Cholelithiasis

Gallstone disease is a disease characterized by the formation of concrements in the gallbladder (cholecystolithiasis), the common bile duct (choledocholithiasis), which can occur with symptoms of bile (biliary, hepatic) colic in response to transient obstruction with a stone of the gall bladder or common bile duct, accompanied by smooth muscle spasm and intra-cellular hypertension.

Possible complications of cholelithiasis include obturation with a stone of the bladder or common bile duct, acute cholecystitis and cholangitis, wedging of the stone into the lumen of the large papilla of the duodenum, acute biliary pancreatitis, chronic cholecystitis.

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Epidemiology

In ecologically developed countries, cholelithiasis develops in 10-15% of the population. At the age of 21 to 30 years, ZSH suffers 3-4% of the population, from 41 to 50 years - 5%, over 60 years - up to 20%, over 70 years - up to 30%. The predominant sex is female (2-5: 1), although there is a tendency for the incidence rate to increase in men.

Although it is believed that infection does not play a significant role in the formation of cholesterol stones, with the help of polymerase chain reaction, bacterial DNA is found in stones containing less than 90% cholesterol. Probably, bacteria are able to deconjugate the gallstones, as a result of which the bile acids are absorbed and the solubility of cholesterol is reduced.

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Pathogenesis of cholelithiasis

The formation of cholesterol stones is affected by three main factors: gluten cholesterol supersaturation, precipitation of cholesterol monohydrate in the form of crystals and a violation of the function of the gallbladder.

Pathogenesis of cholelithiasis

Symptoms of cholelithiasis

The main symptom of cholelithiasis is biliary colic (usually due to transient obstruction by the stone of the bladder duct). It is characterized by acute visceral pains with localization in the epigastric or right subcostal area, rarely isolated pain in the right side, precordial region or lower abdomen, which significantly complicates the diagnosis.

Classification of cholelithiasis

Gallstones

• Localization: in the gallbladder; in the common bile duct; in the hepatic ducts.
• By the number of stones: single; multiple.
• By composition:
  • cholesterol - contain mainly cholesterol, have a round or oval shape, a lamellar structure, diameter from 4-5 to 12-15 mm; typical localization is a gallbladder;
  • pigment (bilirubin) are characterized by small sizes, usually multiple; rigid, brittle, perfectly homogeneous, located both in the gall bladder and in the bile ducts;

Classification of cholelithiasis

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Diagnosis of cholelithiasis

Often cholelithiasis proceeds asymptomatically (latent flow is observed in 60-80% of persons with stones in the gallbladder and in 10-20% of individuals with stones in the common bile duct), and concrements are found by chance during ultrasound. The diagnosis of cholelithiasis is based on clinical data (the most frequent option in 75% of patients is biliary colic) and ultrasound results.

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Treatment of cholelithiasis

Objectives of treatment of cholelithiasis :

• Removal of gallstones (either the stones themselves from the bile ducts, or the gallbladder along with the calculi).
• Closing of clinical symptoms without surgical intervention (in the presence of contraindications to surgical treatment).
• Prevention of complications, as the nearest (acute cholecystitis, acute pancreatitis, acute cholangitis), and distant (gall bladder cancer).