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Cholelithiasis

DEFINITION

Cholelithiasis is the medical word for gallstones which are small stones formed from various things that collect in the gallbladder. The normal job of the gallbladder is to store bile, which is made in the liver then passed down the bile duct system to the gallbladder. This bile is used to help break down the fats that we eat. When something fatty enters the stomach, bile is released from the gallbladder to help break down fats to be used by the body. Gallstones can be made of breakdown products from blood in people with certain medical conditions (called pigment gallstones), but are more commonly made from an imbalance of the cholesterol and bile salts in the gallbladder (cholesterol gallstones). These gallstones can either stay in the gallbladder or move down the bile duct system and block either the common bile duct or the pancreatic duct. Gallstones can be asymptomatic or can be quite painful. Usually, the pain comes with eating fat-containing foods. Risk factors for gallstones include being female, being overweight, being at an age near forty, and being pregnant or on hormonal contraception. Gallstones can be very serious if they block off ducts and cause infection.

SYMPTOMS
Abdominal pain (especially in the right upper part of the abdomen), pain exacerbated by eating, yellowing of the skin, pain in the back or shoulder blades, nausea and vomiting, bloating, gas, indigestion

DIAGNOSIS
The diagnosis of gallstones is made after a careful history and physical exam by your doctor. You will likely have blood drawn for lab tests including liver functions test which show the activity of your gallbladder. You will likely also have an ultrasound (sonogram) of your right upper abdomen which will show if you have gallstones in your gallbladder. A CT scan (which provides pictures of your abdomen taken from the outside) can also be used to test for the presence of gallstones.

TREATMENT
The treatment of gallstones or cholelithiasis depends on the severity of your symptoms. If you don’t have any symptoms, likely no treatment will be necessary. Sometimes, your doctor will choose to treat your pain. Other medication options include ursodeoxycholic acid, but the course of treatment can be quite long. If your gallstones obstruct any of your ducts, a Gastroenterologist may do an endoscopic retrograde cholangiopancreatography (ERCP) which is a procedure that injects dye into the bile duct system to see where gallstones might be stuck and attempt to remove them. Extracorporeal Shock Wave Lithortripsy, a procedure which sends sound waves toward the body, can also be tried to break apart the stones and allow them to pass. Surgery is also an option for removal of the gallbladder. This type of surgery can either be done with an open abdominal surgery (laparotomy) or can be done by inserting a small camera and tools in small incisions in the abdomen (laparoscopy). Often, this is an outpatient surgery. Most people do not have problems living without a gallbladder, but some can have diarrhea.

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