Cholelithiasis

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Objectivve
• To Define cholelithiasis
• To Identify risk factor
• To Define pathophysiology
• To Know about Management

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Cont…
• A gallstone is a stone formed within the gallbladder out of bile
components.
• The term cholelithiasis may refer to the presence of gallstones or to
the diseases caused by gallstones.
• Most people with gallstones (about 80%) never have symptoms.
When a gallstone blocks the bile duct, a crampy pain in the
right upper part of the abdomen, known as biliary colic (gallbladder
attack) can result
• Reference wikipidea

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• CHOLELITHIASIS
• Common locations of gallstones
• •It is calculi, or gallstones, usually in the gallbladder from the solid
constituents of bile.

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Risk factors for cholelithiasis

• Age (common in >40 yrs)- hepatic secretion of cholesterol and decreased bile acid synthesis
• Family history, also Native Americans and persons of northern European heritage
• Obesity, Hyperlipidemia
• Females, use of oral contraceptives, estrogens; w/c increases biliary cholesterol saturation.
• Conditions which lead to biliary stasis: pregnancy
• Fasting
• prolonged parenteral nutrition
• Diseases including cirrhosis, sickle-cell anemia, glucose intolerance
reference bruner 12th edition

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Pathophysiology

• There are two major types of gallstones:

• Cholesterol gallstones (80% of cases)
• Cholesterol, a normal constituent of bile, is insoluble in water. Its solubility depends
on bile acids and lecithin (phospholipids) in bile.
• Decreased bile acid synthesis and increased cholesterol synthesis
• Bile supersaturated with cholesterol, which precipitates out of the bile to form
stones.
• The cholesterol-saturated bile predisposes to the formation of gallstones
reference bruner 12th edition

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cont

• Pigment stones (20% of cases)

• unconjugated pigments in the bile precipitate to form stones
• The risk increased in patients with cirrhosis, hemolysis, and infections
of the biliary tract
• cannot be dissolved and must be removed surgically

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Clinical Manifestations

• Gallstones may be silent

• Symptoms are due to disease of the gallbladder itself and those due to
obstruction of the bile passages by a gallstone.
• They can be acute or chronic
• Epigastric distress
• pain and biliary colic (RU Abdomen)
• Jaundice
• Very dark urine
• Clay-colored stool
• Vitamin deficiency due to vomiting
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Medical management

• Are to reduce the incidence of acute episodes of gallbladder pain and

cholecystitis by supportive and dietary management
• Rest
• Intravenous fluids
• low-fat liquids diet
• Nasogastric suction
• Analgesia
• Antibiotic agents

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med mag’t cont’d
• •Unless the patient’s condition deteriorates, surgical intervention is
delayed until the acute symptoms subside and a complete evaluation
carried out.
• •Dietary management may be major mode of therapy in patients who
have vague gastrointestinal symptoms to fatty foods

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pharmacologic therapy
• •Ursodeoxycholic acid (UDCA) and chenodeoxycholic acid (cdca)-to
dissolve small gallstones composed primarily of cholesterol.
• They inhibit synthesis and secretion of cholesterol
• Indicated for patients who refuse surgery or for whom surgery is
considered too risky
• Six to 12 months of therapy are required

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Nonsurgical removal of gallstones

• Dissolving gallstones by infusion of a solvent (monooctanoin or

methyl tertiary butyl ether) to gallbladder
• Shock-wave lithotripsy- uses repeated shock waves directed at the
gallstones to fragment the stones

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Surgical management
• To relieve persistent symptoms and to remove the cause of biliary
colic
• Pigment stones cannot be dissolved and must be removed surgically
• Laparoscopic cholecystectomy (removal of the gallbladder through a
small incision through the umbilicus is a new standard therapy )
• Open abdominal Cholecystectomy
• Choledochotomy

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Postoperative Interventions
• May have NG tube
• NPO until bowel sounds return, then a soft, low-fat, high-carbohydrate diet
• Care of biliary drainage system
• Administer analgesics as ordered
• Turning and encouraging coughing and deep breathing- prevent pneumonia and
atelectasis
• splinting to reduce pain.
• Encourage ambulation
• Monitor vital sign
• Monitor for complications
• Patient education

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Prevalence
• 10% in western Europe 3.2% to 15.6 have been from asia
• Research made in Gondar 5.2% of pt in gall stone disease 55 were
female & 28 were male 2:1 ratio
• The prevalence among age group was 7.3 %, 10.1%for females &4.8%
for male
• The ratio of asymptomatic to symptomatic is 1:1
• Reference ‘’prevalence of cholelihiasis gonder hospital 2008’’

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Cont
• Prevalence in female 72.7% than in male 27.3% was 2:1 ratio
• The mean age at which the stone occur in 42 yr age most case 51 .5
%prevalent in age of 30 and 49
• 65.2 % were asymptomatic
Thirteen yrs trend in the magnitude of urollithiasis and cholelithiasis in Ethiopia evidence from
hospital based study 2005/2006-2017/2018

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