Gallbladder Disorders:  Gallstones and Related Conditions

Overview

• Gallstones (Cholelithiasis): Formation of stones in the gallbladder.
• The term cholelithiasis:
  • Chole-: pertains to cholesterol.
  • Lith: means stone.
• Gallstones form when bile becomes dehydrated and concentrates, often mixing with calcium.

Normal Gallbladder Function

• Stores bile, which is primarily cholesterol and bilirubin pigment.
• Bile emulsifies fats in digestion.
• Located in the right upper quadrant of the abdomen.

Formation of Gallstones

• Dehydration of bile causes precipitation of cholesterol and pigments.
• Pigment gallstones: formed from bilirubin, a breakdown product of hemoglobin.
• Small stones may pass unnoticed (silent).
• Large stones can cause obstructions and severe pain.

Types of Gallstones & Their Locations

• Cholesterol stones: most common.
• Pigment stones: related to hemolysis.

Obstructions & Symptoms

• Small stones may pass easily.
• Large stones can lodge in:
  • Cystic duct: causes cholelithiasis.
  • Common bile duct: causes choledocholithiasis.

• Symptoms:
  • Severe colicky pain in the right upper quadrant.
  • Pain worsens after fatty meals.
  • Pain may radiate to shoulder.

Causes and Risk Factors

• High cholesterol intake.
• Obesity.
• Multiple pregnancies (hormonal changes).
• Estrogen therapy or oral contraceptives.
• Hemolysis (excess bilirubin production).
• Liver cirrhosis (damage affects bile production).
• Biliary infections causing bile stasis and dehydration.
• Increased abdominal pressure (pregnancy, obesity).

Pathophysiology

• Dehydrated bile forms precipitates.
• Stagnant bile promotes stone formation.
• Fatty meals stimulate gallbladder contractions.
• Contraction can cause:
  • Obstruction by stones.
  • Peristalsis against stones causes colicky pain.
  • Irritation leads to leukocytosis (white blood cell increase) and fever.

Complications

• Inflammation of the gallbladder (cholecystitis).
• Gallbladder rupture: bile spills into the peritoneal cavity, causing peritonitis.
• Bile duct obstruction:
  • Causes jaundice (yellowing of skin/eyes).
  • Can block the pancreatic duct, causing pancreatitis.
  • Blockage of pancreatic enzymes can damage the pancreas.

Diagnosis

• Imaging:
  • Ultrasound.
  • Cholangiography.
• Blood tests:
  • Elevated white blood cells (infection).
  • Liver function tests for jaundice.

Treatment

• Surgical removal:
  • Laparoscopic cholecystectomy.
  • Shockwave lithotripsy (ESWL) for smaller stones.
• Medications:
  • Low-fat diet (hepatobiliary diet).
  • Bile acids (dissolution therapy) in some cases.
• Prevention:
  • Avoid high cholesterol and obesity.
  • Manage risk factors such as pregnancy and infections.

Summary

• Gallstones develop when bile concentrates and precipitates.
• Blockages lead to pain, inflammation, and potential complications like pancreatitis or jaundice.
• Treatment involves surgical removal of gallstones and lifestyle modifications to prevent recurrence.