Gallstone disease

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

Possible complications of cholelithiasis include obstruction of the cystic or common bile duct by a stone, acute cholecystitis and cholangitis, impaction of a stone into the lumen of the major duodenal papilla, acute biliary pancreatitis, and chronic cholecystitis.

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Epidemiology

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

Although infection is not thought to play a significant role in cholesterol stone formation, polymerase chain reaction has detected bacterial DNA in stones containing less than 90% cholesterol. It is possible that bacteria are able to deconjugate bile salts, resulting in bile acids being absorbed and cholesterol becoming less soluble.

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Pathogenesis of cholelithiasis

The formation of cholesterol stones is influenced by three main factors: supersaturation of liver bile with cholesterol, precipitation of cholesterol monohydrate in the form of crystals and dysfunction of the gallbladder.

Pathogenesis of cholelithiasis

Symptoms of Gallstone Disease

The main symptom of gallstone disease is biliary colic (usually due to transient obstruction of the cystic duct by a stone). It is characterized by acute visceral pain localized in the epigastric or right hypochondrium; less commonly, isolated pain occurs in the right side, precordial region, or lower abdomen, which significantly complicates diagnosis.

Classification of gallstone disease

Gallstones

• By 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, layered structure, diameter from 4-5 to 12-15 mm; typical localization is the gallbladder;
  • pigment (bilirubin) are characterized by small sizes, usually multiple; hard, fragile, completely homogeneous, located both in the gallbladder and in the bile ducts;

Classification of gallstone disease

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Diagnosis of gallstone disease

Gallstone disease is often asymptomatic (latent course is observed in 60-80% of people with gallstones and in 10-20% of people with stones in the common bile duct), and stones are discovered accidentally during ultrasound. The diagnosis of gallstone disease is based on clinical data (the most common variant in 75% of patients is biliary colic) and ultrasound results.

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Treatment of gallstone disease

Goals of treatment for gallstone disease:

• Removal of gallstones (either the stones themselves from the bile ducts, or the gallbladder together with stones).
• Relief of clinical symptoms without surgical intervention (if there are contraindications to surgical treatment).
• Prevention of the development of complications, both immediate (acute cholecystitis, acute pancreatitis, acute cholangitis) and distant (gallbladder cancer).