Cholelithiasis (Gallstones)

Cholelithiasis is the medical term for gallstones, aka, calculi, which are hardened digestive juices in the gallbladder. Stone formation is the result of gallbladder stasis and biliary precipitate. It is thought that biliary sludge is the precursor to gallstones; this consists of calcium bilirubinate, cholesterol microcrystals, mucin, and develops during stasis (i.e., pregnancy and total parental nutrition). This can clear up, or it can progress to gallstone formation. Biliary colic: when cholelithiasis is symptomatic, we call it "biliary colic" – this is typically characterized by right upper quadrant pain that can radiate to other areas, with possible nausea and vomiting. Biliary colic is an intermittent pain that is caused by gallbladder contraction that pushes a stone into the opening of the cystic duct; when the gallbladder relaxes, the stone usually falls back into the gallbladder and the pain subsides. ("colic" refers to the intermittent nature) In general, biliary colic is triggered by fatty meals, and the pain begins within an hour of eating; be aware that this pattern can vary significantly. Diagnosis We use ultrasound to visualize and diagnose gallstones. Treatment Can include stone dissolution with oral ursodeoxycholic acid or laparoscopic cholecystectomy. Complications of gallstones include inflammation and infection, which we'll learn about in a moment. Gallstones are extremely common, and nearly always asymptomatic (80% of cases). However, there may be complications associated with Gallstones: Acute cholecystitis Choledocholithiasis Cholesterol-based gallstones: Excess cholesterol forms crystals and gets trapped in gallbladder "sludge;" excessive cholesterol can be the result of excessive secretion (as we see in obesity) or with decreased bile salts (as we see in cystic fibrosis). Cholesterol-based stones make up 80-90% of all gallstones. Key risk factors for their formation include: obesity, elevated estrogen (female sex, pregnancy, multiparity, etc.), some medications, rapid weight loss or gain, being 40+ years old, and having American Indian or Central or South American ancestry. Pigment, aka, bilirubin, gallstones: Less common. Black pigment stones are small and hard; they comprise calcium bilirubinate and inorganic calcium salts. They are associated with alcoholic liver disease and chronic hemolysis. Brown pigment stones are soft and greasy; they comprise bilirubinate and fatty acids. They are associated with bacterial and parasitic infection and inflammation. Gallbladder Ultrasound Gallbladder stone Review more Gallbladder Pathologies Other causes of abdominal pain