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GallstoneAka: Cholelithiasis

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  1. Epidemiology
    1. Cholelithiasis affects 20 million in United States
    2. Cholecystectomies per year in U.S.: 300,000
    3. Management complications result in 6000 US deaths/year
    4. Cholelithiasis Incidence increases with age
  2. Definitions
    1. Biliary Colic
      1. Transient cystic duct obstruction
    2. Acute Cholecystitis
      1. Persistent obstruction of the cystic duct
    3. Cholelithiasis
      1. Presence or formation of gallstones
    4. Choledocholithiasis
      1. Calculi in the common bile duct
  3. Risks Factors
    1. Classic 5 F's
      1. Female
      2. Forty (age over 40 years)
      3. Fat (Obesity with BMI >30)
      4. Fair skinned (Scandinavian)
      5. Family History (first degree relative)
    2. Other risks
      1. Pregnancy
      2. History of ileal disease, resection or bypass
      3. Medications: Ceftriaxone, TPN, Premarin
  4. Pathophysiology
    1. Gall Stones
      1. Composition
        1. Cholesterol stones (70-95%) make up 75% gallstones
        2. Pigment stones account for 25% of gallstones
      2. Development
        1. Cholesterol supersaturation
        2. Cholesterol crystals nucleate
        3. Increased by impaired gallbladder immotility
    2. Progression to symptoms
      1. Gallbladder distention (hydrops)
      2. Serosal edema
      3. Infection secondary to obstructed cystic duct
  5. Differential Diagnosis
    1. Hepatitis
    2. Hepatic Abscess
    3. Pancreatitis
    4. Gastritis
    5. Peptic Ulcer Disease (perforated or penetrating)
    6. Appendicitis
    7. Fitz Hugh-Curtis Syndrome
      1. Gonorrhea or Chlamydia perihepatitis
    8. Pelvic Inflammatory Disease
    9. Pyelonephritis
    10. Right lower lobe Pneumonia
    11. Pleuritis
    12. Myocardial Ischemia or Myocardial Infarction
  6. Types of Gallbladder Disease
    1. Biliary Colic
    2. Acalculous Cholecystitis (Biliary Dyskinesia)
    3. Acute Cholecystitis
    4. Ascending Cholangitis
  7. Symptoms and Signs
    1. See Biliary Colic
  8. Management
    1. Asymptomatic gallstones
      1. No treatment recommended (See course below)
    2. Symptomatic gallstones (see Biliary Colic)
      1. Consider Cholecystectomy
      2. Consider watchful waiting
        1. Symptoms resolve in 50% of patients without surgery
        2. Verhus (2002) Scand J Gastroenterol 37:834
  9. Course
    1. Symptoms developing per year in cholelithiasis: 1-4%
    2. Symptoms within 5 years of diagnosis: 10%
    3. Symptoms within 10 years of diagnosis: 20%

Cholelithiasis (C0008350)

Definition (MSH)Presence or formation of GALLSTONES in the BILIARY TRACT, usually in the gallbladder (CHOLECYSTOLITHIASIS) or the common bile duct (CHOLEDOCHOLITHIASIS).
Definition (CSP)presence or formation of gallstones in the gallbladder.
ConceptsDisease or Syndrome (T047)
ICD9574
EnglishBiliary calculus, cholelith, Cholelithiases, Cholelithiasis, GALL STONE, gallstone, gallstones
ItalianColelitiasi
Spanishcálculo biliar, calculo biliar, colelitiasis
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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