< Surgical Procedures < Abdominal Surgery

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:

    • 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

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