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Cholelithiasis : Definition, Causes, Symtoms, Diagnosis, Complication and Treatment

Thursday, August 16th 2012. | Digestive System, Disease

Cholelithiasis Definition

Gallstone disease is characterized by the presence of “calculations” in the bile ducts.

Gallstone disease is due to the appearance of insoluble salts of cholesterol in the bile ducts, particularly in terms of the gallbladder or bile duct accessory. This type of gallstone is most common in any place (80%), other stones are said pigment and are associated with an increased rate of bile pigment in bile.

In the vast majority of cases it is not accompanied by any symptoms and does not require specific treatment. It can sometimes lead to crises of colic or complications such as cholecystitis (inflammation of the gallbladder) or acute pancreatitis (inflamed pancreas).

Cholelithiasis is a common condition in Western countries. It covers 10% of the adult population and 30% of subjects over 60 years in France. It is twice as common in women.

In France, about 15% of adults living with cholelithiasis, has mostly they do not suffer.

In 70-80% of cases, the stone remains latent, symptom-free within 15 to 20 years after its discovery. 20 to 30% of patients, the onset of symptoms occurs in the early years (between 2 to 5 years).

Gallstone

Cholelithiasis (img thanks to nhome-remedies-for-you.com)

Cholelithiasis Symptoms

Usually no symptoms of gallstones may cause a crisis of colic.

In the vast majority of cases, gallstones are asymptomatic, that is to say, it is not accompanied by any symptoms bothersome. Nevertheless, it can become symptomatic and cause pain or infection.

The crisis of colic pain is very precise, very violent, such medical emergency. It is located in the right upper quadrant (upper right abdomen) and radiates to the back of the abdomen.

Blocking or inhibiting breathing is one of its main features. The pain reached a climax in fifteen to sixty minutes, and then regress in one to six hours.

During the crisis may appear functional signs accompanying nausea, vomiting, sometimes a slight fever or hypercoloration urine that reflect a level of complication to the common bile duct.

Cholelithiasis Diagnosis

Ultrasonography is the examination which allows for the diagnosis

The calcified stones are visible on radiographs of the abdomen, but the ultrasound remains the modality of choice for detecting gallstones.

Endoscopic retrograde cholangiography is sometimes performed. Advantage of this method: it allows the diagnosis while making the gesture as therapeutic effector cholangiography is a radiographic examination of the gallbladder after introduction of contrast material by natural means. Under anesthesia, the doctor inserts an endoscope into the mouth and passes into the duodenum. Through a small catheter, it may introduce a contrast medium directly into the gallbladder to visualize an obstacle.

A trained surgical team will also perform at the same time by laparoscopic cholecystectomy and exploration of common bile duct.

The choice of these different types of method does not depend on the patient, but the experience of the surgical team.

Cholelithiasis Complication

Acute cholecystitis and acute pancreatitis are the two main complications.

  • Acute cholecystitis (inflammation of the gallbladder) with colic type pain is compounded by high fever, up to 40 ° C with chills. This complication should be treated initially with antibiotics and by surgical intervention.
  • Acute pancreatitis (inflamed pancreas): gallstones, blocking the bile duct below, can have repercussions on the evacuation of pancreatic ducts (acute pancreatitis). This condition characterized by severe pain is treated by removal of the stones in question.
  • The cholangitis is an infection of the bile ducts inside and outside the liverIt is most often due to infection over a calculation stuck in the bile duct. The cholangitis causes pain to type of biliary colic, high fever and jaundice (yellowing of the skin and connective tissue). Its treatment involves antibiotics and surgery.

Cholelithiasis Treatment

If the treatment is surgical complication.

In 70-80% of cases, the stone remains latent, symptom-free within 15 to 20 years after its discovery. 20 to 30% of patients, the onset of symptoms occurs in the early years (between 2 to 5 years). Neither the size nor the number or appearance of the calculations, nor the functionality of the gall not predict the possible occurrence of symptoms or complications.

The gall is justified in cases of symptomatic gallstones, no factors predictive of lithiasis of the bile duct. This procedure can be done either by traditional surgery that is to say, after opening the abdomen or laparotomy or by laparoscopic or endoscopic surgery (surgical materials are introduced by a simple button-hole of 1 cm to 1.5 cm in the abdomen).

Another type of intervention is possible: a retrograde catheterization with endoscopic sphincterotomy and removal of stones after introduction of an endoscope orally. Some calculations are handled by waves delivered externally directly to the calculation of the fragment (extracorporeal shock wave lithotripsy). Finally, for those who refuse surgery, it is possible to prescribe bile acids (ursodeoxycholic acid) that can, in 30 to 40% of cases, to reduce the size of calculations.

Cholelithias Specialties Concerned

Gastroenterology and hepatology

Gastroenterology is the specialty of medicine that studies the digestive organs, their functioning and pathologies. The hepatology supports liver disease. The digestive organs are composed of the digestive tract (esophagus, stomach, intestines), liver and pancreas. Proctology is a medical-surgical specialty which is part of gastroenterology. It explores in particular the last part of the digestive tract: rectum and anus.

Gastroenterology is a specialty as border management often requires the advice of other specialists: ENT, pulmonologists, cardiologists, digestive surgeons, nutritionists, endocrinologists, oncologists …

Practicing a specialty medical technology, the hepato-gastroenterologist practice specific examinations: gastric endoscopy, colonoscopy, proctoscopy …

 

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