Cholelithiasis: Introduction

Cholelithiasis: Is the presence of gallstones in the gallbladder. More detailed information about the symptoms, causes, and

treatments of Cholelithiasis is available below.

General Illness Information

Medical Term: GALLSTONES (Cholelithiasis)
Common Name: Gallstones
Description: Gallstones are a collection of one or more stones in the
gallbladder, which is the hollow organ under the liver, that
stores bile. When the gallstones are in the gallbladder, the
condition is called cholelithiasis; when they are in the bile
ducts the condition is called choledocolithiasis.

Most gallstones in North America are composed primarily

of cholesterol (75%). 25% of gallstones are composed of
pigment (60% in Japan).

Affects both sexes but twice as common in females. It is

also more common in certain groups of people, such as
Native Americans and Hispanics. It can occur at any age,
but incidence increases with age and peaks at age 65. Rarely
occurs in children under ten.

Most gallstones form in the gallbladder. Most gallstones in

the bile ducts travel there from the gallbladder. Stones may
form in the bile duct when bile backs up because a duct has
narrowed or after the gallbladder has been removed.

Causes: Definite cause unknown. Possible causes are as follows:

Alterations in bile composition, such as increased
concentration of cholesterol or decrease in concentration of
phopholipids or bile acids; Failure of gallbladder to empty
adequately; Infection; Hemolytic disorders such as sickle
cell anemia.

Prevention: Avoid risk factors where possible.

Use of ursodiol (drug that dissolves gallstones) with rapid

weight loss prevents stone formation.
Signs & Symptoms
Mostly asymptomatic. Inthe United States, 20% of people over
age 65 have gallstones but most have no symptoms. 5-10%
become symptomatic each year. Over lifetime, less than half
of the patients with gallstones develop symptoms.
Episodic pain in the upper right abdomen or between the shoulder blades.
 Intolerance for fatty foods (indigestion, pain, bloating and belching).
Nausea and vomiting.
Bloating or belching.
Jaundice- sometimes.

Risk Factors
Family history of gallstones.
Genetic factors. Some ethnic groups are more susceptible, such as Native
Americans and Hispanics.
Obesity.
Excess alcohol consumption
Oral contraceptives.
High fat, low fiber diet.
Rapid weight loss.
Women who have had many children.(multiparity)
Hemolytic disorders such as sickle cell anemia, hereditary spherocytosis.
Liver cirrhosis.
Diabetes.
Female gender.
Inflammatory bowel disease such as crohns.

Diagnosis & Treatment

Diagnostic tests may include laboratory studies such as blood count and
blood chemistry, CT scan, ultrasound, cholecystography, and X-rays of the
gallbladder. Ultrasound scanning is the best method for diagnosing
gallstones in the gallbladder.
General Measures:
Treatment steps vary depending on severity of symptoms. Most people
who have "silent" gallstones do not require any treatment.Gallstones that
cause no symptoms can safely be left alone. They are unlikely to cause
problems. They do no need surgery.
People with intermittent pain can try a low fat diet. Doing so may help
prevent or reduce the number of pain episodes.
If you know you have gallstones and experience pain in the upper right
abdomen, apply heat to the area. If pain worsens or continues more than
3 hours, seek medical help. Hospitalization may be required for patients
with pain lasting more than 6 hours.
If gallstones in the gallbladder cause recurring bouts of pain in spite of
dietary changes than surgery to remove the gallbladder
(cholecystectomy) is indicated. Surgery to remove the gallbladder and
stones in the bile duct may be needed for patients with severe symptoms.

Laparoscopic cholecystectomy is usually the preferred procedure.

Laproscopic surgery was first introduced in 1990. About 90% of
cholecystectomies are performed laproscopically. In laproscopic surgery,
the gallbladder is removed through tubes that are inserted through small
incisions in the abdominal wall. The whole procedure is performed with
the help of a camera (laproscope) , also placed in the abdomen through
the small incisions. Laproscopic surgery has markedly reduced post-
operative discomfort, shortened hospital stay, and reduced time of work.
Shockwave (lithotripsy) treatment to break up (shatter) the stones may be
recommended in some cases.
 Medications:
For minor discomfort, you may use non-prescription drugs such as
acetaminophen.
Oral medication to try to dissolve stones. This treatment is used for
certain types of stones and can take up to two years.

Activity:
No restriction, except to rest during attacks of gallbladder
colic.
Diet:
During an attack, sip water occasionally, but don't eat.
At other times, eat low-fat diet. Fatty meals may bring on mild attacks.
If you are overweight, begin a weight reduction program.

Possible Complications :
Infection or rupture of the gallbladder.
Common bile duct stone with obstructive jaundice.
Gall bladder cancer.
Small bowel obstruction and paralysis due to gallstone causing
obstruction.

Prognosis
Most people with gallstones have no symptoms. For those who do, the
disorder is curable with surgery.

About 10 to 15% of people with gall bladder stones will have associated
choledocolithiasis (stones in the bile duct). Also, after cholecystectomy,
stones may recur in the bile duct.

Etymology: Gk, chole + lithos, stone, osis, condition

the presence of gallstones in the gallbladder. The condition affects about 20% of the population above 40 years of age
and is more prevalent in women and in persons with cirrhosis of the liver. Many patients complain of unlocalized
abdominal discomfort, eructation, and intolerance to certain foods. Others have no symptoms. In patients with severe
attacks of biliary pain associated with cholelithiasis, cholecystectomy is recommended to prevent such complications as
cholecystitis, cholangitis, and pancreatitis. Also called chololithiasis. See also biliary calculus, cholecystitis.

Overview, Causes, & Risk Factors

Cholelithiasis is usually incidentally discovered by routine x-ray study, surgery, or autopsy. Virtually all
gallstones are formed within the gallbladder, an organ that normally functions to store bile excreted from the
liver.

Bile is a solution composed of water, bile salts, lecithin, cholesterol and some other small solutes. Changes in
the relative concentration of these components may cause precipitation from solution and formation of a
nidus, or nest, around which gallstones are formed.
 These stones may be as small as a grain of sand, or they may become as large as an inch in diameter,
depending on how much time has elapsed from their initial formation. Depending on the main substance that
initiated their formation (for instance, cholesterol), they may be yellow or otherwise pigmented in color.

Cholelithiasis is a common health problem worldwide, affecting approximately 1 out of 1,000 people. The
prevalence is greater in women, Native Americans, and people over the age of 40.

In general, risk factors include increasing age, ethnic and hereditary factors, female gender, obesity, diabetes
, liver cirrhosis, long-term intravenous nutrition (total parenteral nutrition) and certain operations for peptic
ulcers.

Cholelithiasis
GENERAL INFORMATION:

What is cholelithiasis? Cholelithiasis (ko-le-li-THI-ah-sis) is a condition where you have gallstones

(stones in the gallbladder). The gallbladder is a pouch-like organ located just below the liver. The
gallbladder acts as a storage area for bile. Bile is a green-colored fluid made by the liver. Bile passes
through tubes called bile ducts and is released into the intestines when you eat. Bile helps in
digesting fats and other substances. Many people may have gallbladder stones but may not know it.
Pain in the abdomen (stomach) may happen when gallstones grow big and start blocking the bile
ducts.
What causes cholelithiasis? Problems with the way bile is made and excreted (emptied) from the
gallbladder may cause cholelithiasis. Bile is a balanced mixture of water, cholesterol (fat), bile salts
and bilirubin (yellow pigment). Stones may be made from different bile materials. Cholesterol stones
are formed when the bile has too much cholesterol and not enough bile salts. It is thought that liver
and blood diseases, such as hepatitis and anemia, may cause pigment stones. Gallstones may also
be formed when bile does not empty from the gallbladder as fast as it should. The following may
increase the chances of having cholelithiasis:

• Being overweight.

• Certain medicines, such as estrogen,

antibiotics, and cholesterol-lowering
medicines.

• Diabetes or previous surgery of the

small intestines.

• Fasting (going without food) or rapid

weight loss.

• Having another family member with

cholelithiasis.

• Pregnancy.

What are the signs and symptoms of cholelithiasis? The most common symptom of cholelithiasis
is a severe, steady pain felt in the right upper abdomen. It is usually just below the right rib cage. The
pain may also be felt in the right shoulder and between the shoulder blades. There may also be
nausea (feeling sick to the stomach) and vomiting (throwing up). These symptoms may go away on
their own, only to come back later, especially after a fatty meal. Other signs and symptoms may
include:

• Jaundice (yellowing of the skin or

whites of the eyes).
 • Feeling bloated or having too much
gas in the stomach.

• Pale colored stools (bowel

movements).

• Dark colored urine.

How is cholelithiasis diagnosed? You may need one or more of the following tests:

• Blood tests: You may need blood

taken for tests. The blood can be taken
from a blood vessel in your hand, arm, or
the bend in your elbow. It is tested to see
how your body is doing. It can give your
caregivers more information about your
health condition. You may need to have
blood drawn more than once.

• ERCP: ERCP is also called

endoscopic retrograde
cholangiopancreatography. This test is
done during an endoscopy to find stones,
tumors, or other problems. Dye is put into
the endoscopy tube. The dye helps your
pancreas and bile ducts show up better on
x-rays. People who are allergic to shellfish
(lobster, crab, or shrimp) may be allergic to
this dye. Tell your caregiver if you are
allergic to shellfish, dyes, or any medicines.
If you have stones, they may be removed
during ERCP.

• Liver and gallbladder scan: This

test may also be called a HIDA scan. This
is a test to look at your liver and
gallbladder. You are given a small amount
of radioactive dye in your IV. Pictures are
then taken by a special scanner that can
"see" the dye in your body. Caregivers look
at the pictures to see if your liver and
gallbladder are working normally.

• Oral cholecystography: Oral

cholecystographyis a test to look at your
gallbladder and its ducts (passages). You
are given pills to swallow that have a
special dye in them. Then, x-rays are taken
over time. The dye makes your gallbladder
and its ducts show up on the x-rays. This
may make it easier for your caregiver to
see any stones or swelling in your
 gallbladder. Some people may be allergic
to the kind of dye used in the pills. Tell
caregivers if you are allergic to dye or
shellfish (crab, lobster, or shrimp). It is also
very important to tell your caregiver if there
is any chance you could be pregnant. Your
caregiver will tell you what you can and
cannot eat before the test. It is important to
follow your caregiver's instructions or the
test may not work.

• Abdominal ultrasound: An
abdominal ultrasound is a test that is done
to see inside your abdomen. Sound waves
are used to show pictures of your abdomen
on a TV-like screen.

How is cholelithiasis treated? You may have any of the following:

• Surgical treatment: Surgery is often

needed to treat cholelithiasis. This may be
done by any of the following procedures:

o Open cholecystectomy: Open

cholecystectomy is surgery to
remove your gallbladder through
an incision (cut) under your right
rib cage. Ask your caregiver for
more information about open
cholecystectomy.

o Laparoscopic
cholecystectomy: This procedure
uses a laparoscope to take out the
gallbladder. A laparoscope is a
thin, lighted tube with a camera at
the tip. Small incisions are made in
the abdomen, where the
laparoscope and other surgical
instruments are inserted. Ask your
caregiver for more information
about laparoscopic
cholecystectomy.

• Non-surgical treatment: When

surgery cannot be done, you may have any
of the following treatments:
 o Lithotripsy: During lithotripsy,
shock waves are used to break
apart stones in your gallbladder,
kidney, or other areas. You may be
placed in a water bath or on a
water-filled cushion. You may be
given medicine to make you
drowsy before the procedure.
Shock waves are sent through the
water and toward the stone or
stones. The stones may break
apart when the shock waves hit
them. Pieces of the stones may
then pass out of your body when
you use the toilet. A lithotripsy,
though seldom used, is an option
that may be used in selected
patients.

o Oraldissolution therapy: These

are medicines that can melt small
cholesterol gallstones. Ask your
caregiver for more information
about using oral dissolution
therapy for cholelithiasis.

pathophysiology

• Cholelithiasis is the presence of stones in the gallbladder. Cholecystitis is acute or chronic inflammation
of the gallbladder. Choledocholithiasis is the presence of stones in the common bile duct.
• Most gallstones result from supersaturation of cholesterol in the bile, which acts as an irritant, producing
inflammation in the gallbladder, and which precipitates out of bile, causing stones. Risk factors include
gender (women four times as like to develop cholesterol stones as men), age (older than age 40),
multiple parity, obesity, use of estrogen and cholesterol-lowering drugs, bile acid malabsorption with GI
disease, genetic predisposition, rapid weight loss. Pigment stones occur when free bilirubin combines
with calcium. These stones occur primarily in patients with cirrhosis, hemolysis, and biliary infections.
• Acute cholecystitis is caused primarily by gallstone obstruction of the cystic duct with edema,
inflammation, and bacterial invasion. It may also occur in the absence of stones, as a result of major
surgical procedures, severe trauma, or burns.
• Chronic cholecystitis results from repeated attacks of cholecystitis, presence of stones, or chronic
irritation. The gallbladder becomes thickened, rigid, fibrotic, and functions poorly.
• Complications of gallbladder disease include cholangitis; necrosis, empyema, and perforation of
gallbladder; biliary fistula through duodenum; gallstone ileus; and adenocarcinoma of the gallbladder.