Cholelithiasis

Definition

Cholelithiasis is the fifth leading cause of hospitalization among adults. The disease may also be occur in persons who are obese, who have high cholesterol, or who are on cholesterol lowering drugs. In most cases, gallbladder and bile duct diseases occur during middle age. Between ages 20 and 50, they're six times more common in women, but incidence in men and women becomes equal after age 50. Incidence rises with each succeeding decade. Diseases of the gallbladder and biliary tract are common and painful conditions that may be life threatening and mostly require surgery. They are generally associated with deposition of calculi and inflammation.

Causes of Cholelithiasis

• Cholelithiasis may be occur due to changes in bile components
• Hormonal contraceptives
• Diabetes mellitus
• Celiac disease
• Pancreatitis
• Unexplained sepsis
• Right upper quadrant pain
• Fever
• Leukocytosis

This condition occurs when stones pass out of the gallbladder and lodge in the hepatic and common bile ducts, obstructing the flow of bile into the duodenum. Cholangitis, infection of the bile duct, is commonly associated with choledocholithiasis. Predisposing factors may include bacterial or metabolic alteration of bile acids. Cholecystitis, acute or chronic inflammation of the gallbladder is usually associated with a gallstone impacted in the cystic duct, that may cause painful distention of the gallbladder. Postcholecystectomy syndrome commonly results from residual gal1stones or stricture of the common bile duct. It may be occurs in 1 % to 5 % of all patients whose gallbladders have been surgical1y removed and may produce right upper quadrant abdominal pain, biliary colic, dyspepsia. and indigestion.

Symptoms of Cholelithiasis

• Acute cholelithiasis
• Acute cholecystitis
• Choledocholithiasis
• Classic gallbladder attack
• Biliary colic
• Flatulence
• Indigestion
• Diaphoresis
• Nausea
• Vomiting

Clinical features of cholangitis include:

• A rise in eosinophils
• Jaundice
• Abdominal pain
• High fever and chills
• Related itching
• Weakness
• Fatigue
• Slight weight loss
• Abdominal pain

Treatment of Cholelithiasis

• Surgery is the treatment of choice for gallbladder and biliary tract diseases and may include open or laparoscopic cholecystectomy, cholecystectomy with operative cholangiography and, possibly, exploration of the common bile duct.
• Other treatments such as low-fat diet to prevent attacks and vitamin K for itching, jaundice, and bleeding tendendes due to vitamin K deficiency.
• Treatment during an acute attack such as insertion of a nasogastric tube and an I.V.line and, possibly, antibiotic and analgesic administration.
• Another treatment for this disease is non surgical, it involves placement of a catheter through the percutaneous transhepatic cholangiographic route. Guided by fluoroscopy, the catheter is directed toward the stone. A basket is threaded through the catheter,opened, twirled to entrap the stone, closed, and withdrawn. This procedure can be performed endoscopically.