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

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

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

Investigation
<li>USG.</li> <li>CT.</li>

Asymptomatic gallstones disease
(Symptomless) <li>Approximately 50% gallstone sufferer are Asymptomatic.</li> <li>Generally do not require Surgical treatment. (Depending on the  indication).<ul> <li>Relative Indication:<ul> <li>Large stones ( &gt;2-3 cm ) with high risk of cholecystitis.</li> <li>High or increased risk of malignancy (cancer).</li> <li>Sufferer's age above 70.</li> <li>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..</li> <li>Sufferer with Immune diseases.</li> </ul> </li> </ul> </li>
 * Suggestive of gallstone disease.
 * Sufferer with Dyspepsia.
 * Vague abdominal discomfort.
 * Around Epigastric region.
 * Sufferer with increased flatulence.

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

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