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Gallstones

Gallstones, or cholelithiasis, are solid deposits in the gallbladder affecting 10-15% of adults, particularly females and those over 40. They can be asymptomatic or lead to complications like cholecystitis and pancreatitis, with diagnosis primarily through ultrasound. Management varies from observation in asymptomatic cases to cholecystectomy for symptomatic patients.

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10 views18 pages

Gallstones

Gallstones, or cholelithiasis, are solid deposits in the gallbladder affecting 10-15% of adults, particularly females and those over 40. They can be asymptomatic or lead to complications like cholecystitis and pancreatitis, with diagnosis primarily through ultrasound. Management varies from observation in asymptomatic cases to cholecystectomy for symptomatic patients.

Uploaded by

chelseanjee01
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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GALLSTONES

(Cholelithiasis)
OUTLINE
• INTRODUCTION
• RISK FACTORS
• PATHOPHYSIOLOGY
• CLINICAL FEATURES
• DIAGNOSTIC WORK UP
• MANAGEMENT
• COMPLICATIONS
INTRODUCTION
• Gallstones (cholelithiasis) are solid
deposits formed in the gallbladder,
typically composed of cholesterol, bile
salts, and/or calcium.
• Affects 10–15% of the adult population in
developed countries.
• More common in females, obese
individuals, and those over 40 years of
age.
INTRODUCTION cont’d
RISK FACTORS
• Female: Estrogen increases cholesterol
saturation in bile.
• Forty: Risk increases with age.
• Fertile: Hormonal changes during
pregnancy predispose to gallstone
formation.
• Fat: Obesity increases cholesterol
secretion into bile.
• Fair Genetic predisposition.
PATHOPHYSIOLOGY
• Imbalance in bile composition →
Supersaturation of bile with cholesterol or
bilirubin.
• Formation of crystals → Aggregation into
stones.
Possible outcomes:
• Asymptomatic (most common).
• Symptomatic: Biliary colic.
• Complications: Cholecystitis,
choledocholithiasis, cholangitis.
CLINICAL FEATURES
• Asymptomatic:
• Incidental finding on imaging.
• Symptomatic (Biliary Colic):
• Episodic RUQ pain radiating to the right
shoulder or back.
• Triggered by fatty meals.
• Pain resolves within hours.
Complications:
• Acute cholecystitis: Persistent pain, fever,
leukocytosis.
• Choledocholithiasis: Jaundice, biliary colic,
elevated liver enzymes.
• Acute cholangitis (Charcot’s triad): Fever,
RUQ pain, jaundice.
• Gallstone pancreatitis: Epigastric pain,
elevated amylase/lipase.
DIAGNOSTIC WORKUP
Laboratory Tests:
• Normal in asymptomatic cases.
• Elevated WBCs in cholecystitis.
• Elevated bilirubin, ALP, and GGT in
choledocholithiasis or cholangitis.
DIAGNOSTIC WORKUP cont’d
Imaging:
• Ultrasound: First-line imaging, detects
gallstones and thickened gallbladder wall.
• CT Scan: Identifies complications like
perforation or abscess.
• MRCP (Magnetic Resonance
Cholangiopancreatography): Visualizes
biliary tree
MANAGEMENT
Asymptomatic Gallstones:

• No treatment required unless high-risk


(e.g., sickle cell disease, porcelain
gallbladder).
MANAGEMENT cont’d
Symptomatic Gallstones:

• Initial management: Pain control, dietary


modifications.
• Definitive treatment: Cholecystectomy
(laparoscopic preferred).
MANAGEMENT cont’
• For complications
• Acute Cholecystitis:
• NPO (nothing by mouth), IV fluids,
antibiotics.
• Early cholecystectomy (within 72 hours).
• Choledocholithiasis:
• ERCP with stone removal.
Acute Cholangitis:
• Emergency: IV antibiotics, biliary
decompression (ERCP).
• Gallstone Pancreatitis:
• Supportive care (IV fluids, NPO).
• Cholecystectomy after resolution.
COMPLICATIONS
• Gallbladder perforation.
• Gangrenous cholecystitis.
• Biliary-enteric fistula.
• Gallstone ileus (rare cause of small bowel
obstruction).
• Recurrence of biliary colic if untreated.
CONCLUSION
• Gallstones are a common condition, often
asymptomatic but capable of causing
significant complications.
• Early recognition of symptoms is critical for
timely intervention.
• Ultrasound is the cornerstone of diagnosis,
• Management depends on clinical
presentation
• Preventive measures include addressing
modifiable risk factors such as obesity and
rapid weight loss

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