Cholelithiasis

Cholelithiasis known as gallstones or gallstones , refers to the formation of stones in the bile ducts. Gallstones are hardened deposits of digestive fluid that form in the gallbladder. Your gallbladder is a small, pear-shaped organ on the right side of your abdomen, just below your liver. The gallbladder has a digestive fluid called bile that is released in the small intestine.

The calculations range in size from as small as a grain of sand to as large as a golf ball. Some people develop only one gallstone, while others develop many gallstones at the same time.

Table of Contents

Summary

[ hide ]

1 Symptoms
2 Epidemiology
3 Causes
4 Tests and reviews
5 Types of gallstones
6 Classification
7 Risk factors
8 Complications
9 Treatment
- 1 Treatment for gallstones that do not cause signs and symptoms
- 2 Treatment for gallstones that cause symptoms and signs
10 Prevention
11 Sources
12 References

Symptoms

The gallstones can cause no signs or symptoms. If a gallstone causes a blockage, you may have abdominal and back pain .

Gallstones may not cause signs or symptoms. If a gallstone lodges in a duct and causes a blockage, signs and symptoms may result, for example:

Sudden, severe pain in the upper right part of your abdomen
Sudden, severe pain in the center of your abdomen, just below the breastbone
Back pain between the shoulder blades
Pain in the right shoulder
Gallstone pain can last from several minutes to a few hours.

Seek medical attention right away if you develop signs and symptoms of a serious gallstone complication, such as:

Abdominal pain so severe that you cannot sit still or find a comfortable position
Yellowing of the skin and whites of the eyes
High feverwith chills.

epidemiology

Cholelithiasis is more frequent in women than in men with a ratio of 4 to 1, and there are factors that predispose to the disease such as obesity , taking contraceptives , dyslipidemia , diabetes .

Causes

Doctors believe that gallstones can occur when your bile contains too much cholesterol or bilirubin . It is unclear what causes gallstones to form. Doctors believe that gallstones can occur when:

The bilecontains too much cholesterol . Normally, bile contains enough chemicals to dissolve cholesterol excreted by the liver . But if your liver excretes more cholesterol than bile it can dissolve excess cholesterol it can form in crystals and eventually in stones.
Bile contains too much bilirubin. Bilirubin is a chemical that is produced when the body breaks down red blood cells . Certain conditions of causing the liver to produce too much bilirubin, such as liver cirrhosis , biliary tract infections, and certain blood disorders. Excess bilirubin contributes to the formation of gallstones.
The gallbladderdoes not empty properly. If your gallbladder does not empty completely or often enough, the bile can become very concentrated, which contributes to the formation of gallstones.

Tests and exams

Tests used to detect the presence of gallstones or inflammation of the gallbladder include:

Abdominal ultrasound
Abdominal computed tomography
Endoscopic retrograde cholangiopancreatography(ERCP)
Radionuclide gallbladder scan
Endoscopic ultrasound
Magnetic resonance cholangiopancreatography(CPRM)
Percutaneous transhepatic cholangiography(CTHP)

The doctor may order the following blood tests:

Bilirubin
Liver function tests
Pancreatic enzymes

Types of gallstones

Types of stones that form in the gallbladder are:

Cholesterolgallstones . The most common type of gallstones, it often appears yellow in color. These gallstones are primarily made up of undissolved cholesterol, but may contain other components.
Pigment gallstones. These are dark brown or black forming stones when the bile contains too much bilirubin.

Classification

Gallstones are usually made up of a mixture of cholesterol , calcium bilirubinate , protein, and mucin . Depending on their predominant compounds they are classified into:

Cholesterol calculations are the most frequent in industrialized countries.
Black pigment calculations, mainly made up of calcium bilirubinate from hemolysis.
Brown pigment stones, formed from bacterial or helminthic infections in the biliary system, are frequent in eastern populations.
Mixed calculations, mainly consist of small amounts of calcium and bilirubinate salts.

The widespread use of abdominal ultrasound for the study of abdominal pain, pelvic disease and alteration of liver enzymes has led to the accidental identification of gallstones in many patients with the absence of the typical symptoms of this disease. About 30% of these cases will develop symptoms throughout their lives, in a proportion of 1.5-2% per year. Symptomatic patients with untreated gallstones have a higher probability of recurrence of symptoms, as well as complications such as cholecystitis , pancreatitis, or choledocholithiasis .

Risk factor’s

Factors that can increase the risk of gallstones include being a woman, being over 60, being overweight or obese, having diabetes , etc.

Factors that can increase the risk of gallstones include:

To be a woman
Be over 60 years old
Being overweight or obese
Have diabetes
Lose weight fast
Be pregnant
Eating a high fat diet
Eating a diet rich in cholesterol
Eating a low fiber diet
Having a family history of gallstones
Take some cholesterol-lowering medications
Taking estrogen-containing medications, such as hormone therapy drugs

Complications

Complications of gallstones can be inflammation of the gallbladder and obstruction of the common or pancreatic bile duct. Gallstone complications can be:

Inflammation of the gallbladder. A gallstone that lodges in the neck of the gallbladder can cause inflammation of the gallbladder ( cholecystitis). Cholecystitis can cause severe pain and fever.
Common bile duct obstruction. Gallstones can block the tubes (ducts) through which bile flows from the gallbladder or liver to the small intestine. Jaundice infection and bile ducts can result.
Pancreatic duct obstruction. The pancreatic duct is a tube that runs from the pancreas to the common bile duct. Pancreatic juices, which aid digestion, flow through the pancreatic duct. A stone can cause a blockage in the pancreatic duct, which can lead to inflammation of the pancreas (pancreatitis). Pancreatitis causes severe and constant abdominal pain and generally requires hospitalization.
Gallbladder cancer. People with a history of gallstones have an increased risk of gallbladder cancer. But gallbladder cancer is very rare, so although the risk of cancer is high, the risk of gallbladder cancer is still very small.

Diagnosis Tests and procedures used to diagnose gallstones include tests to create images of the gallbladder.

Tests and procedures used to diagnose gallstones include:

Tests to create images of the gallbladder. Your doctor may recommend an abdominal ultrasound and computed tomography (CT) to create images of the gallbladder. These images can be analyzed to look for signs of gallstones.
Tests to check the bile ducts for gallstones. A test that uses a special contrast medium to highlight the bile ducts on the images can help your doctor determine if a gallstone is causing an obstruction. Tests may include hepatobiliary iminodiacetic acid (HIDA), magnetic resonance imaging (MRI), or endoscopic retrograde cholangiopancreatography (ERCP). Gallstones discovered using ERCP can be removed during the procedure.
Blood tests to look for complications. Blood tests can reveal an infection, jaundice, pancreatitis, and other complications caused by gallstones.

Treatment

Gallstones that don’t cause any signs or symptoms usually don’t need treatment. Treatment options for gallstones include surgery to remove the gallbladder and medications to dissolve the gallstones.

Treatment for gallstones that do not cause signs and symptoms

Gallstones that do not cause signs and symptoms, such as those found during an ultrasound or CT scan for some other condition, usually do not require treatment.

Your doctor may recommend that you be alert to the symptoms of gallstone complications, as the pain intensifies in the right upper abdomen. If gallstone signs and symptoms occur in the future, you may have treatment. But most people with gallstones that don’t cause symptoms will never need treatment.

Treatment for gallstones that cause symptoms and signs

Treatment options for gallstones include:

Surgery to remove the gallbladder (cholecystectomy). The doctor may recommend surgery to remove the gallbladder, gallstones as they frequently recur. Once the gallbladder is removed, the bile flows directly from the liver to the small intestine, rather than being stored in the gallbladder. You don’t need your gallbladder to live, and removal of the gallbladder does not affect your ability to digest food, but it can cause diarrhea, which is usually temporary. Read more.
Medicines to dissolve gallstones. Medicines taken by mouth can help dissolve gallstones. But it can take months or years of treatment to dissolve gallstones in this way. Gallstone medications are not for general use and are reserved for people who cannot have surgery.

Prevention

You can reduce your risk of gallstones by skipping meals, losing weight slowly, and maintaining a healthy weight. To reduce your risk of gallstones:

Do not skip meals. Try to keep your usual meals every day. Skipping meals or fasting can increase the risk of gallstones.
Lose weight slowly. If you need to lose weight, go slow. Rapid weight loss can increase the risk of gallstones. Try to lose 1 to 2 pounds (0.5 to 1 kilogram) a week.
Maintain a healthy weight. Obesity and being overweight increase the risk of gallstones. Work toward a healthy weight by reducing the number of calories you eat and increasing the amount of physical activity you get. Once you achieve a healthy weight, work to maintain that weight by following a healthy diet and continuing to exercise.