Def
Cholelithiasis- metabolite
disease characterised by
formation of stones in
gallbladder and or bile duct
Types of stone- cholesterol,
bilirubin, mixed
Cholecystitis- acute or
chronic inflammation of
the gallbladder eventually
the bile duct
Chronic
Etiology
 The change in the
composition of bile is the
main factor
 Due to changed ratio of its
usual ingredients
(increased level of
cholesterol, decreased
level of phospholipids and
bile salts
Predisposition
 Increased level of
cholestrol- hereditary
hypercholesterolemia,
hypothyroidism, diabetes
 Indirect bilirubin-
haemolytic anaemia
 Increased level of calcium-
hyperparathyroidism
 Obstructed drainage of
gall bladder or bile duct
 Usually bacteria- e.coli,
klebsiella
 Protozoa
Predisposition
 Obstruction in drainage of
bile
 Stones in gallbladder
 
Symptoms
1. Latent form- no symptoms
stone discovered by
abdominal US accidentaly
2. Dyspeptic- nausea ,
vomiting, bitter taste in
mouth, heaviness or dull
pain in right hypogastric
3. Biliary- severe pain in right
hypogastric- propagating
towards back and right
shoulder, nausea, vomiting
of green fluid with bitter
taste, jaundice, brown urine
 Harsh pain in right
hypogastria often
propbaging towards the back
and right shoulder
 High fever with shivers
 Nausea
 Vomiting
 Jaundice and
 Brown urine
Dull pain or heaviness in
right hypogastria
 Rigidity
 Guarding
Physical exam Lab/instrumental Complication
 Impaired general  Abdominal US-
condition enlarged cystic duct
 Icter or subicter  X-ray
 Severe pain in right  Cholecystography
hypogastria with contrast
 Enlarge or tender  ERCP
liver  MRI
 Increased liver
enzymes ASAT AND
ALAT

 Imapired general  Increased WBC
condition usually  Increased sed rate and
icier CRP
 Palpitation- severe  Increased ASAT and
pain right ALAT
hypogastric  Urine- elevated
 Enlarged tender urobilinogen
liver  Abdominal US-
thickening of
gallbladder wall
 Palpitation + sign of  Duodenal intubation
murphy with samples from 3
 Boas sign- feel of types of bile fluid- bile
hyperesthesia duct, gall bladder and
 between 9th and 11th liver
posteriorly  Abdominal US
 Enlarged liver  CT