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. Investigation USG. CT. Asymptomatic gallstones disease (Symptomless) Approximately 50% gallstone sufferer are Asymptomatic. Generally do not require Surgical treatment. (Depending on the indication). Relative Indication: Large stones ( >2-3 cm ) with high risk of cholecystitis. High or increased risk of malignancy (cancer). Sufferer's age above 70. Sufferer with Sugar disease (Diabetes): New evidence suggests that cholecystectomy should be done for the same indications as general population. thaere is no need of prophylactis cholecystectomy in asymptomatic gallstones in diabetics.. Sufferer with Immune diseases. 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