Cholelithiasis is
the presence of calculi, or stones,
in the gallbladder.
Cholelithiasis is commonly referred
to as gallstones. The
gallstones can be present in the
body of the gallbladder or in the
bile duct. Gallstones
typically consist of cholesterol,
but can also consist of bilirubin.
Bilirubin gallstones are called
pigment stones. For the sake of this
article, the term "gallstones" will
refer only to cholesterol stones,
and not pigment stones. [1]
The components of
bile are cholesterol, bile acids,
phospholipids, electrolytes, and
water. Gallstones form
when the bile becomes supersaturated
with cholesterol. This results
from cholesterol levels being too high, or if
the levels of bile acids and
phospholipids are low in the bile. [2]
Slow or inefficient emptying of the
gallbladder, or biliary sludge, can also
contribute to the formation of
gallstones.
Gallstones are
usually multiple when diagnosed,
though patients can be symptomatic
with a single stone. Gallstones are
usually less than 2 cm in diameter. [3] They pose a risk to individuals if
they cause partial or total
obstruction of the bile duct,
blocking outflow.
Gallstones
affect both men and women, though
women are more likely to get them
earlier in life. Native Americans
and Hispanics are more prone to
gallstones than Caucasians. There is
an increased risk for developing
gallstones with a positive family
history. Obesity increases the risk
by 3-7 times that of a non-obese
person. [4]
The signs and
symptoms of gallstones can be
variable. Many will have stones
present for years with no clinical
symptoms. The most common presenting
sign is pain, occurring when a stone
has caused partial or total
obstruction of the bile duct. [5]
Pain is usually on
the right side and located just
under the rib cage. It can radiate
to the back, usually in between the
scapulae, or shoulder blades. The
pain can be described as colic. It
is usually constant and progressive
until the stone has passed or after the blockage
is removed. [6]
Other symptoms that
can occur due to gallstones are
belching, bloating, fatty food
intolerance, nausea, and vomiting. If total blockage occurs the
gallbladder can become inflamed and
fever and chills will develop. Fever
and chills are absent without
inflammation. [7]
-
It is estimated
that 20 million Americans or 10%
of the population have gallstones.
-
About 1 million new
cases will be diagnosed this year.
-
Each year at
least 500,000 people will undergo
surgery to remove their
gallbladder because of gallstones.
-
There are
approximately 800,000
hospitalizations each year due to
gallbladder pain.
-
20% of women and
10% of men will have gallstones
after the age of 60. [8]
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