# Surgical Procedures/Abdominal Surgery/Cholelithiasis

Cholelithiasis GallStones

## Introduction:

* Approximately 10% of the population have gallstones.
* The majority of the gallstones are asymptomatic.
* Only approximately 30% of sufferers have surgery.

## Types

* Cholesterol stones (Approximately 6%, less common).
* Mixed stones (Approximately 90%, common).
* Pigment stones (Uncommon).

## Incidence of gallstones:

Classically: Fat, fertile flatulent female of fifty (forty).

## Commonest Causal Factors:

* Cholesterol stones: Approximately 75% of all gall stones are Cholesterol stones.
** Excess of cholesterol relative to bile salts and phospholipids allowing cholesterol crystals to form.
** Infection can cause cholesterol gallstone.
** Oestrogens reduces gallbladder contraction and increases chances to gallstone formation.
** Multiple pregnancies/contraceptive use.
** Obesity.
** Rapid weight loss.
** Infestation with:
*** Clonorchis sinensis, Ascaris Lumbricoides etc.
* Pigmented stones: Approximately 25% of all gall stones are Pigmented Stones.
** Black color Pigmented Stones:
*** Sufferer with Hemolytic disorders.
*** Sufferer with cirrhosis.
** Brown color Pigmented stones:
*** Sufferer are mostly Asian population.
*** Bacterial Infection.
* Mixed stones:
** mixed of cholesterol and pigmented.

## Asymptomatic gallstones disease

(Symptomless)
* Suggestive of gallstone disease.
** Sufferer with Dyspepsia.
** Vague abdominal discomfort.
*** Around Epigastric region.
** Sufferer with increased flatulence.

## Symptomatic Gallstone Disease

* Pain:
** Known as Biliary colic.
** Usually Right Upper Quadrant (sided) chest/abdominal pain.
*** Usually pain after oily food.
*** Quick pain which lasts few moments to few hours.
*** Pain with discomfort.
*** Pain often radiates (travels) towards right scapula (back).
* Nausea and Vomiting may also present with pain.
* Acute Cholecystitis:
** Occurs in approximately 10% of symptomatic gallstone disease.
** Treatment of choice:
*** Laparoscopic cholecystectomy.
*** Open cholecystectomy.
*** Percutaneous transhepatic placement of a cholecystostomy tube.

## Effects and Complication of GallStones

* In the gall bladder:
** Asymptomatic gallstone.
** Hydrops of the gallbladder.
** Flatulent dyspepsia.
** Gallstone colic.
** Acute Obstructive cholecystitis which may lead to:
*** Mucocele.
*** Empyema.
*** Gangrene.
*** Perforation.
*** Fistula.
** Chronic Cholecystitis.
** Carcinoma.
* In the CBD:
** Obstructive jaundice..
** Liver failure.
** Cholangitis.
** Acute or recurrent pancreatitis.
* In the pancreas:
** Acute Pancreatitis.
** Acute relapsing Pancreatitis.
** Chronic Pancreatitis.
* In the Intestine:
** Gallstone Ileus.

## Gallstones with other Diseases:

Gallstone may be associated with other diseases.
* Saint's Triad:
** Gallstone + Hiatus Hernia + Diverticulosis of the Colon.
* Cholecystic Heart:
** Diseased gallbladder may cause decreased coronary blood flow, arrythmia or heart block in previously heart disorder.
* Asymptomatic Gallstones:
** After long follow-ups, approximately 50% asymptomatic turns into symptomatic.

### About Gall Bladder and Cholelithiasis

* : Gall Bladder Questions