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Cholelithiasis - Definition, Causes, Symptoms and Treatment
Author: Juliet Cohen
Article:
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. Gallstones may be as small as a grain of
sand, or they may become as large as an inch in diameter,
depending on how long they have been forming. 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.
About the author:
Juliet Cohen writes articles for health care clinic
and home remedies.
She also writes articles on beauty tips
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