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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;),
    • pigment:
      • 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]

thumb|ERCP – kámen ve žlučovodu

  • 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; …

When fused with the surroundings, the stones can travel as biliodigestive fistula into the surrounding structures - duodenum, colon transversum, choledochus, abdominal wall - biliary ileus;

  • Gallbladder cancer;

Differential diagnostics[edit | edit source]

Therapy[edit | edit source]

thumb|Duodenoskopie – extrakce pigmentového kamenu ze žlučovodu

  • 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]

External links[edit | edit source]

References[edit | edit source]

Source[edit | edit source]

Kategorie:Chirurgie Kategorie:Gastroenterologie Kategorie:Patologie Kategorie:Vnitřní lékařství Kategorie:Interní propedeutika