Gallstone disease, or cholelithiasis, refers to the formation of solid deposits (gallstones) within the gallbladder. These stones consist primarily of cholesterol, bile pigments, and calcium salts.

Gallstone Disease (Cholelithiasis & Its Complications)
Definition:
Gallstone disease, or cholelithiasis, refers to the formation of solid deposits (gallstones) within the gallbladder. These stones consist primarily of cholesterol, bile pigments, and calcium salts. Gallstones can remain asymptomatic or lead to complications such as biliary colic, cholecystitis, choledocholithiasis, and gallstone pancreatitis.

Types of Gallstones:
Cholesterol Stones (80%) – Composed mainly of cholesterol, often associated with obesity, high-fat diets, and metabolic disorders.
Pigment Stones (20%) – Composed of bilirubin, associated with chronic haemolysis (e.g., sickle cell disease, hereditary spherocytosis).
Mixed Stones – Contain cholesterol, bile pigments, and calcium.
Pathophysiology:
Gallstone formation occurs due to:
✅ Supersaturation of bile with cholesterol or bilirubin.
✅ Biliary stasis leading to sludge and stone formation.
✅ Gallbladder hypomotility causing bile stasis and precipitation.

Risk Factors ("4 F's – Female, Fat, Forty, Fertile")
✅ Non-Modifiable Factors:

Female sex (estrogen increases cholesterol secretion).
Age > 40 years.
Genetic predisposition.
✅ Modifiable Factors:

Obesity & rapid weight loss.
High-fat, low-fiber diet.
Diabetes, metabolic syndrome.
Prolonged fasting or total parenteral nutrition (TPN).
Clinical Features:
1. Asymptomatic Gallstones:
Found incidentally on ultrasound.
No treatment required unless symptomatic.
2. Symptomatic Gallstone Disease (Biliary Colic):
Intermittent RUQ or epigastric pain (after fatty meals).
Radiates to right shoulder or back.
Nausea & vomiting.
Resolves within hours without fever or jaundice.
3. Acute Cholecystitis (Inflammation of Gallbladder):
Severe RUQ pain lasting >6 hours.
Murphy’s sign positive (pain on inspiration with palpation).
Fever, leukocytosis.
Gallbladder wall thickening & pericholecystic fluid on ultrasound.
4. Choledocholithiasis (Common Bile Duct Stones):
Obstructive jaundice (yellow skin & sclera).
Dark urine, pale stools, pruritus.
Elevated alkaline phosphatase (ALP) & bilirubin.
5. Cholangitis (Infection of Biliary System – Medical Emergency!)
Charcot’s Triad:
✅ Fever & chills
✅ RUQ pain
✅ Jaundice
Reynolds’ Pentad (Severe Cases):
✅ Hypotension
✅ Altered mental status
6. Gallstone Pancreatitis (Blockage of Pancreatic Duct):
Epigastric pain radiating to the back.
Elevated serum amylase & lipase.
Requires urgent management.
Diagnosis:
✅ Ultrasound (First-line imaging):

Detects gallstones, gallbladder wall thickening, and pericholecystic fluid.
✅ Liver Function Tests (LFTs):

Elevated ALP & bilirubin → Suggests bile duct obstruction.
✅ Magnetic Resonance Cholangiopancreatography (MRCP):

Non-invasive imaging for common bile duct stones.
✅ Endoscopic Retrograde Cholangiopancreatography (ERCP):

Diagnostic & therapeutic for choledocholithiasis & cholangitis.
✅ CT Scan:

Used in complications like gallbladder perforation.
Management:

1. Gallstone diseaseGallstone disease
The department of the surgical diseases and transplantology of the
Urganch branch
of the Tashkent medical academy

2. Gallstone disease. Cholecystitis, Gallstone disease. Cholecystitis,
diagnosis and treatmentdiagnosis and treatment

3. Topicality
•According to the 6th World Congress of
Gastroenterology in the world for about 10% of the
population suffer from gallstone (more common in
developed countries, often in women, usually elderly)
•Only in the U.S. per year performed more than
1 million cholecystectomy in Russia - more
than 200 thousand in Uzbekistan - more than 5
thousand
•The cost of treatment of cholelithiasis in
France over 800 million euros a year.

4. Historical information
•Galen (Cl. Galenus) showed stones at autopsy. In 1341 Gentile da
Foligno in Padua in embalming the corpse of a noble woman found
in the neck of the gall bladder large green stone. In the second half
of XV century, the famous Florentine physician Antonio Benevieni at
autopsy woman who suffered long bouts of biliary colic, found in the
gall bladder stone black size of a walnut.
•Abu Ali ibn Sina - GSD called "disease-rich."
•V. Coiter in 1573 French physician J. Fernel (1574) described the
clinical presentation of gallstone disease and established its
connection with jaundice. Chemical study of gallstones was first
undertaken by S. Galeati (1746).
•J. Thudichum, suggested that the rudiments of rock formed by the
condensation cacocholia still in the intrahepatic bile ducts.

5. Syntopy gallbladder
1 - Gall Bladder 2 – duodenum 3 - The right proportion of liver

6. Gall bladder and biliary tractGall bladder and biliary tract

1 - bottom of the
gallbladder,
2 - body
3 - neck,
2 - area of
​​union with
the liver,
5 - right - and 6 left
hepatic ducts,
7 - cystic duct
8 - common duct
9 - sphincter of Oddi,
10 - Vater papilla
11 - Flow-term pancreas
cancer (Virsung).

7. Topography structures enclosed
in hepatoduodenal ligament.
1 — ductus hepaticus communis;
2 — ramus sinister a. hep. propriae;
3 — ramus dexter a. hep. propriae;
4 — a. hepatica propria;
5 — a. gastrica dextra;
6 — a. hepatica communis;
7 — ventriculus;
8 — duodenum;
9 — a. gastroduodenalis;
10 — v. portae;
11 — ductus choledochus;
12 — ductus cysticus;
13 — vesica fellea.

8. Physiology of the gallbladder
•1. During the day, the
liver produces about a liter
of bile.
•2. Sphincter of Oddi is
reduced (7), the output of
bile into the duodenum 12
(8) is terminated.
•3. Bile is continuously
fed into the bile duct (3)
•4. Next comes the
gallbladder (1) through the
cystic duct (2)
•5. The wall of the
bladder is very actively
sucks the water from the
bile

9. •When food enters from
stomach to 12 duodenum, it
begins to develop a hormone
- cholecystokinin.
•This hormone is a
powerful stimulant to reduce
gall bladder, and at the same
time, this hormone relaxes
the sphincter of Oddi.
•The wall of the bladder is
reduced simultaneously with
the relaxation of the
sphincter of Oddi and the
concentrated bile from the
gall bladder comes in 12
duodenal ulcer
Physiology of the gallbladder

10. •The composition of
bile
•Water
•Bile acids (U-ny
instvenny functional
component of bile)
•Lecithin
(phospholipid)
•Cholesterol (fat)
•Bilirubin (the pigment
that gives bile yellow)
•Proteins (proteins)
•Electrolytes
(potassium ions, sodium,
calcium, chlorine)
•Bile - a yellow liquid. The basis of bile is water, which
are major components of bile.
•The composition of bile

11. Causes of Gallstones
•Infectious inflammation of the biliary tract.
•Metabolic disorders (increased cholesterol in
the bile).
•Stagnation of bile in the biliary ducts.
Cholesterol Bile acids
Taurohol acid

12. Cholesterol gallstones

13. Black pigment stones of the
gallbladder

14. Brown pigment gallbladder
stone

15. Current stage of gallstone
disease
•The first stage - the physical and chemical.
(Nye litogen-bile). Clinical manifestations are
absent.
•The second stage - the latent asymptomatic
carriers of the stone. The process of stone
formation + + bile stasis inflammation. Clinical
manifestations are absent, and the stones are
discovered by accident.
•The third stage - marked clinical
manifestations. Acute inflammation in the
gallbladder, choledocholithiasis, stenosis of the
major duodenal papilla, acute cholangitis, acute
pancreatitis

16. Subjective manifestations of Subjective manifestations of
gallstonegallstone
•Pain in right hypochondrium
•Nausea
•Bitterness in the mouth
•Heartburn
•Vomiting
•Relationship of pain with food intake
•Abdominal distention

17. Localization of pain complaints
in Gallstone diseaseGallstone disease

18. 5 Symptoms to «F»
•FEMALE - female, female
•FORTY - forty
•FAT - thick, full
•FERTILE - fertile (multiparous)
•FAIR - blond, light (blonde)

19. Methods of diagnosis of gallstone
diseasedisease
•Duodenal intubation
•Ultrasonography
•Radiography (cholecysto-,holangiography)
•KT
•Laparoscopy
•Magnetic resonance imaging

20. The normal ultrasound pattern of gallbladder
1. cavity of
the
gallbladder
2. wall of the
gallbladder
3. cystic duct
4. liver tissue

21. Gallstones

22. Cholecystography

1. shadow of the
gallbladder
2. Shadow of
common bile duct
3. spine
4. ribs

23. Cholecystography in the presence
of two large stones in the
gallbladder
1. gallbladder
2. stones
3. edge
Disadvantages of the study
- Harm to the body.
- The need for training.
- The contrast is not always
accumulate in the biliary tract
Vaeth,
- Non-operation in the
gallbladder, the contrast he
does not fall

24. Computed tomography

25. retrograde pankretiko-
cholangiography
Antegrade
cholangiography

26. Percutaneous transhepatic-
cholecysto-, holangiography.

27. diagnostic laparoscopydiagnostic laparoscopy

28. Complications of gallstoneComplications of gallstone
disease disease
•Acute cholecystitis
•Choledocholithiasis
•Obstructive jaundice
•Acute pancreatitis
•Cholangitis
•Bile peritonitis
•Hepatic failure
•Abscesses

29. Surgeries GSDSurgeries GSD
•Laparoscopic cholecystectomy
•Open cholecystectomy
•Holedoholitotomy
•Papillosfinkterotomy
•Cholecystitis and holangiostomy
•Holedohoduodenostomy

30. Laparoscopic cholecystectomyLaparoscopic cholecystectomy
Puncture of the gall bladderSelect items
Clipping
The intersection of the
cystic duct Isolation of arterial Cholecystectomy

31. Open Open
cholecystectomycholecystectomy

32. Open cholecystectomy

33. Cholecystectomy "from the
neck" and "the bottom"

34. CholedochalduodenostomyCholedochalduodenostomy
метод Юраша Флеркена Финстерера