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Last updated: 11/24/2009
Diagnostically, gallstone disease, which can lead to gallbladder removal, is divided into four diseases: biliary colic, acute cholecystitis, choledocholithiasis, and cholangitis. Biliary colic is usually caused by intermittent cystic duct obstruction...
by a stone (without any inflammation), causing a severe, poorly localized, and intensifying pain on the upper right side of the abdomen. These painful attacks can persist from days to months in patients with biliary colic.
Persons affected with acute cholecystitis caused by an impacted stone in the cystic duct also suffer from gallbladder infection in approximately 50% of cases. These people have moderately severe pain in the upper right portion of the abdomen that lasts longer than six hours. Pain with acute cholecystitis can also extend to the shoulder or back. Since there may be infection inside the gallbladder, the patient may also have fever. On the right side of the abdomen below the last rib, there is usually tenderness with inspiratory (breathing in) arrest (Murphy's sign). In about 33% of cases of acute cholecystitis, the gallbladder may be felt with palpation (clinician feeling abdomen for tenderness). Mild jaundice can be present in about 20% of cases.
Persons with choledocholithiasis, or intermittent obstruction of the common bile duct, often do not have symptoms; but if present, they are indistinguishable from the symptoms of biliary colic.
A more severe form of gallstone disease is cholangitis, which causes stone impaction in the common bile duct. In about 70% of cases, these patients present with Charcot's triad (pain, jaundice, and fever). Patients with cholangitis may have chills, mild pain, lethargy, and delirium, which indicate that infection has spread to the bloodstream (bacteremia). The majority of patients with cholangitis will have fever (95%), tenderness in the upper right side of the abdomen, and jaundice (80%).
In addition to a physical examination, preparation for laboratory (blood) and special tests is essential to gallstone diagnosis. Patients with biliary colic may have elevated bilirubin and should have an ultrasound study to visualize the gallbladder and associated structures. An increase in the white blood cell count (leukocytosis) can be expected for both acute cholecystitis and cholangitis (seen in 80% of cases). Ultrasound testing is recommended for acute cholecystitis patients, whereas ERCP is the test usually indicated to assist in a definitive diagnosis for both choledocholithiasis and cholangitis. Patients with either biliary colic or choledocholithiasis are treated with elective laparoscopic cholecystectomy. Open cholecystectomy is recommended for acute cholecystitis. For cholangitis, emergency ERCP is indicated for stone removal. ERCP therapy can remove stones produced by gallbladder disease.
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The narrated 3D animations shows the function of the gallbladder and explains how gallstones can be formed from cholesterol and bile salts. If gall stones block the outflow of bile from the gallbladder, a cholecystectomy (gallbladder removal) may need to be performed.
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Also known as cholelithotomy, gallstone removal is the medical procedure that rids the gallbladder of calculus buildup.
Surgery to remove the entire gallbladder with all its stones is usually the best treatment, provided the patient is able to tolerate the procedure. Over the past decade, a new technique of removing the gallbladder using a laparoscope has resulted in quicker recovery and much smaller surgical incisions than the six-inch gash under the right ribs that used to be standard. Not everyone is a candidate for this approach.
If a stone is lodged in the bile ducts, additional surgery must be done to remove it. After surgery, the surgeon will ordinarily leave in a drain to collect bile until the system is healed. The drain can also be used to inject contrast material and take x rays during or after surgery.
Other Information
In 2000, the estimated number of hospital admissions among adults aged 18 or older with urinary incontinence listed as a diagnosis was of 47,802 hospital stays (1,332 men; 46,470 women).
From: NKUDIC
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