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Gallstones, Cholelithiasis

Sunday, June 17th 2012. | Uterine system

What is Gallstones or Cholelithiasis

The gallbladder serves as a reservoir for bile that is synthesized by the liver and is concentrated in the gallbladder. The bile ducts carry bile from the liver to the small intestine via the gallbladder. When feeding, the gallbladder contracts and bile is poured into the small intestine where digestion continues.

Bile is composed of 80% water, it also contains bile acids, cholesterol, bile salts and bile pigments. When the bile composition changes (eg excessively high content of cholesterol) stones, which denominates gallstones may form.

Causes of Gallstones

Cholesterol stones are most common and may be in the gallbladder or bile ducts. The gallstone formation is promoted by inflammatory processes, by obstacles to the flow of bile or by disturbances of the contraction of the gallbladder.

Risk factors :

  • Poor diet (too much cholesterol, too low in fiber, with fast weight-loss plan).
  • Overweight and obesity
  • Women are two times more affected than men
  • hormonal contraception
  • familial predisposition

The following diseases may also foster the development of gallstones:

  • Diabetes mellitus
  • Liver cirrhosis
  • Hyperfunction of the adrenal gland
  • Chronic inflammatory diseases of the digestive tract (Crohn’s disease, ulcerative colitis)

 Gallstones

Disorders (symptoms)

The majority of patients who have gallbladder calculations show no symptoms. The subjects are asymptomatic and are unaware of their gallstones.

Clinical symptoms:

  • Feeling of pressure and fullness in the upper abdomen, especially after drinking coffee, alcohol and high fat meals
  • Nausea, vomiting, flatulence

The most common clinical symptoms during attacks of colic :

  • Strong colicky abdominal pain in the upper abdomen radiating pain in the back and between the shoulder blades
  • vomiting
  • Episodes of sweating, chills
  • Sometimes fever during inflammation of the gallbladder
  • Yellowing of the skin: when the calculation is trapped in the bile duct, it can block the flow of bile, leading to cholestasis with passage of bile in the blood.
  • Such colic are found in approx. 10% of subjects, they can last for hours or even days.

Examinations (diagnosis)

  • History taking into account the patient’s presenting symptoms of
  • Laboratory tests (liver enzymes)
  • Ultrasound (sonography)
  • Retrograde visualization of the biliary tree with contrast (ERCP).

Treatment Options

Gallstones should normally be removed during surgery. When using non-surgical measures, it is not uncommon for gallstones recur in subsequent years.

Treatment of gallbladder colic crisis

Any attack of colic should be supported by a doctor. Its treatment is symptomatic and primarily relies on analgesics and muscle relaxants.

In cases of suspected cholecystitis, the physician must decide whether to prescribe antibiotics. A total fast is recommended. When the crisis of colic has passed, it is appropriate to adopt a diet low in fat and high in fiber. If overweight, the patient should try to lose weight. Moreover, all chronic conditions need to be supported appropriately.

When multiple attacks of colic are repeated, the doctor usually recommends the patient to have surgery.

The following interventions can be performed:

  • Cholecystectomy : when the gallbladder is filled with calculations, inflamed or dilated. The procedure is performed laparoscopically through three small incisions or, rarely, laparotomy through a large incision below the right rib cage. There is recently a minimally invasive operative method for removing the gallbladder through a single incision in the navel, also called Laparo Endoscopic Single-Site Surgery or LESS method. With this method, the doctor first placed a special device through a small incision in the navel. It then uses this device to bring the full surgical equipment – camera included – into the abdominal cavity and can carefully remove the gallbladder. This gentle method leaves a scar barely visible in the navel. The patient subsequently suffers less pain and hospital stay is shortened compared with the usual methods operative.
  • Calculations in the bile ducts: can usually be removed during the endoscopy (ERCP).

Other possibilities:

  • Nonsurgical destruction of gallstones by shock waves, in many cases, small stones.
  • In some patients, a litholyse (destroying) drug calculations can be effective.

Possible complications

Without proper treatment, gallstones can cause the following complications :

  • Jaundice
  • cholecystitis
  • liver damage
  • Pancreatitis, inflammation of the pancreatic parenchyma
  • Intestinal obstruction (ileus)
  • Cancer of the gallbladder
  • The surgery of the gallbladder and biliary tract are very common and well tolerated with, in most cases, symptoms disappear after surgery.
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