in the gallbladder or bile ducts.


Presentation

Majority of patients do not show any symptoms but when symptoms are available the first complaint is pain [7]. 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.

Pain
  • Absence of abdominal pain was reported by 60.3% of the patients. Patients classified as ASA II as opposed to ASA I were less likely to report absence of pain (OR 0.41, 95% CI 0.17-0.99).[ncbi.nlm.nih.gov]
  • In addition to more common etiologies, such as gastroenteritis, constipation, and urinary tract infection, the differential diagnoses of acute abdominal pain in young children with sickle cell disease include vaso-occlusive pain crisis and splenic sequestration[ncbi.nlm.nih.gov]
  • 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.[symptoma.com]
  • CASE PRESENTATION: We present here two females of Aryan ethnicity, one 55 and another 45 years old, who presented with pain at upper abdomen and retrosternal chest pain; on investigations were found to have cholelithiasis along with Morgagni hernia which[ncbi.nlm.nih.gov]
  • During follow-up, abdominal pain completely relieved. Hepatobiliary ultrasonography in sixth month follow-up showed entirely regression of cholelithiasis.[ncbi.nlm.nih.gov]
Gaucher Disease
  • Clinically, 3 types of Gaucher disease have been defined on the basis of the presence or absence of neurological symptoms.[ncbi.nlm.nih.gov]
  • BACKGROUND AND AIM: Patients with Gaucher disease type 1 (GD1) show an altered lipid profile and a certain degree of insulin resistance, which might contribute to cholelithiasis (CL) and could possibly be associated with ABCG5/ABCG8 gene variants.[ncbi.nlm.nih.gov]
Vomiting
  • For vomiting : PC-6 For jaundice : SJ-9 For back pain : UB-18 For rib pain : GB-40, SJ-3 For biliary colic : 1.[americandragon.com]
  • Prolonged vomiting, gastric aspiration, and restricted oral intake can lead to deficits in sodium, potassium, and chloride. Eliminate noxious sights or smells from environment. Reduces stimulation of vomiting center.[nurseslabs.com]
  • Liraglutide causes some adverse affects including nausea, vomiting, acute nasopharyngitis and acute pancreatitis. However, development of liraglutide-dependent cholelithiasis has not been reported in the literature.[ncbi.nlm.nih.gov]
  • When this happens, a child may have abdominal pain and nausea, vomiting or fever. How do gallstones form? Normally, bile drains from the liver into the small intestine where it helps digest food. Between meals, bile is stored in the gallbladder.[childrenshospital.org]
Nausea
  • Clinical Manifestations Steady, severe pain in the right upper quadrant or Epigastric pain Nausea Vomiting Jaundice Fever Treatment Principle Herb Formulas Points GB-34, LI-11, LIV-4 (right side), PC-4, ST-36, UB-18, UB-19, UB-22 Sedate GB-33, GB-38,[americandragon.com]
  • Liraglutide causes some adverse affects including nausea, vomiting, acute nasopharyngitis and acute pancreatitis. However, development of liraglutide-dependent cholelithiasis has not been reported in the literature.[ncbi.nlm.nih.gov]
  • When this happens, a child may have abdominal pain and nausea, vomiting or fever. How do gallstones form? Normally, bile drains from the liver into the small intestine where it helps digest food. Between meals, bile is stored in the gallbladder.[childrenshospital.org]
  • Symptoms may include abdominal pain, fever, yellowing of skin nausea and vomiting .[drugs.com]
Abdominal Pain
  • We describe a case of a toddler with sickle cell disease initially presenting with abdominal pain who was found to have symptomatic cholelithiasis.[ncbi.nlm.nih.gov]
  • The episodic nature of abdominal pain associated with symptomatic cholelithiasis warrants long-term follow-up studies.[ncbi.nlm.nih.gov]
  • During follow-up, abdominal pain completely relieved. Hepatobiliary ultrasonography in sixth month follow-up showed entirely regression of cholelithiasis.[ncbi.nlm.nih.gov]
  • We report a 7-year-old boy with sickle cell disease who presented with right upper quadrant abdominal pain. An ultrasonograph demonstrated a dilated common bile duct with sludge and stones. A cholecystectomy was performed.[ncbi.nlm.nih.gov]
  • Abdominal pain was the most frequent symptom. No risk factors were identified in 56.6% of the patients. Ceftriaxone (20%) was the most commonly associated risk factor.[ncbi.nlm.nih.gov]
Colic
  • Abstract A small fraction of patients undergoing cholecystectomy for biliary colic are subsequently diagnosed with an obstructive pancreatic head mass.[ncbi.nlm.nih.gov]
  • Little correlation exists between the severity and frequency of biliary colic and pathologic changes in the gallbladder. Biliary colic can occur in the absence of cholecystitis.[merckmanuals.com]
  • KEYWORDS: Biliary colic; Cholelithiasis; Gallbladder dyskinesia; Gallstones; Sphincter of Oddi dysfunction[ncbi.nlm.nih.gov]
  • It’s biliary colic that just doesn’t go away. The pain lasts longer than 6h and is usually associated with nausea/vomiting, fever and right upper quadrant pain. Choledocholithiasis – gallstones in the common bile duct.[sketchymedicine.com]
Dyspepsia
  • Patients with cholelithiasis often have other illnesses (e.g. peptic ulcer, gastro-oesophageal reflux disease, lactose intolerance, coeliac disease, functional dyspepsia, irritable bowel syndrome, pancreatitis or even cancer).[books.google.de]
  • Flatulent dyspepsia. Gallstone colic. Acute Obstructive cholecystitis which may lead to: Mucocele. Empyema. Gangrene. Perforation. Fistula. Chronic Cholecystitis. Carcinoma. In the CBD: Obstructive jaundice.. Liver failure. Cholangitis.[en.wikibooks.org]
  • […] over 10-20 minutes, and then gradually wanes • Pain that is constant; not relieved by emesis, antacids, defecation, flatus, or positional changes; and sometimes accompanied by diaphoresis, nausea, and vomiting • Nonspecific symptoms (eg, indigestion, dyspepsia[hamrodoctor.com]
  • The most common symptom is biliary colic; gallstones do not cause dyspepsia or fatty food intolerance.[merckmanuals.com]
Retrosternal Chest Pain
  • CASE PRESENTATION: We present here two females of Aryan ethnicity, one 55 and another 45 years old, who presented with pain at upper abdomen and retrosternal chest pain; on investigations were found to have cholelithiasis along with Morgagni hernia which[ncbi.nlm.nih.gov]
Diastolic Hypertension
  • On multivariate analysis, the risk of gallstone disease is correlated to rural locale, diastolic hypertension, age, and TG levels.[ncbi.nlm.nih.gov]
Jaundice
  • After "simple" cholecystectomy for lithiasis, biliary disorders can appear, with the onset more than 3 years postoperative, like cholangitis or transitory jaundice.[ncbi.nlm.nih.gov]
  • Abstract We report the case of a newborn infant affected by congenital hyperinsulinism who developed cholelithiasis associated with cholestatic jaundice following treatment with octreotide, a somatostatin analogue.[ncbi.nlm.nih.gov]
  • Because cholangitis and obstructive jaundice progressed after admission, emergent endoscopic retrograde cholangiopancreatography was performed, and a common bile duct stone was removed endoscopically. It was a bilirubin stone.[ncbi.nlm.nih.gov]
  • Thirteen (26%) infants were symptomatic, most commonly presenting with emesis and jaundice. Complications from gallstones included choledocholithiasis (9), cholecystitis (3), and pancreatitis (1).[ncbi.nlm.nih.gov]
  • At presentation, at least one of the following complications was seen in 14.1% of patients: cholecystitis (10.9%), obstructive jaundice (2.7%), pancreatitis (1.96%) and cholangitis (1.2%).[ncbi.nlm.nih.gov]
Biliary Colic
  • Abstract A small fraction of patients undergoing cholecystectomy for biliary colic are subsequently diagnosed with an obstructive pancreatic head mass.[ncbi.nlm.nih.gov]
  • Little correlation exists between the severity and frequency of biliary colic and pathologic changes in the gallbladder. Biliary colic can occur in the absence of cholecystitis.[merckmanuals.com]
  • KEYWORDS: Biliary colic; Cholelithiasis; Gallbladder dyskinesia; Gallstones; Sphincter of Oddi dysfunction[ncbi.nlm.nih.gov]
  • It’s biliary colic that just doesn’t go away. The pain lasts longer than 6h and is usually associated with nausea/vomiting, fever and right upper quadrant pain. Choledocholithiasis – gallstones in the common bile duct.[sketchymedicine.com]
Dark Urine
  • The presence of associated bile duct stones (choledocholithiasis) should be suspected through clinical signs such as jaundice and dark urine (bilirubinuria), together with radiologic and laboratory findings, such as bile duct dilation or increases in[link.springer.com]
  • urine Maybe thirst or thirst with no desire to drink Diarrhea with foul smell or Constipation Fever Sweet sticky taste or bitter taste in mouth T: Pink C: Thick, yellow and greasy (maybe sticky) P: Soft and rapid or Slippery and rapid Treatment Principle[americandragon.com]

Workup

On physical examination, everything appears normal apart from the possible tenderness in the right abdomen [8]. 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.

Salmonella Typhi
  • Salmonella typhi and Helicobacter infections have been shown to increase risk of gallbladder cancer (GBC), but findings have been inconsistent. Other bacterial infections may also be associated with GBC.[ncbi.nlm.nih.gov]

Treatment

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) [9].

Prognosis

In most cases, the prognosis for cholelithiasis is very positive as 80% of patients do not develop any symptoms [6]. 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.

Etiology

In many cases, cholelithiasis arises as a result of excess amounts of cholesterol in the bile which is stored in the gallbladder [3]. 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.

Epidemiology

Cholelithiasis is a common problem in most western cultures [4]. 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.

Sex distribution
Age distribution

Pathophysiology

The first step to the development of gallstones is the formation of biliary sludge [5]. 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.

Prevention

Common tips in the prevention of gallstones include [10]:

  • Avoiding fasts or skipping meals
  • Losing weight slowly
  • Maintaining a healthy weight
  • Getting an ursodeoxycholic acid treatment

Summary

Cholelithiasis is a medical disorder that signifies the presence of gallstones in the gallbladder [1]. 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 [2].

Patient Information

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.

References

Article

  1. Wang DQH, Afdhal NH (2010). Gallstone disease. In M Feldman et al., eds., Sleisenger and Fordtran’s Gastrointestinal and Liver Disease, 9th ed., vol. 1 , pp. 1089–1120. Philadelphia: Saunders.
  2. Huang CS, Lichtenstein DR (2006). Biliary tract stones. In MM Wolfe et al., eds., Therapy of Digestive Disorders, 2nd ed., pp. 395–408. Philadelphia: Saunders Elsevier.
  3. Sanders G, Kingsnorth AN (2007). Gallstones. BMJ, 335(7614): 295–299.
  4. Heuman DM, Moore EL, Vlahcevic ZR. Pathogenesis and dissolution of gallstones. In: Zakim D, Boyer TD, eds. Hepatology: A Textbook of Liver Disease. 1996. 3rd ed. Philadelphia, Pa: WB Saunders; 1996:376-417.
  5. Acalovschi M, Blendea D, Feier C, Letia AI, Raitu N, Dumitrascu DL, Veres A. Risk factors for symptomatic gallstones in patients with liver cirrhosis: a case-control study. The American Journal of Gastroenterology 2003 98 (8): 1856–1860
  6. Center SA. Diseases of the gallbladder and biliary tree. Vet Clin North Am Small Anim Pract. May 2009;39(3):543-98. 
  7. Portincasa P, Moschetta A, Palasciano G. Cholesterol gallstone disease. Lancet. Jul 15 2006;368(9531):230-9. 
  8. Poupon R, Rosmorduc O, Boëlle PY, Chrétien Y, Corpechot C, Chazouillères O, et al. Genotype-phenotype relationships in the low-phospholipid associated cholelithiasis syndrome. A study of 156 consecutive patients. Hepatology. Mar 26 2013.
  9. Halldestam I, Kullman E, Borch K. Incidence of and potential risk factors for gallstone disease in a general population sample. Br J Surg. Nov 2009;96(11):1315-22.
  10. Shaffer EA. Epidemiology and risk factors for gallstone disease: has the paradigm changed in the 21st century?. Curr Gastroenterol Rep. May 2005;7(2):132-40. 

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2018-06-22 10:23