What is Cholelithiasis?

Cholelithiasis is a medical condition where hard, pebble-like deposits develop within the gallbladder of an individual. They are also known as gallstones. These stones can be as small as a grain of sand or as large as a golf ball. The gallbladder is a small organ present in the abdominal cavity of human beings whose function is to store the bile. When stones develop within this organ, it may give rise to excruciating pain along with jaundice. Treatment is essential immediately after detection as gallstones may lead to severe complications.

There are two types of gallstones

Cholesterol Stones

The most prevalent kind, approximately 80 per cent of all gallstones fall into this category. They are made of cholesterol and are yellow-green.

Pigment Stones

Also called bilirubin stones, these stones are made of bilirubin, and they mostly develop at the time of haemolysis ( the destruction of red blood cells in the body ). They are dark brown or black in color

How does Cholelithiasis occur?

The exact cause for the occurrence of cholelithiasis has not been determined. Recent studies hint that the presence of excess cholesterol in the blood may be responsible for the formation of cholesterol stones. When bile in the liver cannot dissolve excess cholesterol, it develops into gallstone.

Similarly, the pigment stones develop as a result of abundant bilirubin in the body. Specific conditions like liver damage or blood disorders lead to the formation of excess bilirubin which the gallbladder is unable to break down. It may result in the development of hard, dark coloured pigment stones within the gallbladder.

Who is Prone to Cholelithiasis?

The risk of developing cholelithiasis.

  • Age above 40 years.
  • Family history of cholelithiasis.
  • Organ transplant or bone marrow transplant.
  • Diabetes
  • Cirrhosis of the liver.
  • Medical conditions like haemolytic anaemia and sickle cell anaemia.

What are the Symptoms of Cholelithiasis? How is Cholelithiasis Diagnosed?

The symptoms of cholelithiasis include:

  • Pain on the right side of the upper abdomen.
  • Nausea and vomiting.
  • Fever.
  • Jaundice.
  • Dark coloured stools.
  • Dark coloured urine discharge.
  • Diarrhoea.

In some cases, when cholelithiasis does not produce any symptoms, its known as “silent gallstones” or “asymptomatic cholelithiasis.” The pain occurs when these gallstones block the pathway of the cystic duct or common bile duct. This condition is also known as biliary colic. In 80 per cent of the cases, gallstones remain asymptomatic. The patient remains unaware of this condition until it gets detected through X-Ray at the time of routine health analysis.

Diagnosis

In most of the cases, cholelithiasis gets diagnosed at the time of routine health check-up through X-Rays and lower abdomen ultrasound examination. However, if the patient experiences sharp pain in the middle to the upper abdomen, the doctor performs a physical exam to detect abnormalities in the physical characteristic of the body. If he notices a yellow tint on the skin and in the eyes, he diagnostic tests like ultrasound examination, abdominal CT scan, gallbladder radionuclide scan and Endoscopic retrograde cholangiopancreatography (ERCP). All these tests help in the confirmation or ruling out of cholelithiasis in patients. The gallbladder radionuclide scan helps to find out whether there is an infection or blockage associated with the cholelithiasis.

What are the Complications of Cholelithiasis?

If left untreated for a prolonged period, gallstones may lead to severe complications like:

Acute Cholecystitis

Here the gallstones block the cystic duct which supplies the bile juice from the gallbladder. It results in inflammation, infection, along with excruciating pain in the abdominal region. Approximately 1-3 per cent of patients having gallstones may develop cholecystitis in the future.

Other complications of cholelithiasis include sepsis (infection in the blood), gallbladder cancer, cholangitis (a disorder in the gallbladder), fever, chills, jaundice, pain in the abdomen, and appetite loss.

What is the Treatment for Cholelithiasis?

If Cholelithiasis becomes symptomatic, surgery is the best treatment. This process is known as a cholecystectomy. Earlier, surgeons usually performed open cholecystectomy or removal of the entire gallbladder to eliminate the stones. Nowadays, laparoscopic cholecystectomy is a more common course of treatment. Some doctors also use chemicals like chenodeoxycholic acids (CDCA) or ursodeoxycholic acid (UDCA, ursodiol) to dissolve the gallstones and flush it out through urine. However, a higher probability of recurrence of cholelithiasis exists, and this treatment takes a longer time to show effective results.

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