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| {{Gallstone disease}} | | {{Gall stone disease}} |
| {{CMG}}
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| ==Overview==
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| == Physical Examination ==
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| Gallstones usually remain asymptomatic initially.<ref>{{cite web |url=http://www.emedicine.com/med/topic836.htm#section~clinical |title=Cholelithiasis |accessdate=2007-08-25 |work=emedicine from WebMD}}</ref> They start developing symptoms once the stones reach a certain size (>8mm).<ref>{{cite web |url=http://www.nlm.nih.gov/medlineplus/ency/article/000273.htm#Symptoms%20Medline%20Plus |title=Gallstones |accessdate=2007-08-25 |work=Medline Plus}}</ref> A main symptom of gallstones is commonly referred to as a gallstone "attack", also known as '''biliary colic''', in which a person will experience intense pain in the upper abdominal region that steadily increases for approximately thirty minutes to several hours. A victim may also encounter pain in the back, ordinarily between the shoulder blades, or pain under the right shoulder. In some cases, the pain develops in the lower region of the abdomen, nearer to the pelvis, but this is less common.
| | ==References== |
| ====Biliary colic====
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| '''Biliary colic''' is [[pain]] associated with irritation of the viscera secondary to [[cholecystitis]] and gallstones. Unlike renal colic, the phrase 'biliary colic' refers to the actual [[cholelithiasis]].
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| Though unlike renal colic, the phrase 'biliary colic' refers to the actual cholelithiasis. Although it is frequently described as
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| a [[colic]], the pain is steady, starts rapidly and lasts at least 30 minutes and up to several hours. Many patients complain of right upper quadrant pain, rt flank pain, or even mid chest pain with cholelithiasis. There may be
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| irradiation to the back and shoulders and other concomitant symptoms such as [[vomiting]] and [[diarrhea]]. Fatty foods
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| can provoke biliary pain, but this association is relatively non-specific.
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| Biliary pain can be associated with objective findings (dilation of the biliary tract, elevation of plasma liver enzyme
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| concentration, elevation of bilirubin, gamma-GT and alkaline phosphatase).
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| =====Causes=====
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| Biliary pain is most frequently caused by obstruction of the [[common bile duct]] or the [[cystic duct]] by a [[gallstone]]. However,
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| the presence of [[gallstones]] is a frequent incidental finding and does not always necessitate treatment,
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| in the absence of identifiable disease. Furthermore, biliary pain may be associated with functional disorders of the
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| biliary tract, so called acalculous biliary pain, and can even be found in patients post-cholecystectomy (removal
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| of the gallbladder), possibly as a consequence of dysfunction of the [[biliary tree]] and the sphincter of oddi.
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| =====Differential Diagnosis=====
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| *Amoebic liver abscess
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| *Perforated peptic ulcer
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| *Upper small bowel obstruction.
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| =====Complications=====
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| The more serious complication is total blockage of the bile duct which leads to [[jaundice]], which if it is not corrected naturally or by a surgical procedure can be fatal as it causes [[liver]] damage.
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| The presence of gallstones can lead to infection of the gall bladder (cholecystitis) or the biliary tree
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| (cholangitis) or acute inflammation of the pancreas (pancreatitis). Rarely, an impacted gallstone can obstruct
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| the bowel, causing [[gallstone ileus]] (mechanical [[ileus]]).
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| Biliary pain in the absence of gallstones may severely impact the patient's quality of life, even in the absence
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| of disease progression.
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| =====Presentation=====
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| This condition causes crescendos of severe pain in the [[right upper abdomen]] and sometimes through to the upper [[back]] and/or right shoulder. The pain relates to the obstruction of the passage of bile and can be associated with eating fatty foods. There is usually an inflammatory component to the pain as the characteristic colic is not completely relieved between crescendos.
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| Often, these attacks occur after a particularly fatty meal and almost always happen at night.
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| =====Treatment===== | |
| These attacks are intensely painful, similar to that of a [[kidney stone]] attack. One way to alleviate the abdominal pain is to drink a full glass of water at the start of an attack to regulate the bile in the [[gallbladder]], but this does not work in all cases. Another way is to take magnesium followed by a bitter liquid such as [[coffee]] or [[swedish bitters]] an hour later. Bitter flavors stimulate bile flow. A study has found lower rates of gallstones in coffee drinkers.<ref>{{cite web |url=http://jama.ama-assn.org/cgi/content/abstract/281/22/2106t |title=A Prospective Study of Coffee Consumption and the Risk of Symptomatic Gallstone Disease in Men |accessdate=2007-08-25 |work=The Journal of the American Medical Association}}</ref>
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| Pain management is an important part of treating biliary colic. Treatment is often with [[NSAIDs]] such as [[ketorolac]] (Toradol) and [[diclofenac]] (Voltaren). [[Hyoscine butylbromide]] (Buscopan) is occasionally used but is less effective than analgesics.<ref>{{cite web |url=http://www.bestbets.org/bets/bet.php?id=882 |title=BestBets: Buscopan (hyoscine butylbromide) in biliary colic. |format= |work= |accessdate=}}</ref>
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| ====Other symptoms====
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| Other symptoms include
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| *[[Jaundice]]
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| *[[Nausea]] and [[vomiting]]
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| *[[Diarrhea]]
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| *[[Bleeding]] caused by continuous vomiting
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| *[[Dehydration]] caused by the nausea and diarrhea.
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| *Abdominal bloating
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| *Intolerance of fatty foods
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| *Belching
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| *Indigestion.
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| If the above symptoms coincide with chills, [[low-grade fever|lowgrade fever]], yellowing of the skin or eyes, and/or clay-colored stool, a doctor should be consulted immediately.<ref name="nih_gall">{{cite web |url=http://digestive.niddk.nih.gov/ddiseases/pubs/gallstones/index.htm#symptoms |title=Gallstones |accessdate=2007-08-25 |work=National Digestive Diseases Information Clearinghouse}}</ref>
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| Some people who have gallstones are asymptomatic and do not feel any pain or discomfort. These gallstones are called "silent stones" and do not affect the [[gallbladder]] or other internal organs. They do not need treatment.<ref name="nih_gall"/>
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| ==References==
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| {{reflist|2}} | | {{reflist|2}} |
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| {{WS}}
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