CHOLELITHIASIS

• Cholelithiasis refers to the presence of abnormal concretions (gallstones) in the gallbladder. Gallstones are essentially of three types: Cholesterol stones (80%), Pigment stones (20%) and rare stones (1%)
• Patient with cholelithiasis become symptomatic due to inflammation or obstruction caused by the stones. Cholelithiasis can manifest with biliary colic (postprandial right upper quadrant pain) but is most commonly an incidental finding in asymptomatic individuals

• Biliary stasis is a key component in gallstone formation
• Imbalance in bile salts, lecithin (stabilizer), cholesterol, calcium carbonate, and bilirubin
• Impaired gallbladder emptying leading to biliary sludge and bile stasis

Cholesterol stones

• Cholesterol is essentially water insoluble. Presence of bile acids and phospholipids help in solubilising the cholesterol. Excess cholesterol production, gall bladder stasis, reduced production of bile acids or phospholipids results in unstable cholesterol rich vesicles which later precipitates

Risk factors

• Obesity, insulin resistance, dyslipidemia
• Female sex especially during reproductive years due to increased levels of oestrogen and progesterone

Pigment stones

• Black stones are predominantly composed of calcium bilirubinate, Brown pigment stones are composed of calcium stones of unconjugated bilirubin

Risk factors

• Chronic haemolytic anaemias
• Liver cirrhosis
• Crohn’s disease
• Gilberts syndrome
• Cystic fibrosis

• Most gallstones are asymptomatic
• Symptomatic stones: Cardinal symptom is Biliary colic. It is usually sharp sudden pain in the right upper abdomen or epigastrium after a meal, often radiating to the back along the lateral chest wall and accompanied with or without nausea and vomiting. Pain lasts for 30 minutes to 6 hours
• Nausea, vomiting, early satiety
• Bloating, dyspepsia

Complications

• Emphysematous cholecystitis
• Cholecystoenteric fistula
• Mirzzi’s syndrome
• Porcelain gall bladder

Differential diagnosis

• Acute cholecystitis: Caused due to impacted stone in cystic duct or acute inflammation of gall bladder
• Choledocholithiasis : caused by Primary stone formed in the bile duct or stone passed from gall bladder
• Cholangitis : stone in bile duct causing obstruction
• Nephrolithiasis
• Gall bladder polyp

• USG Abdomen is the best available method
• Abdominal X ray - limited utility as 75% of stones are radiolucent
• CT scan – evaluation of acute and chronic complications
• Magnetic resonance cholangio pancreatography (MRCP)

• Provide supportive care.
• Laproscopic Cholecystectomy
• Oral dissolution therapy

Internal medicines

• Trayantyadi kashaya
• Saptasaram kashaya
• Vaishwanara choorna
• Trikatu choorna
• Siva gutika
• Drakshadi lehya