Gallstone disease overview: Difference between revisions

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==Causes==
==Causes==


Common causes of gallstone disease include pregnancy and obesity.
Common causes of gallstone disease include increasing age, pregnancy and obesity.


==Differentiating {{PAGENAME}} from Other Diseases==
==Differentiating {{PAGENAME}} from Other Diseases==

Revision as of 16:27, 7 December 2017

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Gallstone disease Microchapters

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Gallstone disease from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Lithotripsy
Surgical management

Primary Prevention

Secondary Prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Overview

Gallstone disease is the presence of gallstones (cholelithiasis) within the gallbladder. Gallstones are crystalline bodies formed within the body by accretion or concretion of normal or abnormal bile components. Gallstones can occur anywhere within the biliary tree, including the gallbladder and the common bile duct. Obstruction of the common bile duct is choledocholithiasis; obstruction of the biliary tree can cause jaundice; obstruction of the outlet of the pancreatic exocrine system can cause pancreatitis. Cholelithiasis is the presence of stones in the gallbladder—chole- means "bile", lithia means "stone", and -sis means "process".

Historical Perspective

Gallstone disease has been noted as far back as when Egyptian pharaohs ruled. Autopsies performed on mummies found gallstones present within the body cavities.

Classification

Gallstone disease may be classified according to the chemical analysis of the stone found into 3 subtypes/groups: pure cholesterol, pure bilrubin stones and mixed.

Pathophysiology

It has long been noted that gallbladder stone formation, and in particular cholesterol stones, are associated with bile supersaturation, and this still remains the most common cause for gallstone formation.

Causes

Common causes of gallstone disease include increasing age, pregnancy and obesity.

Differentiating Gallstone disease overview from Other Diseases

Gallstone disease must be differentiated from other diseases that cause (right upper quadrant) such as: gastroesophageal reflux disorder, peptic ulcer disease,hepatitis,sphincter of Oddi dysfunction,appendicitis, bile duct stricture, chronic pancreatitis, irritable bowel syndrome, ischemic heart disease, pyelonephritis, ureteral calculi and complications of gallstone disease include: acute cholecystitis, choledocholithiasis, acute pancreatitis, and acute cholangitis.

Epidemiology and Demographics

Gallstone disease has an overall higher prevalence in females than males of the Western Caucasian, Hispanic and Native American nations. Approximately 62 people will have gallstones per 100,000 worldwide.

Risk Factors

Common risk factors in the development of gallstone disease include age, sex, pregnancy, and oral contraceptives and estrogen replacement therapy. Less common risk factors include obesity, sudden weight loss and diabetes.

Screening

Early treatment of Gallstone disease decreases the morbidity and avoids further cholecystectomy, which in turn may offset the need for screening, since patients would have to finance an ultrasound. However, periodic screening may be useful within the diabetic population. Therefore, there is insufficient evidence to recommend routine screening for Gallstone disease.

Natural History, Complications, and Prognosis

Gallstones develop in many people without causing symptoms. The chance of symptoms or complications from gallstones is about 20%. Nearly all patients (99%) who have gallbladder surgery do not have their symptoms return.


Diagnosis

History and Symptoms

The diagnosis of uncomplicated gallstone disease is made in a patient who may be asymptomatic or experiencing biliary colic with a normal physical examination and normal laboratory tests including complete blood count, aminotransferases, bilirubin, alkaline phosphatase, amylase, and lipase.Typically, the evaluation begins with a transabdominal ultrasound since it is the most sensitive modality for detecting gallbladder stones. Most patients are females over the age of 40 whom have had multiple children and tend to have a BMI over 25.

Physical Examination

Patients with gallstones are usually not ill-appearing and don't have fever or tachycardia. Physical examination of patients with gallstones is sometimes remarkable for right upper quadrant pain, epigastric tenderness, guarding and jaundice. This occurs when stone reach more than 8mm in size. Courvoisier's sign (a palpable gallbladder on physical examination) may be palpated when the common bile duct becomes obstructed and the gallbladder becomes dilated. This mostly occurs with malignant common bile duct obstruction, but has been reported with choledocholithiasis

Laboratory Findings

Laboratory findings are usually normal among patients with uncomplicated gallstone disease, both during asymptomatic periods and during attacks of pain. Abnormal blood tests (leukocytosis, elevated liver or pancreas tests) suggest the development of a complication of gallstone disease, such as cholecystitis, cholangitis, or pancreatitis

Imaging findings

Stones are mainly visualised using transabdominal ultrasonography.

Other diagnostic studies

There are other imaging modalities that can be useful in diagnosing gallstone disease, these include; endoscopic retrograde cholangiopancreatography (ERCP), bile microscopy and oral cholecystography. It should be noted however, that some of these have been replaced by non-invasive, more advanced and less expensive imaging technique

Treatment

Medical Therapy

Nonoperative management is suboptimal (ursodiol, lithotripsy). Cholecystectomy is the therapy of choice.

Surgery

Surgery is not the first-line treatment option for patients with asymptomatic gallstones. Surgery is usually reserved for patients with either symptomatic gallstones and willing to undergo surgery, had complications due to gall stones or are at risk of gallbladder cancer, and having symptomatic recurrent attacks.

Primary Prevention

Effective measures for the primary prevention of gallstone disease include diet with sufficient fat and protein, maintaining a low body weight, and avoiding prolonged fasting.

Secondary Prevention

Effective measures for the secondary prevention of gallstone disease include dietary measures and bile acid therapy. However, medical therapy of asymptomatic stones is not currently indicated.

References

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