CHOLELITHIASIS

Group Members:
• Hanna Jay Galindez
• Galkolage Kalpa Nadeeshan
• Gallage Tharusha
• Gonapinuwala Vithanage Sanduni
• Gutierrez Shiela Mae
 Introduction
• Gallstone disease refers to the condition where gallstones are either in the
gallbladder or common bile duct.
• The presence of stones in the gallbladder is referred to as cholelithiasis.
• If gallstones migrate into the ducts of the biliary tract, the condition is referred to
as choledocholithiasis. Choledocholithiasis is frequently associated with obstruction
of the biliary tree, which in turn can lead to acute ascendingcholangitis, a serious
infection of the bile ducts.
• Gallstones within the ampulla of vater can obstruct the exocrine system of
the pancreas, which in turn can result in pancretitis.
• Gallbladder is a small pear-shaped organ which located under your liver. It stores
bile, a fluid made by your liver to digest fat. As your stomach and intestines digest
food, your gallbladder releases bile through a tube called the common bile duct. The
duct connects your gallbladder and liver to your small intestine.
• Cholelithiasis or gallstones are hardened deposits of digestive fluid that can form in
your gallbladder.
 Epidemiology
• The prevalence of cholelithiasis is affected by many factors, including ethnicity, gender,
comorbidities, and genetics.
• International statistics
• The prevalence of cholesterol cholelithiasis in other Western cultures is similar to that in the
United States, but it appears to be somewhat lower in Asia and Africa.
• Race-, sex-, and age-related demographics
• Prevalence of gallstones is highest in people of northern European descent, and in Hispanic
populations and Native American populations. Prevalence of gallstones is lower in Asians and
African Americans.
• Women are more likely to develop cholesterol gallstones than men, especially during their
reproductive years, when the incidence of gallstones in women is 2-3 times that in men. The
difference appears to be attributable mainly to estrogen, which increases biliary cholesterol
secretion.
• Risk of developing gallstones increases with age. Gallstones are uncommon in children in the
absence of congenital anomalies or hemolytic disorders. Beginning at puberty, the
concentration of cholesterol in bile increases.
• Gallstones continue to form throughout adult life, and the prevalence is greatest at advanced
age.
 pathophysiology
o Gallstones are hard, pebble-like structures that obstruct the cystic duct.
o The formation of gallstones is often preceded by the presence of biliary sludge, a viscous
mixture of glycoproteins, calcium deposits, and cholesterol crystals in the gallbladder or
biliary ducts.
o most gallstones consist largely of bile supersaturated with cholesterol.
o This hypersaturation, which results from the cholesterol concentration being greater than its
solubility percentage, is caused primarily by hypersecretion of cholesterol due to altered
hepatic cholesterol metabolism.
o A distorted balance between pronucleating (crystallization-promoting) and antinucleating
(crystallization-inhibiting) proteins in the bile also can accelerate crystallization of cholesterol
in the bile.
o Mucin, a glycoprotein mixture secreted by biliary epithelial cells, has been documented as a
pronucleating protein.
• It is the decreased degradation of mucin by lysosomal enzymes
that is believed to promote the formation of cholesterol crystals.
• Loss of gallbladder muscular-wall motility and excessive
sphincteric contraction also are involved in gallstone formation.
• Occasionally, gallstones are composed of bilirubin, a chemical
that is produced as a result of the standard breakdown of RBCs.
• Bilirubin stones, often referred to as pigment stones, are seen
primarily in patients with infections of the biliary tract or chronic
hemolytic diseases
• Pigment stones are more frequent in Asia and Africa.
 Risk factors and Causes
• Gallstone risk increases for females (especially before menopause)
and for people near or above 40 years, the condition is more
prevalent among both North and South Americans and among
those of European descent than among other ethnicities.
• A lack of melatonin could significantly contribute to gallbladder
stones, as melatonin inhibits cholesterol secretion from the
gallbladder, enhances the conversion of cholesterol to bile, and is
an antioxidant, which is able to reduce oxidative stress to the
gallbladder.
• Researchers believe that gallstones may be caused by a
combination of factors, including inherited body chemistry, body
weight, gallbladder motility (movement), and low calorie diet.The
absence of such risk factors does not, however, preclude the
formation of gallstones
 SIGNS AND SYMPTOMS
Gallstones may cause no signs or symptoms. If a gallstone
lodges in a duct and causes a blockage, the resulting signs and
symptoms may include:

• Sudden and rapidly intensifying pain in the upper right

portion of your abdomen
• Sudden and rapidly intensifying pain in the center of your
abdomen, just below your breastbone
• Back pain between your shoulder blades
• Pain in your right shoulder
• Nausea or vomiting
• Other digestive problems, including bloating, indigestion
and heartburn, and gas.

Gallstone pain may last several minutes to a few hours.

 Treatment
Surgical
1. Cholecystectomy (gallbladder removal) has a 99% chance of
eliminating the recurrence of cholelithiasis. Surgery is only
indicated in symptomatic patients. The lack of a gallbladder
may have no negative consequences in many people.
However, there is a portion of the population—between 10
and 15%—who develop a condition
called postcholecystectomy syndrome which may cause
gastrointestinal distress and persistent pain in the upper-
right abdomen, as well as a 10% risk of developing
chronic diarrhea.
There are two surgical options for cholecystectomy:
• Open cholecystectomy is performed via an abdominal
incision (laparotomy) below the lower right ribs. Recovery
typically requires 3–5 days of hospitalization, with a return to
normal diet a week after release and to normal activity
several weeks after release.
• Laparoscopic cholecystectomy, introduced in the 1980s, is
performed via three to four small puncture holes for a
camera and instruments. Post-operative care typically
includes a same-day release or a one night hospital stay,
followed by a few days of home rest and pain medication.
2. Sphincterotomy and extraction of gallstones
Sometimes a gallstone may be stuck in the hepatic or common
bile ducts. Sphincterotomy involves cutting the muscle of thec
ommon bile duct (sphincter of Oddi) at the junction of the
common bile duct and the duodenum in order to allow easier
access to the common bile duct. After the sphincter is cut by
surgical instruments pull out of the gallestone or crushing the
gallstone can be done.
 Prevention

• There is no sure way to pevent gallstones. But you can reduce

your risk of forming gallestones that can cause symptoms by
maintaining a healthy weight, diet high in fiber, diet low
in simple carbohydrates etc