Cholelithiasis - Definition, Causes, Symptoms and Treatment

Cholelithiasis also known is Gallbladder. Gallstones are concretions that form in the biliary tract, usually in the gallbladder. Gallstones are formed within the gallbladder, an organ that stores bile excreted from the liver. Further complications of gallbladder disease include gallstone pancreatitis, gallstone ileus, biliary cirrhosis, and gallbladder cancer.  A stone blocking the opening from the gallbladder or cystic duct usually produces symptoms of biliary colic, which is right upper abdominal pain that feels like cramping. If the stone does not pass into the duodenum, but continues to block the cystic duct, acute cholecystitis results. Gallbladder calculi are relatively uncommon in children. However, the incidence of cholelithiasis has been increasing recently. Children may harbor cholesterol gallstones, black- or brown-pigmented stones, or mixed-type gallstones. Complications that occur in adults with this condition may also occur in children. Gallstones may cause irritation and inflammation of the gallbladder mucosa, resulting in chronic calculous cholecystitis and symptoms of biliary colic. Chronic gallstone disease may lead to fibrosis and loss of function of the gallbladder and predisposes to gallbladder cancer. Excision of the gallbladder (cholecystectomy) to cure gallstone disease is among the most frequently performed abdominal surgical procedures.

Gallstones are a common health problem worldwide. 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. Gallstones are rocklike collections of material that form inside the gallbladder. Different types exist, and they are categorized by their primary composition; cholesterol stones are most common (75-80% in the United States) followed by pigment, then mixed stones. The stones form when there is an imbalance or change in the composition of bile. 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. The second factor is the presence of proteins in the liver and bile that either promote or inhibit cholesterol crystallization into gallstones. Increased levels of the hormone estrogen as a result of pregnancy, hormone therapy, or the use of birth control pills, may increase cholesterol levels in bile and also decrease gallbladder movement, resulting in gallstone formation. The pain of biliary colic is not characteristically positional, pleuritic, or relieved by bowel movement or flatus.Other symptoms, often associated with cholelithiasis, include indigestion, dyspepsia, belching, bloating, and fat intolerance. However, these are very nonspecific and occur in similar frequencies in individuals with and without gallstones; cholecystectomy has not been shown to improve these symptoms.

Gallbladder sludge is crystallization within bile without stone formation. Cholesterol gallstones may become colonized with bacteria and can elicit gallbladder mucosal inflammation. Lytic enzymes from bacteria and leukocytes hydrolyze bilirubin conjugates and fatty acids. Gallstones are present in about 80% of people with gallbladder cancer. Symptoms of gallbladder cancer are usually not present until the disease has reached an advanced stage and may include weight loss, anemia, recurrent vomiting, and a lump in the abdomen. When the cancer is caught at an early stage and has not spread deeper than the mucosa (the inner lining), removal of the gallbladder results in five-year survival rates of 68%. If cancer has spread to deeper layers, more extensive surgery or other treatments may be required. Sickle cell disease has been identified as an independent risk factor associated with an increase in the frequency of cholelithiasis. Cholesterol gallstones develop when bile contains too much cholesterol and not enough bile salts. Besides a high concentration of cholesterol, two other factors seem to be important in causing gallstones. Acute gallstone pancreatitis is often characterized by epigastric tenderness. In severe cases, retroperitoneal hemorrhage may produce ecchymoses of the flanks and periumbilical ecchymoses.

There are several available treatments for Cholelithiasis. Electrohydraulic shock wave lithotripsy (ESWL) has also been employed to treat cholelithiasis. Urodeoxycholic acid (UDCA, ursodiol), a more contemporary medical therapy, is successful in only 40% of cases. Both CDCA and UDCA therapies are useful only for gallstones formed from cholesterol.  Surgery-Removal of the gallbladder, or cholecystectomy , is usually needed to treat symptoms associated with gallstones. It is a relatively safe procedure that does not cause any nutritional problems. Oral Bile Salts-If surgery is not desirable, bile salts to dissolve gallstones can be taken by mouth. However, it may take a long time to dissolve the gallstones, and because the gallbladder is still present, gallstones may recur. Laparoscopic techniques, which have been used for years in the field of gynecology, have recently been adapted to cholecystectomy, in an effort to decrease complications, recovery time and cost. Laparoscopic cholecystectomy is associated with a lower incidence of intra-abdominal adhesions, wound site hernia and scar formation. Postoperative pain is also reduced, and recovery time is shorter. Lithotripsy has been investigated as adjunctive therapy for failed endoscopic stone retrieval and for retained ductal stones after laparoscopic cholecystectomy.