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Gallstone disease: Difference between revisions
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'''Cholelithiasis''' refers to the presence of gallstones in the gallbladder, while | '''Cholelithiasis''' refers to the presence of gallstones in the gallbladder, while choledocholithiasis refers to gallstones in the common bile duct. '''Gallstone disease''' refers to various clinical manifestations of the presence of gallstones, including: | ||
* Uncomplicated gallstone disease | * Uncomplicated gallstone disease | ||
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** [[Gallstone ileus]] | ** [[Gallstone ileus]] | ||
'''''Complicated'' gallstone disease''' refers to the presence of gallstone-related complications, | '''''Complicated'' gallstone disease''' refers to the presence of gallstone-related complications, mentioned above. Complicated gallstone disease may present with biliary colic. If biliary colic is present without gallstone-related complications, the condition is called ''uncomplicated gallstone disease''. | ||
The majority of gallstones are asymptomatic (and therefore not considered as gallbladder disease) and are discovered incidentally on imaging. Gallstones exist in 10 – 15% of the Western population, but only 1 – 4% become symptomatic. | The majority of gallstones are asymptomatic (and therefore not considered as gallbladder disease) and are discovered incidentally on imaging. Gallstones exist in 10 – 15% of the Western population, but only 1 – 4% become symptomatic. | ||
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* 6 Fs | * 6 Fs | ||
** Fat (obesity) | ** Fat ([[obesity]]) | ||
** Female | ** Female | ||
** Fertile (multiparity or pregnancy) | ** Fertile (multiparity or pregnancy) | ||
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For pigment stones: | For pigment stones: | ||
* Chronic haemolytic anaemias | * Chronic [[Haemolytic anaemia|haemolytic anaemias]] | ||
* Billiary infection | * Billiary infection | ||
* Gastrointestinal disorders | * Gastrointestinal disorders | ||
** Crohn disease | ** [[Inflammatory bowel disease (Crohn disease and ulcerative colitis)|Crohn disease]] | ||
** Ileal resection | ** Ileal resection | ||
** Cystic fibrosis with pancreatic | ** [[Cystic fibrosis]] with pancreatic insufficiency. | ||
== Pathology == | == Pathology == | ||
Two types of stones exist. The most common type is the ''cholesterol stone'', which accounts for 80% of all stones in the west. Bile formation is the only significant pathway for the body to eliminate excess cholesterol, either as free cholesterol or as bile salts. Cholesterol is dissolved in bile. The solution gets ''supersaturated'' if the cholesterol concentration exceeds the solubilization capacity of the bile. | Two types of stones exist. The most common type is the ''[[cholesterol]] stone'', which accounts for 80% of all stones in the west. Bile formation is the only significant pathway for the body to eliminate excess cholesterol, either as free cholesterol or as bile salts. Cholesterol is dissolved in bile. The solution gets ''supersaturated'' if the cholesterol concentration exceeds the solubilization capacity of the bile. | ||
Cholesterol won’t crystallize out of the solution until there is a ''nucleus'', a “starting point” that it can precipitate onto. This ''nucleation'' process is then followed by ''growth'', as more and more cholesterol precipitate into the nucleus, causing the stone to grow in size. Biliary ''stasis'' is also essential for the development of a stone. | Cholesterol won’t crystallize out of the solution until there is a ''nucleus'', a “starting point” that it can precipitate onto. This ''nucleation'' process is then followed by ''growth'', as more and more cholesterol precipitate into the nucleus, causing the stone to grow in size. Biliary ''stasis'' is also essential for the development of a stone. | ||
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== Diagnosis and evaluation == | == Diagnosis and evaluation == | ||
Leukocytosis is often present in cholecystitis and cholangitis. An afebrile patient with biliary colic and normal inflammatory parametres likely has uncomplicated gallstone disease. Elevated liver enzymes, bilirubin, or jaundice is suspicious for choledocholithiasis. | [[Leukocytosis]] is often present in [[Acute calculous cholecystitis|cholecystitis]] and [[cholangitis]]. An afebrile patient with biliary colic and normal inflammatory parametres likely has uncomplicated gallstone disease. Elevated [[Liver enzyme|liver enzymes]], [[bilirubin]], or [[jaundice]] is suspicious for [[choledocholithiasis]]. | ||
Ultrasound is the most sensitive imaging modality for detecting gallbladder stones and evaluating the biliary tree. | [[Ultrasound]] is the most sensitive imaging modality for detecting gallbladder stones and evaluating the biliary tree. | ||
Abdominal CT may be used to rule out certain complicated gallstone diseases, like gangrenous cholecystitis, gallbladder perforation, emphysematous cholecystitis, or gallstone ileus. CT cannot visualise the stones themselves well. | Abdominal [[CT]] may be used to rule out certain complicated gallstone diseases, like gangrenous cholecystitis, gallbladder perforation, emphysematous cholecystitis, or [[gallstone ileus]]. CT cannot visualise the stones themselves well. | ||
[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
[[Category:Gastrointestinal surgery]] | [[Category:Gastrointestinal surgery]] | ||