Cholelithiasis

 
INTRODUCTION–

Cholelithiasis is also known as gall stones in common terminology which is a disease of gall bladder which remains asymptomatic and very common now a days, in cases where they become symptomatic needs medical management.
First of all, gall bladder is a right abdominal organ just below the liver which act as reservoir of secretions from liver mainly bile (greenish-yellow) which is responsible for assisting fat digestion by enzymes in human digestive system. So, when bile which is normally is in liquid state which contains like cholesterol, salts, etc. get solidify due to any cause then it turns into stones or pebble like structure which is then called as ‘’gall stones’’ or medically diagnosed as ‘’Cholelithiasis’’.

CLASSIFICATION–

Gall stones are mainly of two types based on their composition, they are as follows-
1)Pigment type – It is made up of bilirubin. They are mostly smaller and darker in appearance than others.
2)Cholesterol type– It is made up of cholesterol. They are most common type of stones in all the cases .There sizes vary and are of yellow- green in appearance.
3)Mixed type.

Gall stones on the basis of symptoms are also divided into symptomatic type and asymptomatic type (SILENT GALLSTONES) as gall stones are very common and can remain asymptomatic in many persons without any need of medical intervention, if in any case it turns to be symptomatic with a gall bladder attack or other associated symptoms then medical treatment is to be given to the person.

ETIOLOGY–
The main causation is still not verified in medical world but few causes are considered as major causative factor for gall stones formation, they are as follows-
1)High cholesterol in bile– it may be due to insufficiency of bile to dissolve the amount of cholesterol produced by the liver and they remain stagnant and get solidify to form yellow cholesterol stones eventually.
2)High bilirubin in bile- it is a excretory substance which is end product of RBC decomposition which is produced by liver, so in some medical conditions its production increases than its breakdown in gall bladder which leads to dark brown to black coloured stones.
3) Highly concentrated bile– In normal physiology 400-800 ml of bile is produced per day and around 600ml bile flow is daily but in any case where bile is not utilized at its optimum capacity and gall bladder is not emptied its bile contents properly, it leads to increased concentration of bile in gall bladder as it act as carrying sac for bile produced by liver in the body which ultimately leads to formation of stones.

SIGN AND SYMPTOMS-

1)PAIN-The character, location, time of pain is typical and very helpful in clinical diagnosis of gall stones, they are as follows-
a) location-Right upper quadrant of abdomen as well as centre of stomach.
b)Character- Acute sudden severe onset of pain which intensifies in the upper right part of abdomen as well as centre of stomach.
c)Time- It is not fixed as such but it often experienced by individuals from time to time especially when they eat food which are fatty, fried, etc. which are hard to digest , onset of pain can occur almost at any time, duration is also not fixed it can range from few minutes to few hours it depends on every individual case.
Any case of gall stone which is managed properly or mis diagnosed can lead to more symptoms in long duration of time which can be due to gall bladder infection or liver or pancreas infection along with it, so proper diagnosis and management is very important in any case, they are as follows-
1)Loss of appetite and nausea at the sight or smell of fatty or fried food items.
2)On and off diarrhoea.
3)Jaundice is marked (yellowing of sclera and skin )
4)Skin is itchy without any lesion or cause.
5)Signs of fever- high temperature, chills, etc.
6)Heartbeat increases in some cases.
7)Mental alertness also decreases as well as confusion is seen.

RISK FACTORS–
Risk factors of 5F’s in gall stones are-
‘’Fat, Fair, Fertile, Female, Forty’’.
Other than this lifestyle plays a very important role in gall stone formation, they are as follows-
1)Obesity as well as when a person goes in rapid weight loss too.
2)Type 2 diabetes.
3)Diet pattern where it is high in fat or cholesterol but low in fibers.
Beside these other major factors are as follows-
1)Genetic disposition- it means having family history of gall stones.
2)Old age group.
3)liver diseases mainly- cirrhosis, etc.
4)Pregnancy as well as birth control medications.
5)Medications for high cholesterol for longer duration.

DIAGNOSIS–
It includes physical /clinical examination as well as diagnostic tests both-
1)Physical examination-
Examination for clinical sign and symptoms. As many signs are also present (sign of jaundice) is present.
2)Diagnostic tests-
a) USG- It is confirmatory investigation. It also helps in determining the abnormalities related to abdomen if present.
b) GB radionuclide scan- It helps in determining the infection, GB duct blockage in patient of cholelithiasis and also if helps in confirmation of stones in any suspected case.
c)CT abdomen.
d) Haematological investigation- To determine the levels in blood especially amount of bilirubin and LFT (liver function test ) is routinely done.

MANAGEMENT–
Asymptomatic gall stones most of the time remain unnoticed and does not need any treatment unless they turn into symptomatic and causes pain and other symptoms. Most of the cases needs surgery unless the person is liable to surgical complications then nonsurgical mode is attempted to treat them but there is no confirmation for complete cure and also relapse of stones is highly possible.

Choice of treatment –
1)Surgical mode of treatment-
Operation done to remove GB (Gall bladder) is known as Cholecystectomy. It is mainly of two types-
1)Open cholecystectomy.
2)Laparoscopic cholecystectomy.
After effect of both of the procedure is laxative effect which causes diarrhoea but it get resolved on its own as it occurs as bile is directly enters into intestine and is less concentrated .
2) Nonsurgical mode of treatment.

In cases where there is high risk of surgical complications as well as patient is of older age, then nonsurgical mode is opted by using-
a) Oral medications- Mechanism is by dissolving the stones or breaking down them in smaller sizes so that they do not block duct in order to prevent attack ,but this treatment mainly acts on cholesterol stones and also it can take up to several months for their complete action.
b) lithotripsy- By the help of wave mechanism using lithotripter stones are disintegrated into smaller pieces in the patient.

PREVENTION–
Although it is a preventable condition but still there is not a single 100% method to prevent it completely as many factors plays an important role in its formations, but still by controlling cholesterol in daily diet is helpful in prevention of stone formation as most of the cases suffers from cholesterol stones, it can be done by following ways which mainly aim at limiting high saturated fat in diet, they are as follows-
a) Refined carbs, sugar, bakery products- cakes, cookies, cream puffs, etc.
b) Red meat, fatty meat- sausage, bacon, etc.
c)Certain cheese and its products.
At the same time few things which is to include in diet are-
a)Healthy fatty sources- fish oil, olive oil, etc.
b)Drink plenty of water in daily life.
c)Proper intake of fiber in daily diet is necessary.
Along with these, weight management is needed as one of the F of risk factor is ‘FAT’, so person with obesity must reduce their weight to moderate but sudden weight loss is also needed to avoid in order to prevent stone formation.

By life style modification and physical exercise in daily routine one can easily prevent gall stones even in cases where there is family history is present as it is one of the most common problem but can be prevented easily at the same time.

HAPPY LEARNING

Contributor- Dr. Apurva Varangi