Cholelithiasis and Cholecystitis Overview

Cholelithiasis

• Characterized by the presence of gallstones in the gallbladder.
• Gallstones are hardened deposits of cholesterol, bile pigments, and calcium salts.
• Symptoms:
  • Abrupt onset of severe, steady pain localized to the epigastrium and right upper quadrant (RUQ) of the abdomen.
  • Radiates to the back, right scapula, and shoulder.
  • Pain lasts for 30 minutes to 5 hours.
  • Aggravated by movement and breathing.
  • Associated symptoms: nausea, vomiting.
• Complications:
  • Can lead to cholecystitis, common bile duct obstruction, pancreatitis, gangrene, perforation, peritonitis.
  • May result in chronic cholecystitis, empyema, fistula formation, and gallstone ileus.

Cholecystitis

• Inflammation of the gallbladder.
• Caused by gallstones blocking the cystic duct.
• Symptoms:
  • Abrupt onset of severe, steady pain in the right upper quadrant (RUQ) of the abdomen.
  • Pain lasts for 12 to 18 hours and is generalized in the RUQ.
  • Radiates to the back, right scapula, and shoulder.
  • Associated symptoms: anorexia, nausea, vomiting, RUQ tenderness and guarding, chills and fever.

Biliary Colic

• Caused by the passage of a gallstone through the cystic duct or common bile duct.
• Symptoms:
  • Severe, steady ache in the RUQ that begins suddenly and lasts for several hours.
  • May radiate to the right scapula or back.
  • Nausea and vomiting are common.
  • Fat intolerance.
• Treatment:
  • Analgesics for pain relief.
  • Adequate rest and nutrition.
  • Correction of electrolyte imbalances.
  • Antiemetics for nausea.
  • Surgery to remove the gallbladder (cholecystectomy) is the definitive treatment.

Choledocholithiasis

• Presence of gallstones in the common bile duct.
• Symptoms:
  • RUQ pain.
  • Fever.
  • Jaundice (yellowing of the skin and eyes).
  • Pruritus (itching).
  • Abdominal tenderness.
• Treatment:
  • Analgesics for pain relief.
  • Antihistamines for itching.
  • Adequate nutrition.
  • Antibiotics for infection.
  • Antiemetics for nausea.
  • Surgery to remove the gallstones.

Cholangitis

• Infection of the bile ducts.
• Usually occurs in the presence of choledocholithiasis.
• Symptoms:
  • RUQ pain.
  • Fever.
  • Jaundice.
  • Pruritus.
  • Abdominal tenderness.
  • Clay-colored stools.
  • Dark urine.
  • Low blood pressure.
  • Lethargy.
• Treatment:
  • Aggressive intravenous antibiotics.
  • Antiemetics for nausea.
  • Surgery is often needed to remove the gallstones and drain the infected bile ducts.

Treatment of Cholelithiasis and Cholecystitis

• Treatment depends on the severity of the condition and the patient's health.
• Asymptomatic patients with low complication risk are treated conservatively.
• Surgical removal of the gallbladder is indicated for frequent symptoms, acute cholecystitis, or large stones.

Diagnostic Tests

• Tests identify stones, complications, and differentiate gallbladder disease from other disorders.
• Elevated direct bilirubin suggests obstructed bile flow.
• Elevated WBC count in CBC indicates infection and inflammation.
• Serum amylase and lipase levels help diagnose pancreatitis related to common duct obstruction.
• Abdominal x-ray can detect calcium-rich gallstones.
• Ultrasonography accurately diagnoses cholelithiasis and assesses gallbladder emptying.
• Oral cholecystogram assesses gallbladder's ability to concentrate and excrete bile.
• Cholescintigraphy (HIDA scan) uses an IV radioactive solution to diagnose cystic duct obstruction and acute or chronic cholecystitis.

This quiz explores the key aspects of cholelithiasis and cholecystitis, including their symptoms, causes, and potential complications. It is designed for students studying gastrointestinal disorders or relevant medical fields. Test your knowledge on gallstones and gallbladder inflammation.