Cholelithiasis
Basics
Description
Description
- Symptoms arise due to transient gallstone obstruction of cystic duct
- Biliary dyskinesia can produce symptoms similar to biliary colic in the absence of stones
- Choledocholithiasis (common bile duct stones), may lead to prolonged pain, elevated LFTs and bilirubin, and to more complications like cholangitis or pancreatitis
Etiology
Etiology
- Cholesterol stones:
- Most common type of gallstone (>90% in the U.S. and Europe)
- Form due to disturbance of cholesterol disposal
- Pigment stones:
- Much less common
- Composed of calcium bilirubinate
- Associated with clinical conditions such as hemolytic diseases, cirrhosis, cystic fibrosis that lead to increased concentration of unconjugated bilirubin
- Incidence increases with age and favors females to males 2:1 (4:1 during reproductive years). Other risk factors include Hispanic ethnicity, obesity, pregnancy, rapid weight loss, and drugs that induce biliary stasis (e.g., ceftriaxone and oral contraceptives), family history of gallstones
- Gallstones are exceedingly rare in childhood and are most commonly associated with sickle cell disease, hereditary spherocytosis, or other hemolytic diseases that result in pigment stone formation
- Biliary sludge:
- Nonstone, crystalline, granular matrix
- Associated with rapid weight loss, pregnancy, ceftriaxone or octreotide therapy, and organ transplantation
- May develop symptoms identical to cholelithiasis and its complications
- “Porcelain gallbladder” from mucosal precipitation of calcium salts owing to recurrent obstruction of cystic duct
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Citation
Schaider, Jeffrey J., et al., editors. "Cholelithiasis." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307130/all/Cholelithiasis.
Cholelithiasis. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307130/all/Cholelithiasis. Accessed December 9, 2024.
Cholelithiasis. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307130/all/Cholelithiasis
Cholelithiasis [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 09]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307130/all/Cholelithiasis.
* Article titles in AMA citation format should be in sentence-case
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