Cholelithiasis

cholelithiasis/Gallstones

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Cholelithiasis
Shemil
Clinical Instructor
DM WIMS

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A gallstone is a stone formed within the 
gallbladder out of bile components.The
term cholelithiasis may refer to the presence of
gallstones or to the diseases caused by gallstones.

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Bile also called gall, is a greenish yellow secretion that
is produced in the liver and passed to
the gallbladder for concentration, storage, or transport
into the first region of the small intestine,
the duodenum.
Its function is to aid in the digestion and absorption
of fat & Fat soluble vitamins.
Besides its digestive function, bile serves also as the
route of excretion for bilirubin, a byproduct of red blood
cells recycled by the liver. 
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Bile is composed of bile acids and salts,
phospholipids, cholesterol, bilirubin pigments, water,
and electrolyte chemicals.
About 800 to 1,000 ml of bile (before concentration) are
produced daily by the liver.
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Gallstones range in size from as small as a grain of
sand to as large as a golf ball. Some people develop just
one gallstone, while others develop many gallstones at
the same time.

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Types of gallstones
Types of gallstones that can form in the gallbladder
include:
Cholesterol gallstones. The most common type of
gallstone, called a cholesterol gallstone, often appears
yellow in color. These gallstones are composed mainly
of undissolved cholesterol, but may contain other
components.

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Pigment gallstones. These dark brown or black
stones form when bile contains too much
bilirubin
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Mixed stones
Mixed (brown pigment stones) typically contain 20–
80% cholesterol. Other common constituents are calcium
carbonate, palmitate phosphate, bilirubin and other bile
pigments (calcium bilirubinate, calcium palmitate
and calcium stearate)
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Causes
It's not clear what causes gallstones to form.
Bile contains too much cholesterol. Normally, bile
contains enough chemicals to dissolve the cholesterol
excreted by the liver. But if the liver excretes more
cholesterol than the bile can dissolve, the excess cholesterol
may form into crystals and eventually into stones.
The bile contains too much bilirubin. Bilirubin is a
chemical that's produced when the body breaks down red
blood cells. Certain conditions cause the liver to make too
much bilirubin, including liver cirrhosis, biliary tract
infections and certain blood disorders. The excess bilirubin
contributes to gallstone formation.
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The gallbladder doesn't empty correctly. If the
gallbladder doesn't empty completely or often
enough, bile may become very concentrated,
contributing to the formation of gallstones.
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Risk factors
Being female
Being age 40 or older
Being overweight or
obese
Being pregnant
Eating a high-fat diet
Eating a high-cholesterol
diet
Eating a low-fiber diet
Having a family history
of gallstones
Having diabetes
Losing weight very
quickly
Taking medications that
contain estrogen(oral
contraceptives)
Having liver disease
Skipping Meals
Constipation
Less intake of fluids
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SIGNS & SYMPTOMS
Gallstones may cause no signs or symptoms. If a
gallstone lodges in a duct and causes a blockage, the
resulting signs and symptoms may include:
A characteristic symptom of gallstones is a gallstone
attack, in which a person may experience colicky pain in
the upper-right side of the abdomen, often accompanied
by nausea and vomiting.
 

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Often, attacks occur after a particularly fatty meal and
almost always happen at night, and after drinking.
Back pain between the scapula
Pain in/below right shoulder
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If the stones block the duct and cause bilirubin
to leak into the bloodstream and surrounding
tissue, there may also be jaundice and itching.
Clay-colored stools

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Prevention
Don't skip/delay meals. Try to stick to the usual
mealtimes each day. Skipping meals or fasting can
increase the risk of gallstones.
Lose weight slowly. When lose weight, go slow. Rapid
weight loss can increase the risk of gallstones. Aim to
lose 1 or 2 pounds (about 0.5 to 1 kilogram) a week.
Maintain a healthy weight. Obesity and being
overweight increase the risk of gallstones. Work to
achieve a healthy weight by reducing the number of
calories eat and increasing the amount of physical
activity .

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Tests to Diagnose Cholelithiasis
Ultrasound of the abdomen.
CT scan of the abdomen.
Endoscopic retrograde cholangiopancreatography
(ERCP).
Percutaneous transhepatic cholangiogram (PTCA).
Magnetic resonance cholangiopancreatography
(MRCP).
Blood tests to check for bilirubin level.
Liver function tests.
Pancreatic enzymes

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Treatment options for gallstones include:
Surgery to remove the gallbladder
(cholecystectomy). Doctors may recommend surgery to
remove gallbladder, since gallstones frequently recur.
Once the gallbladder is removed, bile flows directly
from the liver into the small intestine, rather than being
stored in gallbladder.
Gallbladder removal doesn't affect the ability to
digest food, but it can cause diarrhea, which is usually
temporary.

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Medications to dissolve gallstones. Medications
(ursodeoxycholic acid, chenodeoxycholic acids ) may
help dissolve gallstones. But it may take months or
years of treatment to dissolve the gallstones in this
way and gallstones will likely form again if treatment
is stopped.
Sometimes medications don't work. Medications for
gallstones aren't commonly used and are reserved for
people who can't undergo surgery.

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Inflammation of the gallbladder (cholecystitis)
when a gallstone gets lodged in the neck of the
gallbladder
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Inflammation of the bile duct (cholangitis)
when a gallstone blocks the tubes (ducts) through
which bile flows from the gallbladder or liver to small
intestine
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Inflammation of the pancreas (biliary pancreatitis) –
when a gallstone blocks the pancreatic duct
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Obstruction of the intestine (gallstone ileus)
when an abnormal channel (known as a fistula)
opens up near the gallbladder to the duodenum,
blocking the bowel with stones

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