Cholelithiasis

Under a cholelithiasis mean the presence of one or more calculi (gallstones) in the gallbladder. In developed countries, about 10% of adults and 20% of people have> 65 years gallstones. Gallstones are usually asymptomatic. The most common symptom is the biliary colic, gallstones do not cause dyspepsia or intolerance of fatty foods. More severe complications include cholecystitis, the bile ducts (due to bile duct stones [cholelithiasis]), sometimes associated with inflammation (cholangitis) and biliary pancreatitis. The diagnosis is usually using an ultrasound scan. If cholelithiasis causes symptoms or complications, a cholecystectomy is indicated.

(See also Overview biliary function.)

Under a cholelithiasis mean the presence of one or more calculi (gallstones) in the gallbladder. In developed countries, about 10% of adults and 20% of people have> 65 years gallstones. Gallstones are usually asymptomatic. The most common symptom is the biliary colic, gallstones do not cause dyspepsia or intolerance of fatty foods. More severe complications include cholecystitis, the bile ducts (due to bile duct stones [cholelithiasis]), sometimes associated with inflammation (cholangitis) and biliary pancreatitis. The diagnosis is usually using an ultrasound scan. If cholelithiasis causes symptoms or complications, a cholecystectomy is indicated. (See also Overview biliary function.) Risk factors for gallstones are female gender, obesity, older age, American Indian descent, a Western diet, rapid weight loss and a positive family history. Gallstones are the most common cause of biliary tract disease. Pathophysiology Gallenblasensludge is often the precursor to gallstones. Sludge consists of Kalziumbilirubinat (a polymer of bilirubin), cholesterol microcrystals and mucins. Sludge develops in the rest gallbladder, z. As during pregnancy or parenteral nutrition. Sludge usually is asymptomatic and disappears as soon as the triggering cause no longer exists. On the other hand, can develop gallstones and Ludge can migrate to the bile ducts and seal it from sludge, leading to biliary colic, Cholangitisoder pancreatitis. There are several types of gallstones. Cholesterol stones are responsible for> 85% of gallstones in the Western world. The formation of cholesterol stones following events are necessary: ??The bile must be supersaturated with cholesterol. Normally, water insoluble cholesterol is made water-soluble by it forms with bile salts and lecithin micelles. A supersaturation of bile with cholesterol is often caused by an excessive causes the cholesterol, (diabetes mellitus as in obesity or), but can also by reducing the Gallensalzsekretion (z. B. in cystic fibrosis due to Gallensalzmalabsorption) or by Lecithinsekretion (z. B. be caused in a rare genetic defect that leads to progressive intrahepatic cholestasis family). The excess cholesterol precipitated from the liquid and solid microcrystals. Such precipitates in the gallbladder are accelerated by mucin, a glycoprotein, or other proteins in the bile. aggregate microcrystals and grow. This process is aided by the binding effect of mucin, which forms a framework, and by the retention of micro-crystals in the gall bladder with reduced contractility due to increased cholesterol in the bile. Black Pigment stones are small, hard gallstones, resulting from Kalziumbilirubinat and inorganic calcium salts (z. B. calcium carbonate, calcium phosphate) composed. Among the factors that accelerate stone formation include alcoholic liver disease, chronic hemolysis and higher age. Brown pigment stones are soft and greasy, and consist of bilirubinate and fatty acids (calcium palmitate or stearate). They form z. B. (z. B. liver flukes in Asia) during infection, inflammation and parasite infestation. Gallstones grow at a rate of about 1-2 mm / year and takes about 5-20 years before they are large enough to cause complications. The majority of gallstones forms in the gall bladder, brown pigment stones occur in the bile ducts. This sentence makes no sense content! Gallstones can migrate into the bile duct or v after a cholecystectomy. a. in the case of brown pigment stones develop behind strictures due to stasis or infection. Symptoms and complaints Over 80% of people with gallstones are asymptomatic. The rest have symptoms that are characteristic of pain (biliary colic) extend to cholecystitis and life-threatening cholangitis. Biliary colic is the most common symptom. Sometimes wander to cause the cystic duct without symptoms gallstones. However, the migration of gallstones through leads mostly to seal the cystic duct, which in turn, at least temporarily, causing a biliary colic. A biliary colic begins characteristic right upper quadrant, but can also occur in the abdomen elsewhere. It is often poorly localized, particularly in diabetics and the elderly. The pain may radiate to the back or in the right shoulder and arm. It starts suddenly takes within 15 minutes to 1 hour in intensity, then (usually less than 6 hours) achieved a pain Plateau (not colicky) up to 12 h, recedes slowly over the following 30 to 90 minutes, leaving a dull Feeling. The pain is strong enough to search patient to induce pain relief in the emergency room usually. Nausea and vomiting are some frequently during fever and chills only occur in the context of a cholecystitis. The upper right quadrant and the epigastric region may be sensitive to pressure, but there are no Peritonitissymptome. Between the episodes of pain the patient feels well. Although biliary colic can occur after heavy meals, high-fat diet is not a specific trigger factor. Non-specific gastrointestinal Sympotome, such as belching, bloating and nausea have been unfairly associated with gallstone disease. These symptoms are very common and have the same prevalence of cholelithiasis, an ulcer disease and functional disorders of the gastrointestinal tract. Tips and risks Fatty foods are no specific causes of biliary colic and gas, bloating and nausea are no specific symptoms of gallbladder disease. Between the severity and incidence of colic and pathological changes in the gallbladder there is little correlation. The biliary colic can occur without the presence of a cholecystitis. If the colic persists for more than 12 hours, especially if it is accompanied by vomiting and fever, is probably based on an acute cholecystitis or pancreatitis. Diagnostic sonography in patients with biliary colic is suspected gallstones. For the diagnosis of gallbladder stones the abdominal ultrasonography is the imaging method of choice; it has a sensitivity and specificity of 95%. Using sonography can be seen very closely Sludge. Alternative methods challenge the CT and MRI, as well as oral cholecystography represents (the latter is now very little available, although it is very accurate). EUS detects small gallstones (<3 mm) is very accurate and can be necessary when other tests are inconclusive. Abdominal imaging (gallstones) © Springer Science + Business Media var model = {thumbnailUrl: '/-/media/manual/professional/images/536-abdominal-imaging-gallstones-s130-springer-arrows-high_de.jpg?la= de & thn = 0 & mw = 350 ', imageUrl:' /-/media/manual/professional/images/536-abdominal-imaging-gallstones-s130-springer-arrows-high_de.jpg?la=de&thn=0 ', title:' imaging the abdomen (gallstones) ', description:' u003Ca id = "v37892662 " class = ""anchor "" u003e u003c / a u003e u003cdiv class = ""para "" u003e u003cp u003eAuf the left side shows an abdominal ultrasound several gallstones (arrows). On the right side the plain abdominal shows radiopaque gallstones (arrows) u003c / p u003e u003c / div u003e 'credits'. © Springer Science + Business Media'

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