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Cholecystolithiasis – Gallstones Explained

Cholecystolithiasis refers to the presence of gallstones in the gallbladder. It can cause pain, digestive issues, and serious complications if left untreated.

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Things worth knowing about "Cholecystolithiasis"

Cholecystolithiasis refers to the presence of gallstones in the gallbladder. It can cause pain, digestive issues, and serious complications if left untreated.

What is Cholecystolithiasis?

Cholecystolithiasis is the medical term for the presence of gallstones within the gallbladder. Gallstones are hardened deposits that form from components of bile fluid – primarily cholesterol, bilirubin, and calcium salts. They can vary widely in size and number, ranging from tiny sand-like particles to stones several centimetres in diameter. The condition is highly prevalent and affects approximately 10–15% of adults in Western countries.

Causes and Risk Factors

Gallstones develop when there is an imbalance in the chemical composition of bile. Key risk factors include:

Overweight and obesity: Excess body weight leads to increased cholesterol production in the liver.
Female sex: Women are more frequently affected, as oestrogen promotes cholesterol secretion into bile.
Older age: The risk increases with advancing age.
Pregnancy: Hormonal changes slow gallbladder emptying.
Rapid weight loss: Triggers mobilisation of cholesterol into bile.
High-fat, low-fibre diet: Promotes supersaturation of bile with cholesterol.
Genetic predisposition: A family history of gallstones is a known risk factor.
Certain medical conditions: Including diabetes mellitus, Crohn's disease, liver cirrhosis, and haemolytic anaemias.

Types of Gallstones

There are three main types of gallstones:

Cholesterol stones: The most common type (approx. 80%); form when bile is supersaturated with cholesterol.
Pigment stones (bilirubin stones): Result from elevated bilirubin breakdown, e.g. in haemolytic disorders.
Mixed stones: Contain both cholesterol and bilirubin along with calcium salts.

Symptoms

Many individuals with gallstones remain asymptomatic. When symptoms do occur, they typically include:

Biliary colic: Sudden, cramping pain in the upper right abdomen or epigastric region, often triggered by fatty meals, and may radiate to the right shoulder or back.
Nausea and vomiting
Bloating and a feeling of fullness
Intolerance to fatty foods

In cases of complications, fever, jaundice (icterus), or severe persistent pain may occur, requiring immediate medical attention.

Diagnosis

The diagnosis of cholecystolithiasis is established through several diagnostic methods:

Ultrasound (sonography): The method of choice; gallstones appear as hyperechoic structures with acoustic shadowing.
Blood tests: Assessment of liver enzymes, bilirubin, and inflammatory markers (CRP, white blood cell count).
Endoscopic ultrasound (EUS): Used when stones in the bile duct are suspected.
ERCP (Endoscopic Retrograde Cholangiopancreatography): For visualisation and, if necessary, removal of bile duct stones.
MRI/MRCP: Magnetic resonance cholangiopancreatography for detailed imaging of the biliary tract.

Treatment

Asymptomatic Gallstones

Gallstones discovered incidentally without symptoms are generally managed with a watchful waiting approach, as many individuals remain symptom-free long term.

Symptomatic Cholecystolithiasis

For recurrent biliary colic or complications, laparoscopic cholecystectomy (minimally invasive surgical removal of the gallbladder) is the treatment of choice. It is safe, effective, and generally well tolerated.

Other Treatment Options

Medical dissolution therapy: Ursodeoxycholic acid (UDCA) may dissolve small cholesterol stones when gallbladder function is preserved; used infrequently.
Extracorporeal shock wave lithotripsy (ESWL): Stone fragmentation using sound waves; reserved for exceptional cases.
ERCP with stone extraction: For stones located in the common bile duct (choledocholithiasis).

Complications

Untreated or complicated gallstone disease can lead to the following conditions:

Cholecystitis: Inflammation of the gallbladder
Choledocholithiasis: Stones in the bile duct
Cholangitis: Inflammation of the bile ducts
Pancreatitis: Inflammation of the pancreas
Gallbladder carcinoma: A rare long-term complication

References

Lammert F. et al. - Gallstones: Guidelines of the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS) - Z Gastroenterol 2018; 56(08): 912-966.
Stinton L.M., Shaffer E.A. - Epidemiology of gallbladder disease: cholelithiasis and cancer - Gut Liver 2012; 6(2): 172-187.
Portincasa P., Moschetta A., Palasciano G. - Cholesterol gallstone disease - Lancet 2006; 368(9531): 230-239.

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