Cholelithiasis

Cholelithiasis

  • Cholelith / ˈ k oʊ l ə l ɪ θ / , cholelithiasis / ˌ k oʊ l ə l ɪ ˈ θ aɪ ə s ɪ s /
Gallstone
Other names Gallstone disease, cholelith, cholecystolithiasis (gallstone in the gallbladder), choledocholithiasis (gallstone in a bile duct) [1]
Gallstones typically form in the gallbladder and may result in symptoms if they block the biliary system.
Pronunciation
Specialty General surgery
Symptoms None, crampy pain in the right upper abdomen [2] [3] [4]
Complications Inflammation of the gallbladder, inflammation of the pancreas, liver inflammation [2] [4]
Usual onset After 40 years old [2]
Risk factors Birth control pills, pregnancy, family history, obesity, diabetes, liver disease, rapid weight loss [2]
Diagnostic method Based on symptoms, confirmed by ultrasound [2] [4]
Prevention Healthy weight, diet high in fiber, diet low in simple carbohydrates [2]
Treatment Asymptomatic: none [2]
Pain: surgery [2]
Prognosis Good after surgery [2]
Frequency 10–15% of adults (developed world) [4]

A gallstone is a stone formed within the gallbladder out of bile components. [2] The term cholelithiasis may refer to the presence of gallstones or to the diseases caused by gallstones. [5] Most people with gallstones (about 80%) never have symptoms. [2] [3] When a gallstone blocks the bile duct, a cramp-like pain in the right upper part of the abdomen, known as biliary colic (gallbladder attack) can result. [4] This happens in 1–4% of those with gallstones each year. [4] Complications of gallstones may include inflammation of the gallbladder (cholecystitis), inflammation of the pancreas (pancreatitis), jaundice, and infection of a bile duct (cholangitis). [4] [6] Symptoms of these complications may include pain of more than five hours duration, fever, yellowish skin, vomiting, dark urine, and pale stools. [2]

Risk factors for gallstones include birth control pills, pregnancy, a family history of gallstones, obesity, diabetes, liver disease, or rapid weight loss. [2] The bile components that form gallstones include cholesterol, bile salts, and bilirubin. [2] Gallstones formed mainly from cholesterol are termed cholesterol stones, and those mainly from bilirubin are termed pigment stones. [2] [3] Gallstones may be suspected based on symptoms. [4] Diagnosis is then typically confirmed by ultrasound. [2] Complications may be detected on blood tests. [2]

The risk of gallstones may be decreased by maintaining a healthy weight with exercise and a healthy diet. [2] If there are no symptoms, treatment is usually not needed. [2] In those who are having gallbladder attacks, surgery to remove the gallbladder is typically recommended. [2] This can be carried out either through several small incisions or through a single larger incision, usually under general anesthesia. [2] In rare cases when surgery is not possible, medication can be used to dissolve the stones or lithotripsy to break them down. [7]

In developed countries, 10–15% of adults have gallstones. [4] Rates in many parts of Africa, however, are as low as 3%. [8] Gallbladder and biliary related diseases occurred in about 104 million people (1.6% of people) in 2013 and they resulted in 106,000 deaths. [9] [10] Women more commonly have stones than men and they occur more commonly after the age of 40. [2] Certain ethnic groups have gallstones more often than others. [2] For example, 48% of Native Americans have gallstones. [2] Once the gallbladder is removed, outcomes are generally good. [2]

Contents

Definitions [ edit ]

Gallstone disease refers to the condition where gallstones are either in the gallbladder or common bile duct. [5] The presence of stones in the gallbladder is referred to as cholelithiasis, from the Greek chol— (bile) + lith— (stone) + —iasis (process). [1] Presence of gallstones in the common bile duct is called choledocholithiasis, from the Greek chol— (bile) + docho— (duct) + lith— (stone) + iasis— (process). [1] Choledocholithiasis is frequently associated with obstruction of the bile ducts, which in turn can lead to cholangitis, from the Greek: chol— (bile) + ang— (vessel) + itis— (inflammation), a serious infection of the bile ducts. Gallstones within the ampulla of Vater can obstruct the exocrine system of the pancreas, which in turn can result in pancreatitis.

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Signs and symptoms [ edit ]

Gallstones, regardless of size or number, [11] may be asymptomatic, even for years. Such "silent stones" do not require treatment. [12] [13] A characteristic symptom of a gallstone attack is the presence of a colicky pain in the upper-right side of the abdomen, often accompanied by nausea and vomiting. The pain steadily increases for approximately 30 minutes to several hours. A person may also experience referred pain between the shoulder blades or below the right shoulder. Often, attacks occur after a particularly fatty meal and almost always happen at night, and after drinking.

In addition to pain, nausea, and vomiting, a person may experience a fever. If the stones block the duct and cause bilirubin to leak into the bloodstream and surrounding tissue, there may also be jaundice and itching. If this is the case, the liver enzymes are likely to be raised. [14]

Other complications [ edit ]

Rarely, gallstones in cases of severe inflammation may erode through the gallbladder into adherent bowel potentially causing an obstruction termed gallstone ileus. [15]

Other complications include ascending cholangitis if there is a bacterial infection which can cause purulent inflammation in the biliary tree and liver, and acute pancreatitis as blockage of the bile ducts can prevent active enzymes being secreted into the bowel, instead damaging the pancreas. [14] Rarely gallbladder cancer may occur as a complication. [6]

Risk factors [ edit ]

Gallstone risk increases for females (especially before menopause) and for people near or above 40 years; [16] the condition is more prevalent among both North and South Americans [ clarification needed ] and people of European descent than among other ethnicities. A lack of melatonin could significantly contribute to gallbladder stones, as melatonin inhibits cholesterol secretion from the gallbladder, enhances the conversion of cholesterol to bile, and is an antioxidant, which is able to reduce oxidative stress to the gallbladder. [17] Researchers believe that gallstones may be caused by a combination of factors, including inherited body chemistry, body weight, gallbladder motility (movement), and low calorie diet. [ citation needed ] The absence of such risk factors does not, however, preclude the formation of gallstones.

Nutritional factors that may increase risk of gallstones include constipation; eating fewer meals per day; low intake of the nutrients folate, magnesium, calcium, and vitamin C; [18] low fluid consumption; [19] and, at least for men, a high intake of carbohydrate, a high glycemic load, and high glycemic index diet. [20] Wine and whole-grained bread may decrease the risk of gallstones. [21]

Rapid weight loss increases risk of gallstones. [22] The weight loss drug orlistat is known to increase the risk of gallstones. [23]

Cholecystokinin deficiency caused by celiac disease increases risk of gallstone formation, especially when diagnosis of celiac disease is delayed. [24]

Pigment gallstones are most commonly seen in the developing world. Risk factors for pigment stones include hemolytic anemias (such as from sickle-cell disease and hereditary spherocytosis), cirrhosis, and biliary tract infections. [25] People with erythropoietic protoporphyria (EPP) are at increased risk to develop gallstones. [26] [27] Additionally, prolonged use of proton pump inhibitors has been shown to decrease gallbladder function, potentially leading to gallstone formation. [28]

Cholesterol modifying medications can affect gallstone formation. Statins inhibit cholesterol synthesis and there is evidence that their use may decrease the risk of getting gallstones. [29] [30] Fibrates increase cholesterol concentration in bile and their use has been associated with an increased risk of gallstones. [30] Bile acid malabsorption may also be a risk.

Pathophysiology [ edit ]

Cholesterol gallstones develop when bile contains too much cholesterol and not enough bile salts. Besides a high concentration of cholesterol, two other factors are important in causing gallstones. The first is how often and how well the gallbladder contracts; incomplete and infrequent emptying of the gallbladder may cause the bile to become overconcentrated and contribute to gallstone formation. This can be caused by high resistance to the flow of bile out of the gallbladder due to the complicated internal geometry of the cystic duct. [31] The second factor is the presence of proteins in the liver and bile that either promote or inhibit cholesterol crystallization into gallstones. In addition, increased levels of the hormone estrogen, as a result of pregnancy or hormone therapy, or the use of combined (estrogen-containing) forms of hormonal contraception, may increase cholesterol levels in bile and also decrease gallbladder motility, resulting in gallstone formation.

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Composition [ edit ]

The composition of gallstones is affected by age, diet and ethnicity. [32] On the basis of their composition, gallstones can be divided into the following types: cholesterol stones, pigment stones, and mixed stones. [3] An ideal classification system is yet to be defined. [33]

Cholesterol stones [ edit ]

Cholesterol stones vary from light yellow to dark green or brown or chalk white and are oval, usually solitary, between 2 and 3 cm long, each often having a tiny, dark, central spot. To be classified as such, they must be at least 80% cholesterol by weight (or 70%, according to the Japanese–classification system). [33] Between 35% and 90% of stones are cholesterol stones. [3]

Pigment stones [ edit ]

Bilirubin ("pigment", "black pigment") stones are small, dark (often appearing black), and usually numerous. They are composed primarily of bilirubin (insoluble bilirubin pigment polymer) and calcium (calcium phosphate) salts that are found in bile. They contain less than 20% of cholesterol (or 30%, according to the Japanese-classification system). [33] Between 2% and 30% of stones are bilirubin stones. [3]

Mixed stones [ edit ]

Mixed (brown pigment stones) typically contain 20–80% cholesterol (or 30–70%, according to the Japanese- classification system). [33] Other common constituents are calcium carbonate, palmitate phosphate, bilirubin and other bile pigments (calcium bilirubinate, calcium palmitate and calcium stearate). Because of their calcium content, they are often radiographically visible. They typically arise secondary to infection of the biliary tract which results in the release of β-glucuronidase (by injured hepatocytes and bacteria) which hydrolyzes bilirubin glucuronides and increases the amount of unconjugated bilirubin in bile. Between 4% and 20% of stones are mixed. [3]

Gallstones can vary in size and shape from as small as a grain of sand to as large as a golf ball. [34] The gallbladder may contain a single large stone or many smaller ones. Pseudoliths, sometimes referred to as sludge, are thick secretions that may be present within the gallbladder, either alone or in conjunction with fully formed gallstones.

Gallbladder opened to show small cholesterol gallstones

Cholelithíasis — (griech.), s. Gallensteine … Meyers Großes Konversations-Lexikon

Cholelithiasis — Klassifikation nach ICD 10 K80 Cholelithiasis K80.0 Gallenblasenstein mit akuter Cholezystitis K80.1 … Deutsch Wikipedia

Cholelithiasis — Gallensteinleiden * * * Cholelithiasis [ç ] die, /. thi asen, die Gallensteinkrankheit. * * * Cho|le|li|thi|a|sis, die; (Med.): Gallensteinleiden, Gallenkolik … Universal-Lexikon

cholelithiasis — noun Etymology: New Latin Date: circa 1860 production of gallstones; also the resulting abnormal condition … New Collegiate Dictionary

cholelithiasis — /koh leuh li thuy euh sis, kol euh /, n. Pathol. the presence of gallstones. [1855 60; CHOLELITH + IASIS] * * * … Universalium

cholelithiasis — noun gallstones Syn: biliary, lithiasis, gallstones See Also: cholecystitis … Wiktionary

cholelithiasis — Presence of concretions in the gallbladder or bile ducts. SYN: chololithiasis. * * * cho·le·li·thi·a·sis .kō li lith ī ə səs n, pl a·ses .sēz production of gallstones also the resulting abnormal condition * * * n. the formation of stones in the… … Medical dictionary

Cholelithiasis — Chole|li|thi̱a|sis w; , . thia̱|sen (in fachspr. Fügungen: . thi̱a|ses): Gallensteinleiden, Gallensteinkolik … Das Wörterbuch medizinischer Fachausdrücke

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Cholelithiasis — Cho|le|li|thi|a|sis die; <zu ↑. iasis> Gallensteinleiden, Gallenkolik (Med.) … Das große Fremdwörterbuch

cholelithiasis — n. presence of gallstones … English contemporary dictionary

cholelithiasis — [ˌkɒlɪlɪ θʌɪəsɪs] noun Medicine the formation of gallstones … English new terms dictionary

Холелитиаз – что это за болезнь? Суть холелитиаза заключается в образовании в желчном пузыре или в желчных протоках отложений, называемых камнями. Почему это происходит не совсем ясно. Известно лишь, что концентрация и застой желчи оказывают большое влияние на осаждение камней.

Холелитиаз – начало болезни

Желчнокаменная болезнь – это образование в желчном пузыре или в желчных протоках известковых калиевых и кальциевых осадков, образующих в дальнейшем сгусток конкрементов, концентрация которых способствует образованию камней в желчных путях.

Холестерин и желчные красители, содержащиеся в нем, накапливаются в виде отложений и раздражают слизистую оболочку фолликула, вызывая его воспалительную реакцию, которая, в свою очередь, вызывает высвобождение кальция, который дополнительно накапливается в этих камнях.

Камни препятствуют правильному оттоку желчи, необходимой для здорового пищеварения. Поэтому симптомы обычно появляются после употребления различных, особенно жирных продуктов, которые трудно перевариваются, что обеспечивает растяжение стенки желчного пузыря из-за застоя желчи.

Засорение шейки везикулы или желчного протока с камнем приводит к насильственной атаке – желчной колике.

Застой желчи вызывает боль, когда желчный пузырь перемещается и высвобождает желчь. Если в шейке желчного пузыря застревает камень, происходит раздражение слизистой оболочки, вызывая острый холецистит. Всё это сопровождается длительной и постоянной болью, которые могут исчезнуть спонтанно, когда после перемещения камня желчь находит выход. Однако повторное воспаление может привести к хроническому холециститу и, как следствие, к дальнейшим осложнениям, требующим немедленного хирургического вмешательства.

Холелитиаз – симптомы

Холелитиаз начинается с плохой переносимости шоколада, яиц, молока и так далее. Очень часто мы пренебрегаем этими признаками и помещаем их в болезни печени или язвенную болезнь желудка и двенадцатиперстной кишки.

Затем симптомы усиливаются:

  • через несколько часов после еды возникают боли на правой стороне желудка;
  • определяется болевой синдром под ребрами, излучающий боль к лопатке, и продолжающийся несколько часов;
  • отмечаются газы, вздутие живота и отрыжка;
  • появляется внезапная тошнота и рвота;
  • возникает сильная боль в грудине при вдохе;
  • чувствуется озноб, состояние лихорадки и повышения температуры тела.

Все эти симптомы холелитиаза обычно усиливаются в ночное время или утренние часы после пробуждения. Всё что нужно сделать в этом случае, это вызвать скорую помощь.

Важнейший клинический признак холелитиаза – желтуха, обусловленная обструкцией желчных протоков.

Описанные выше симптоматические признаки могут означать, что человек страдает от присутствия желчных камней, с резким приступом желчной и/или печеночной колики.

Такой комплекс симптоматических проявлений довольно распространенное состояние в области брюшной полости. Наиболее часто, диагноз холелитиаз определяется у женщин и мужчин после 45-50 лет, а процент вероятности достигает от 15 до 30% у взрослого населения. Как правило, в зону риска входят тучные люди, социально неадаптированные пациенты, а также больные с хроническими патологиями органов пищеварительной системы.

Холелитиаз – диагностика

Врач, исходя из типичных симптомов, способен быстро диагностировать холелитиаз на ранней стадии развития. Тем не менее, для подтверждения диагноза, необходимо провести ультразвуковое исследование, компьютерную и магнитно-резонансную томографию, которых достаточно для обнаружения отложений.

Холелитиаз: лечение болезни

По-прежнему эффективным лечением холелитиаза является хирургическое удаление камней, то есть холецистэктомия. В настоящее время эта процедура обычно выполняется с использованием лапароскопа.

Консервативные методы, включающие в себя применение пероральных препаратов, содержащих урсодезоксихолевую кислоту, которая является физиологическим компонентом желчи, также возможны, но врачи считают их дорогостоящими и не очень эффективными. Кроме того, их применение, возможно, лишь при неспецифической желчнокаменной болезни.

Первая неотложная помощь при холелитиазе

Алгоритм действий первой доврачебной помощи при холелитиазе:

  • При приступах желчной колики облегчение болевому синдрому принесет теплая грелка и голодание в дюжину часов.
  • До приезда врача не следует принимать какие-либо лекарственные препараты.
  • Категорически запрещено употребление алкоголя и спиртосодержащих напитков.

Приступ желчной колики может продолжаться от нескольких часов до нескольких дней. Поэтому вызов скорой помощи обязателен. Берегите себя и будьте всегда здоровы!

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