Surgical Procedures/Abdominal Surgery/Cholelithiasis
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- Approximately 10% of the population have gallstones.
- The majority of the gallstones are asymptomatic.
- Only approximately 30% of sufferer have surgery.
- 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.
- 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.
- Black color Pigmented Stones:
- Mixed stones:
- mixed of cholesterol and pigmented.
Asymptomatic gallstones disease
- 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
- 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:
- Chronic Cholecystitis.
- In the CBD:
- Obstructive jaundice..
- Liver failure.
- 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.