Surgical Procedures/Abdominal Surgery/Cholelithiasis

Cholelithiasis
GallStones

Introduction:

• Approximately 10% of the population have gallstones.
• The majority of the gallstones are asymptomatic.
• Only approximately 30% of sufferers have surgery.

Types

1. Cholesterol stones (Approximately 6%, less common).
2. Mixed stones (Approximately 90%, common).
3. Pigment stones (Uncommon).

Incidence of gallstones:

Classically: Fat, fertile flatulent female of  fifty (forty).

Commonest Causal Factors:

• Cholesterol stones:
  Approximately 75% of all gall stones are Cholesterol stones.
  • Excess of cholesterol relative to bile salts and phospholipids allowing cholesterol crystals to form.
  • Infection can cause cholesterol gallstone.
  • Oestrogens reduces gallbladder contraction and increases chances to gallstone formation.
  • Multiple pregnancies/contraceptive use.
  • Obesity.
  • Rapid weight loss.
  • Infestation with:
    • Clonorchis sinensis, Ascaris Lumbricoides etc.
• Pigmented stones:
  Approximately 25% of all gall stones are Pigmented Stones.
  • Black color Pigmented Stones:
    • Sufferer with Hemolytic disorders.
    • Sufferer with cirrhosis.
  • Brown color Pigmented stones:
    • Sufferer are mostly Asian population.
    • Bacterial Infection.
• Mixed stones:
  • mixed of cholesterol and pigmented.

Investigation

USG.

CT.

Asymptomatic gallstones disease

(Symptomless)

Approximately 50% gallstone sufferer are Asymptomatic.

Generally do not require Surgical treatment. (Depending on the indication).

• Relative Indication:
  • Large stones ( >2-3 cm ) with high risk of cholecystitis.
  • High or increased risk of malignancy (cancer).
  • Sufferer's age above 70.
  • Sufferer with Sugar disease (Diabetes): New evidence suggests that cholecystectomy should be done for the same indications as general population. thaere is no need of prophylactis cholecystectomy in asymptomatic gallstones in diabetics..
  • Sufferer with Immune diseases.

• Suggestive of gallstone disease.
  • Sufferer with Dyspepsia.
  • Vague abdominal discomfort.
    • Around Epigastric region.
  • Sufferer with increased flatulence.

Symptomatic Gallstone Disease

• Pain:
  • Known as Biliary colic.
  • Usually Right Upper Quadrant (sided) chest/abdominal pain.
    • Usually pain after oily food.
    • Quick pain which lasts few moments to few hours.
    • Pain with discomfort.
    • Pain often radiates (travels) towards  right scapula (back).
• Nausea and Vomiting may also present with pain.
• Acute Cholecystitis:
  • Occurs in approximately 10% of symptomatic gallstone disease.
  • Treatment of choice:
    • Laparoscopic cholecystectomy.
    • Open cholecystectomy.
    • Percutaneous transhepatic placement of a cholecystostomy tube.

 

Effects and Complication of GallStones

• In the gall bladder:
  • Asymptomatic gallstone.
  • Hydrops of the gallbladder.
  • Flatulent dyspepsia.
  • Gallstone colic.
  • Acute Obstructive cholecystitis which may lead to:
    • Mucocele.
    • Empyema.
    • Gangrene.
    • Perforation.
    • Fistula.
  • Chronic Cholecystitis.
  • Carcinoma.

• In the CBD:
  • Obstructive jaundice..
  • Liver failure.
  • Cholangitis.
  • Acute or recurrent pancreatitis.

• In the pancreas:
  • Acute Pancreatitis.
  • Acute relapsing Pancreatitis.
  • Chronic Pancreatitis.

• In the Intestine:
  • Gallstone Ileus.

Gallstones with other Diseases:

Gallstone may be associated with other diseases.

• Saint's Triad:
  • Gallstone + Hiatus Hernia + Diverticulosis of the Colon.

• Cholecystic Heart:
  • Diseased gallbladder may cause decreased coronary blood flow, arrythmia or heart block in previously heart disorder.

• Asymptomatic Gallstones:
  • After long follow-ups, approximately 50% asymptomatic turns into symptomatic.

About Gall Bladder and Cholelithiasis

• : Gall Bladder Questions