Cholelithiasis

Cholelithiasis is also known as gallstone.  gallstones are deposits of digestive fluid that can form within the gallbladder.

Definition of Cholelithiasis

Cholelithiasis also known as gall stone. Cholelithiasis or gallstones are deposits of digestive fluid that can form within gallbladder.

  • The gallbladder is a small organ located just beneath the liver. The gallbladder holds a digestive fluid known as bile that is released in small intestine.

Prevalence

In developed countries, more than 85% of gallstones are cholesterol stones. The Third National Health and Nutrition Examination Survey (NHANES III) indicated a higher prevalence in Mexican-Americans than in non-Hispanic whites, and a lower prevalence in non-Hispanic blacks.

The data from Pakistan has found to be scarce, but previous study in southern Sindh area of Pakistan has reported a surgical incidence of 9.03%, particularly a prevalence rate of 4% in males and 14.2% in females of Pakistan.

Types of Cholelithiasis

There are three types of gallstones.

  1. Pure cholesterol gallstones
  2. Pigmented gallstones
  3. Mixed composition gallstones

1. Pure cholesterol gallstones:

The most common type of gallstone. These are yellow in color. It contain at least 90% cholesterol.

2. Pigment gallstones:

These are brown or black, which contain at least 90% bilirubin.

Brown pigment stones are mainly composed of calcium bilirubin whereas black pigment stones contain bilirubin, calcium and/or tribasic phosphate.

3. Mixed composition gallstones:

These contain varying proportions of cholesterol, bilirubin and other substances such as calcium carbonate, calcium phosphate and calcium palmitate.

Causes

  • The excess cholesterol excretion may form into crystals and eventually into stones.
  • Bile concentration in gallbladder can lead to gallstone formation.
  • Secondary causes e.liver cirrhosis, biliary tract infections and certain blood disorders liver make too much bilirubin which contributes to formation of gallstone.

Risk factors

Factors that may increase your risk of gallstones include:

  • Gender (female)
  • Age (40 or older)
  • Obesity
  • Sedentary lifestyle
  • Eating high-fat diet
  • Eating high-cholesterol diet
  • Eating low-fiber diet
  • Family history of gallstones
  • Having blood disorder
  • Losing weight very quickly
  • Medications that contain estrogen
  • Liver disease
Risk factors of Cholelithiasis

Sign and Symptoms

Gallstones may cause no signs or symptoms. Gallstone can cause blockage in a duct, resulting:

  • Sudden and rapidly intensifying pain in the upper right portion of abdomen
  • Sudden and rapidly intensifying pain in the center of abdomen, below breastbone
  • Back pain between shoulder blades
  • Pain in right shoulder
  • Nausea or vomiting
Sign and Symptoms of Cholelithiasis

Complications

Complications may include:

    • Inflammation of the gallbladder
    • Blockage of the common bile duct.
    • Blockage of the pancreatic duct.
    • Gallbladder cancer.

Diagnosis

  • Abdominal ultrasound.
  • Endoscopic ultrasound (EUS).
  • Blood test.
  • Other imaging tests include oral cholecystography, a hepatobiliary iminodiacetic acid (HIDA) scan, computerized tomography (CT), magnetic resonance cholangiopancreatography (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP).
Diagnosis of Cholelithiasis

Prevention

There are two types of public health approaches:

  1. The first type is aimed at what people eat
  2. The second type is aimed at the time people eat

1. Primary Prevention:

  • Maintaining a non-obese body weight
  • Ingesting meals at regular intervals
  • High fiber intake
  • Avoidance of sex hormone treatment

2. Secondary Prevention:

For secondary prevention, medical treatment of the asymptomatic cholesterol is quite feasible.

Such an approach cannot be recommended because of the benign natural history of asymptomatic gallstones as well as the incomplete efficacy of available medications.

Medical Nutrition Therapy (MNT)

Dietary guidelines for cholelithiasis:

  • Eat more foods that are high in fiber, such as:
  • Fruits, vegetables, beans, and peas.
  • Whole grains, including brown rice, oats, and whole wheat bread.
  • Eat fewer refined carbohydrates and less sugar.
  • Eat healthy fats, like fish oil and olive oil, to help your gallbladder contract and empty on a regular basis.
  • Avoid unhealthy fats, like those often found in desserts and fried foods.

.1. Food to avoid:

  • Coffee
  • Alcohol
  • High fat food
  • Cheese
  • Acidic fruit juices
  • Chocolate
  • Cream
  • Butter
  • Meat products
  • Dairy product
  • Sauces
  • Fried food

2. Practical tips to cut down on fat:

Here some tips you can use during cooking and food preparation.

  • Avoid processed foods.
  • Check food labels.
  • Bulk out meals with vegetables and pulses.
  • Use oil spray when cooking.
  • Measure oil when cooking. A good measure is about one teaspoon per person.
  • Try to use fat/oil in food only when it is absolutely necessary.
  • Remove all visible fatty skin from meat and choose leaner cuts of meat.
  • Try not to fry food. Bake, steam, boil, grill or roast on a drip tray instead.

Treatment

  • Surgery to remove the gallbladder (cholecystectomy).
  • Medications to dissolve gallstones.

Reference

  • Njeze GE. Gallstones. Nigerian Journal of Surgery. 2013;19(2):49-55.
  • Acalovschi M, Lammert F. The growing global burden of gallstone disease. World Gastroenterology News. 2012;17(4):6-9.
  • Bilal M, Haseeb A, Saad M, Ahsan M, Raza M, Ahmed A, Shahnawaz W, Ahmed B, Motiani V. The prevalence and risk factors of gallstone among adults in Karachi, south Pakistan: A population-based study. Glob J Health Sci. 2016;9(4):106-14.
  • Friesen CA, Roberts CC. Cholelithiasis. Clinical pediatrics. 1989 Jul 1;28(7).
  • Ahmad A, Khan MA, Khalid S, Yousaf R, Kaleem A. Diet and Physical Activity Among Gallstone Patients. THE THERAPIST (Journal of Therapies & Rehabilitation Sciences). 2021 Jun 30:18-22.
  • Marschall HU, Einarsson C. Gallstone disease. Journal of internal medicine. 2007 Jun;261(6):529-542.
  • Haal S, Guman MS, Bruin S, Schouten R, van Veen RN, Fockens P, Dijkgraaf MG, Hutten BA, Gerdes VE, Voermans RP. Risk factors for symptomatic gallstone disease and gallstone formation after bariatric surgery. Obesity Surgery. 2022 Apr;32(4):1270-1278.
  • Venneman NG, van Erpecum KJ. Gallstone disease: Primary and secondary prevention. Best Practice & Research Clinical Gastroenterology. 2006 Jan 1;20(6):1063-1073.
  • Hofmann AF. Primary and secondary prevention of gallstone disease: implications for patient management and research priorities. The American journal of surgery. 1993 Apr 1;165(4):541-548.
  • Gutt C, Schläfer S, Lammert F. The treatment of gallstone disease. Deutsches Ärzteblatt International. 2020 Feb;117(9):148-158..
  •