Gall Stones and Gall Bladder Disorders

Gallstone:  a calculus formed in the gallbladder or bile duct.

Gallbladder and biliary tract disorders:  includes Cholecystitis, cholelithiasis, choledocholithiasis, cholangitis, and gallstone ileus

Gallbladder and biliary tract disorders are common and frequently painful conditions that usually require surgery and may be life-threatening.  Usually they often accompany calculus deposition and inflammation.  Gallbladder and duct diseases usually occur in middle age.  They are more common in women, but incidence in both sexes becomes equal after age 50.

Cholecystitis:  acute or chronic inflammation of the gallbladder is usually associated with a gallstone impacted in the cystic duct, causing painful distention of the gallbladder.  Prognosis is good with treatment.  The acute form is most common during middle age; the chronic form, among the elderly.

Cholangitis:  infection of the bile duct.  It is commonly associated with choledocholithiasis (calculi in the common bile duct) and may follow percutaneous (performed through the skin) transhepatic cholangiography (radiography of the bile ducts).  Widespread inflammation may cause fibrosis and stenosis of the common bile duct and biliary radicles.  Prognosis for the rare condition is poor- stenosing or primary sclerosing cholangitis is almost always fatal.

Cholelithiasis:  stones or calculi in the gallbladder (gallstones), results from changes in bile components.  It is the leading biliary tract disease, affecting over 20 million Americans, and accounts for the third most common surgical procedure performed in the United States.  (Cholecystectomy)

Choledocholithiasis:  occurs when gallstones passed out of the gallbladder lodge in the common bile duct, causing partial or complete biliary obstruction.  Prognosis is good unless infection develops.

Gallstone ileus:  involves small bowel obstruction by a gallstone.  Usually, the gallstone travels through a fistula between the gallbladder and small bowel and lodges at the ileocecal valve.  Prognosis is good with surgery. Gallstone ileus is most common in the elderly.

Cause:  The exact cause of gallstone formation is unknown, but abnormal metabolism of cholesterol and bile salts is a likely cause.

Risk factors include:

--A high calorie, high cholesterol diet, associated with obesity
--Elevated estrogen levels from oral contraceptives, postmenopausal therapy, and pregnancy.
--Diabetes mellitus, ileal disease, hemolytic disorders, liver disease, or pancreatitis.

How gallstones form:  Bile is made continuosly by the liver and is concentrated and stored in the gallbladder until needed by the duodenum to help digest fat.  Changes in the composition of bile or in the absorptive ability of the gallbladder epithelium allow gallstones to form.

Symptoms:

In acute cholecystitis, acute cholelithiasis, and choledocholithiasis:

--a classic attack with severe midepigastric or right upper quadrant pain radiating to the back or referred to the right scapula, frequently after meal rich in fats.
--recurring fat intolerance
--belching that leaves a sour taste in the mouth
--flatulence
--indigestion
--diaphoresis (profuse perspiration)
--nausea
--chills and low-grade fever
--possible jaundice and clay colored stools with common duct obstruction.

In cholangitis:
--weakness and fatigue
--abdominal pain
--possible jaundice and related itching
--high fever and chills

In gallstone ileus:
--absent bowel sounds (in complete bowel obstruction)
--intermittent colicky pain over several days
--nausea and vomiting
--abdominal distention

Treatment:

Surgery, usually elective, is the treatment of choice for gallbladder and duct disease.

Low-fat diet

Vitamin K

A nonsurgical treatment for choledocholithiasis involves insertion of a flexible catheter, formed around a T tube, through the sinus tract into the common bile duct.  Guided by fluoroscopy, the doctor directs the catheter toward the stone.  The doctor then threads a Dormia basket through the catheter, opens and twirls it to entrap the calculi, then closes and withdraws the basket.

Chenodiol, a drug that dissolves radiolucent calculi,, provides an alternative for patients who are poor surgical risks or who refuse surgery.  The use of chenodiol is limited by the need for prolonged treatment, the high incidence of adverse effects, and the frequency of calculi re-formation after treatment is stopped.

Lithotripsy:  is the breakup of gallstones through ultrasonic waves, is an investigational procedure with good results in many cases.

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