Cholelithiasis

Cholelithiasis is a topic covered in the 5-Minute Emergency Consult.

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Basics

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

  • 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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Basics

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

  • 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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