Cholelithiasis is the most common biliary tract disease and one of the most common surgical indications. According to autopsy findings, up to 20–30% of the population is affected by cholelithiasis. It occurs four times more often in women, and it is more common in obese, diabetics and patients with prehepatic (hemolytic) jaundice. right|350px
Pathogenesis[edit | edit source]
Choledocholithiasis can be primary or more often secondary – a stone travels from the gallbladder to the bile duct . Stones are formed when there is a disproportion between the concentrations of the basic components of bile (cholesterol, bile acid salts and phospholipids).
Composition of stones:
- according to the predominant component,
- cholesterol – - solitary, spherical, in cross section crystals of cholesterol are arranged the radiallyl . They are formed when there is an increased concentration of cholesterol in the bile (cause – high fat diet;),
- black – solid, multiple, they occur in the gallbladder during hemolytic jaundice (increased bilirubin);
- brown – oily, usually in the bile ducts during cholestasis and inflammation;
- mixed (most common in the Czech Republic) - multiple, faceted stones, they occur mainly in the chronically inflamed gallbladder, their presence is considered precancerous;
- according to the shape –so-called sand ("gallbladder sludge"), larger solitary or multiple stones (multiple stones have a polyhedral shape with flat areas - facets - in places of mutual contact → faceted stones).
Etiology[edit | edit source]
- High fat diet – cholesterol stones;
- hemolysis – black pigment stones;
- cholestasis – brown pigment stones in the choledochus;
- inflammation – brown pigment stones in the choledochus, mixed stones in the gallbladder;
- stones can be both a cause and a consequence of inflammation and cholestasis;
- cystic obstruction causes billiary colic and can lead to acute cholecystitis;
- risk factors include high fat diet, obesity, hemolytic states, pregnancy, DM.
Clinical picture[edit | edit source]
- Asymptomatic form
- Dyspeptic form
- non-specific symptoms - pressure in the abdomen, nausea, vomiting, belching, flatulence, feeling of tension after eating food with fats;;
- sensitivity in the right lower area under rib cage , positive Murphy's sign.
- Colica form
- typical manifestation of the disease;
- when there is closure of the cystic duct with a stone;
- provocative moment - dietary mistake - foods rich in fats, eggs, chocolate, mental shocks, anger;
- but often just drinking water is enough;
- night attacks - they are explained by easier clogging of the cystic duct in a horizontal position;
- they can happen often, almost daily, or in other cases they do not recur for years.
- Nature of pain:
- sudden onset of severe convulsive pain in the area under right rib cage, radiates under the right shoulder blade;
- in contrast to inflammation - this pain forces the patient to move and look for a relief position;
- The pain may spread to the precordium and mimic ischemic coronary heart disease;
Diagnosis[edit | edit source]
- Simple billiary colic lasts for several hours.
- Prolonged pain - beginning of inflammation of the gallbladder is suspected
- Usually a typical clinical picture, to confirm - USG, X-ray of the abdomen (stones, if they contain Ca2+).
- Oral cholecystography, or cholangiography - recommended only after the pain has subsided (for example, after 2-3 weeks).
- The ERCP (Endoscopic retrograde cholangiopancreatography ) gives us an accurate idea of the shape and placement.
Complication[edit | edit source]
- Acute and chronic cholecystitis - we always find different degrees of inflammation, it is difficult to decide what was the first;
- Gallbladder Hydrops - Clogging of the cystic duct, a palpable pear-shaped formation underneath rib cage ;
- Choledocholithiasis - smaller stones pass through the cyst, they can get blocked in the papilla - pancreatitis, obstructive jaundice, cholangitis; …
- Gallbladder cancer;
Differential diagnostics[edit | edit source]
- Ulcer, pancreatitis, hepatitis, gallbladder carcinoma, distension of the hepatic flexion of the colon, irritable bowel syndrome, subhepatic appendicitis, kidney, AIM (acute infarct of myocard) and others.
Therapy[edit | edit source]
- We treat colic without infection by resting in bed, local application of warm compresses (if we are sure that it is not inflammation);
- We administer analgesics and antispasmodics (Spasmoveralgin, Dolsin;…).
- The first two days, until calming - a tea diet;
- After subside of the attack - gallbladder diet;
- There is no conservative treatment for lithiasis (other than cholesterol);
- administration of chenodeoxycholic acid - dissolution of cholesterol stones, frequent recurrences;
- Lithotripsy - compared to the previous treatments it has little results;
- Radical method of treatment - cholecystectomy - classically or laparoscopically;
- should be performed as soon as possible after evidence of cholelithiasis - this will reduce the percentage of complications;
Links[edit | edit source]
Related articles[edit | edit source]
[edit | edit source]
- Cholelitiáza – Cholelithiasis - video on YouTube.com