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Cholelithiasis – Causes, Symptoms, Diagnosis and Treatment

CholelithiasisCholelithiasis or Biliary colic or Gallstones or Gallbladder Attack or Bile Calculus or Gallstone Attack or Biliary Calculus is a condition of gallbladder characterized by the formation of pebble-like, hard deposits. The size of these deposits may vary. They could be the size of a golf ball or as small as sand grain.

Gallstones are very common in Native Americans and other ethnic groups, women and people above the age of 40. It may also be inherited from a family member.

Types of Gallstones:

Two types of gallstones have been identified. These include:

  1. Stones formed from excess bilirubin in the bile – Bile is a substance that helps in the digestion of fats and is generated in the liver. Its components include cholesterol, water, bile salts and bile pigments. Bilirubin is a bile pigment. Excess bilirubin hardens and forms into hard deposits known as pigment stones.
  2. Stones formed from cholesterol – These are the most common type of gallstones. However, these have nothing to do with the levels of cholesterol in the blood.

Causes and Risk Factors:

  • During pregnancy failure to empty bile appropriately by the gallbladder may lead to this condition.
  • Biliary tract infections.
  • Liver cirrhosis (scarring and poor functioning of the liver).
  • Medical conditions such as sickle cell anemia and chronic hemolytic anemia that force the liver to manufacture bilirubin more than what is needed for the body.
  • Diabetes.
  • Eating a very low calorie diet, leading to rapid weight loss.
  • Bone marrow transplant.
  • Intravenous nutrition or intake of nutrition through a vein for a long period.
  • Obesity.
  • Inflammatory bowel diseases.

Symptoms of Cholelithiasis:

Surprisingly, a majority of the people with this condition did not complain of any symptoms. The condition was discovered in such cases during an abdominal surgery or a routine x-ray or some other medical procedures.

But, if the bile duct gets blocked due to the presence of a large stone, it may lead to a cramping pain in the right upper abdomen or middle abdomen. This painful condition is termed as biliary colic. Soon after the stone leaves the duct to enter duodenum (the first part of the small intestine), the pain disappears.

Symptoms include:

  • Jaundice or yellowing of the skin and white portion of the eyes.
  • Pain in the middle or right upper abdomen that may be episodic, sharp or dull and cramping, attacks soon after having a meal and may spread below the right shoulder or to the back.
  • Fever.
  • Clay colored stools.
  • Fullness of abdomen.
  • Nausea and/or vomiting.

Diagnosing Cholelithiasis:

Tests done to diagnose Gallstone Attack include:

  • Endoscopic retrograde cholangiopancreatography (ERCP).
  • Blood tests to check liver functioning, bilirubin levels and pancreatic enzyme levels.
  • Endoscopic ultrasound.
  • Abdominal ultrasound – Imaging technique to examine gallbladder, liver, pancreas, kindneys and spleen, the internal organs in the abdomen.
  • Gallbladder radionuclide scan – Radioactive material is used to check the functioning of gallbladder.
  • Abdominal CT scan – Imaging procedure that involves the usage of X-rays to create cross-sectional images of the abdominal parts.
  • Percutaneous transhepatic cholangiogram (PTCA) – X-ray of the tubes or ducts known as bile ducts that carry bile from liver to the small intestine and gallbladder.

Treatment of Cholelithiasis:

Treatment strategies include medication, surgery and lithotripsy.

  • Medications – Ursodeoxycholic acid (ursodiol, UDCA) and chenodeoxycholic acids (CDCA) are the names of the drugs that dissolve the cholesterol gallstones and are given in pill form. But, the main drawback with them is they may take 2 or more years to work efficiently and the stones may form again soon after the treatment ends. In some rare case scenarios, chemicals that dissolve the stones rapidly are inserted into the gallbladder via a catheter. But, because of the toxic nature of these chemicals this option is not used very often.
  • Surgery – This option is needed only if the symptoms are seen. Earlier, open cholecystectomy (removal of glabbader) was done in most of the cases. But, now an advanced technique called laparoscopic cholecystectomy (removal of the gallbladder with the help of a medical camera called laparoscope) is very often performed.
  • Lithotripsy – Also known as electrohydraulic shock wave lithotripsy (ESWL) this serves as the best option for people who cannot have surgery. This procedure uses shock waves to break the gallstones.  

Because this condition cannot be prevented, losing excess weight and eating low-fat diet may help in controlling the symptoms.

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