Diseases Treatment

What do Doctors call this Condition?

Cholelithiasis, choledocholithiasis, cholecystitis, cholesterolosis, biliary cirrhosis, gallstone ileus

What is this Condition?

Gallstones and other diseases of the gallbladder and bile duct are common, often painful conditions that usually require surgery to remove grainy deposits in the gallbladder and relieve inflammation. Gallstones may be life-threatening.

What Causes it?

Gallstones are caused by changes in the chemistry of the person’s bile, a greenish fluid secreted by the liver that aids in the absorption of fats. The stones are made of cholesterol, a mixture of calcium and bilirubin compounds, or a mixture of cholesterol and bilirubin pigment. Stones form when the gallbladder is sluggish because of pregnancy, oral contraceptive use, diabetes, celiac disease, cirrhosis of the liver, or pancreatitis.

Gallstones are the fifth leading cause of hospitalization among adults, accounting for 90% of all gallbladder and duct diseases. Most people recover with treatment unless they develop an infection, when recovery depends on its severity and how it responds to antibiotics.

Most gallbladder and bile duct diseases strike people between ages 20 and 50. The diseases are 6 times more common in women until after age 50, when they appear in both sexes about equally. The risk of getting these diseases increases with each succeeding decade. Each disorder can produce its own complications, the worst of which are perforations and infections in the abdominal cavity, which can lead to shock and death.

Types of Gallstones

Gallstone and bile duct diseases have a variety of sources and possible outcomes:

• One out of every ten people with gallstones develops choledocholithiasis, or gallstones in the common bile duct (sometimes called common-duct stones). Stones that have passed out of the gallbladder lodge in the liver and common bile ducts and block the flow of bile into the stomach. Most people recover with treatment unless infection occurs.

• Cholecystitis, acute or chronic inflammation of the gallbladder, is usually associated with a gallstone stuck in the cystic duct, causing painful distention of the gallbladder. Cholecystitis accounts for 10% to 25% of all people requiring gallbladder surgery. The acute form is most common during middle age; the chronic form, among elderly people. Most people recover with treatment.

• Cholesterolosis (cholesterol polyps or cholesterol crystal deposits in the gallbladder’s lining) may be caused by high cholesterol and low bile salts in bile secretions. The chance for cure is good with surgery.

• Biliary cirrhosis sometimes follows viral destruction of liver and duct cells, but the primary cause is unknown. This condition usually leads to obstructive jaundice. It strikes women ages 40 to 60 nine times more often than men. The chance of a cure is poor without a liver transplant.

• Gallstone ileus is caused by a gallstone that has lodged at the opening to the large intestine. This condition is more common in elderly people, and the chance of cure is good with surgery .

• Leftover gallstones or stricture of the common bile duct may occur in 1 % to 5% of all people whose gallbladders have been surgically removed and may produce abdominal pain, colic, fatty food intolerance, and indigestion. The chance of a cure is good with selected radiologic procedures, endoscopic procedures, or more surgery.

What are the Symptoms?

Although gallbladder diseases may produce no symptoms, most, at their worst, produce the symptoms of a classic gallbladder attack. The attacks often follow meals rich in fats or may occur at night, suddenly awakening the person. They begin with acute, upper right abdominal pain that may radiate to the back, between the shoulders, or to the front of the chest. The pain may be so severe that the person goes to a hospital emergency department for help. Other signs of gallbladder disease may include recurring fat intolerance, colic, belching, flatulence, indigestion, sweating, nausea, vomiting, chills, low-grade fever, jaundice (if a stone obstructs the common bile duct), and claycolored stools.

How is it Diagnosed?

Ultrasound and other tests can detect gallstones. Specific procedures include the following:

• Ultrasound detects stones in the gallbladder with 96% accuracy.

• Fluoroscopy distinguishes between gallbladder or bile duct disease and cancer of the pancreas in persons with jaundice.

• An endoscopy with a special dye is used to examine the common bile and pancreatic ducts. An endoscopy done through the mouth or rectum may also reveal stones.

• An injected radioisotope (HIDA) scan of the gallbladder detects obstruction of the cystic duct.

• Computed tomography (CAT) scan, although not used routinely, helps distinguish between jaundice with and without obstruction.

• A flat plate X-ray of the abdomen identifies calcified, but not cholesterol, stones with 15% accuracy.

• Blood tests help distinguish gallstone-related diseases from other diseases with some of the same symptoms, such as heart attack, ulcers, and hernia.

How is it Treated?

Treatment during an acute attack may include insertion of a nasogastric tube, an intravenous line and, possibly, antibiotics. Surgery, usually elective, is the doctor’s first recommendation for gallbladder and bile duct diseases. Surgery may be performed using an open procedure or a laparoscopic (using a small incision and a long tube) procedure to remove stones; the bile duct may also be explored.

Other Approaches

Other treatment includes a low-fat diet to prevent attacks and vitamin K for itching, jaundice, and bleeding tendencies.

In a recently developed nonsurgical treatment for choledocholithiasis, the surgeon inserts a flexible catheter into the common bile duct and, guided by fluoroscopy, moves the catheter toward the stone. A “Dormia” basket is threaded through the catheter, opened, twirled to entrap the stone, dosed, and withdrawn through the catheter.

Chenodiol, a drug that dissolves certain kinds of stones, may be given to persons who are either too weak for surgery or who refuse it. The drug has some drawbacks, however: It requires a prolonged course of treatment and causes serious side effects. What’s more, gallstones may recur after the drug is stopped.