Gallstones (Cholelithiasis)

Calculosis gallbladder is one of the most common diseases of the digestive tract in general and is characterized by the formation of stones in the gallbladder.It is present in 10-20% of adults in Europe and the US, in 20% of those aged 40 years and 30% older than 70 years.The reason for such a volume of distribution of this disease is primarily to inadequate diet (fatty and high calorie foods).A significant number of people with calculosis without any problems, and even two-thirds of the patients tolerated well the condition during their lifetime.Unfortunately, in a number of patients coming to complications such as acute inflammation of the gallbladder, and acute cholecystitis.In the event of frequent repetition inflammation occurs a condition called chronic cholecystitis.Basic manifestavija inflammation of the gallbladder represents Sudden severe pain under the right rib arch and upper middle abdomen that often spread to the right shoulder blade and was accompanied by nausea and vomiting.Cholecystectomy is the method of choice in the treatment simptomataske calculosis gallbladder, and for more than two decades method is in most cases performed laparoscopic approach.problem.

Details about the frequency, reasons for the occurrence, diagnosis and treatment of gallbladder calculi read below.

Anatomy and physiology of gallbladder


The gallbladder is a pear-shaped organ that represents a reservoir of bile and is popular with the lower edge of the liver.Its length is 7-10 centimeters wide by 3 to 4 at the widest part and a capacity of 30 to 50 milliliters.Anatomically speaking gall bladder has a bottom, body, narrowing funnel at the turn of the body to the neck and throat that continues into the cystic duct (cystic duct-a) or excretory duct of the gallbladder.I cystic duct length 3-4 centimeters and flows into the main hepatičnični line, forming together the main bile duct which conducts bile into the duodenum.

Acute pancreatitis, ANATOMY. Acute pancreatitis illustration.

In the primary bile produced by the liver water accounts for about 97% and 3% consists of the other substances, primarily bile salts, holetserol, lecithin, bilirubin, mucin, electrolytes and some enzymes.In the gallbladder due to absorption of water concentrates the bile and markedly growing share of cholesterol, bile color, proteins and electrolytes.
During the day, adults excrete about 1000 ml of bile and the amount varies from 500 to 1500 ml and depends on several factors, but mostly from the diet.Bile is produced continuously in the liver and builds up between meals in the gallbladder where it concentrates 6 to 10 times.After the meal under the influence of substances called holecistokinetici comes to contraction of the gallbladder and bile flows into the duodenum.Its primary function is in the process of digestion of fats.Also bile helps absorption of fat-soluble vitamins such as vitamin A, D, E and K. In addition to participating in the absorption of fat, helps in the excretion of cholesterol, bilirubin, iron and copper.Bile acids are the main active component of bile, secreted into the duodenum and efficiently reasorbuju or return to the final part of the small intestine, where the vein through re-enter the liver.

The formation of gallstones


Calculosis gallbladder is one of the most common diseases and surgery for gallbladder kaluloze represent one of the most common in abdominal surgery.It is assumed that 3% -10% of all patients with acute abdominal pain stems from the inflammation of the gallbladder.The incidence of calculi caused by gender, race, geographical location.In this sense, it is more present in Europe and North America, and less in Asia.The formation of calculus is most common in people of middle and old age.Approximately 20% of adults over 40 years old and 30% of people over age 70 have stones in the gallbladder.Are more common in women who had given birth as a result of metabolic changes in pregnancy.The frequency of calculi decreases after menopause and higher in women who used the contraceptive medication for a longer period.

Human Abdominal Anatomy

In the formation of gallstones in the gallbladder disorders have a decisive role in the composition of bile, although there may be other causes such as.hipersaturacija bile bilirubin in hemolytic disease.The largest number of stones (70-90%) in the gallbladder is composed of cholesterol.Such stones are usually smooth and solid on the cross-section of a typical layered structure.The remaining 10-30% of calculi or bilirubin were mixed and contain bilirubin, cholesterol, bile salts, organic matter and less salt and calcium.These concrements are usually irregularly shaped, dark, dark-green color and are softer than cholesterol.
Fortunately, about half of the holders of bile stones have no symptoms, or they are quite mild.On the other hand the presence of calculus can lead to very particular problems if not treated properly and in time, can lead to potentially life-threatening complications such as perforation of the gallbladder.

Acute calculous cholecystitis


This disease is one of the most common diseases in surgery and is almost always the consequence of obstruction of the gallbladder or its bile stone duction channels.For obstructing the discharge of bile is difficult or impossible.In this zastojnoj bile leads to infections and due to accumulation of fluid in the gallbladder it expands thereby increasing the pressure in it and I gallbladder wall becomes thickened.In most cases, jammed stone is returned to the gall bladder that empties so acute inflammation settles.After a few days there is povalačenja island and changes in the appearance of scars and surrounding wall changes.However, if the infection is severe and obstruction duction channels complete combustion can progress to the appearance of gangrene and perforation.

The clinical picture is characterized by sudden onset of pain under the right rib arch and epigastric, often accompanied by nausea, nausea and vomiting.Body temperature is usually mild and moderately elevated.The review notes the sensitivity under the right costal margin, and laboratory findings represent a value increase of leukocytes.Of all the diagnostic ultrasound method is the easiest, fastest and highly reliable method (diagnostic test of choice, with a sensitivity of 90-95%).This method can be observed enlargement, thickening and often stratification of the gallbladder wall.The lumen can see the presence of calculus.A good echo sonography can give us information on the size of the gallbladder, size and number of stones, wall thickness and the presence of periholecističnog effusion, as indicators of the degree of inflammation.Also, the dimensions of the main bile duct is a significant figure in planning further treatment.In case of doubt on the existence of stones in the common bile duct, the main bile duct (considered to be 3-10% of patients with calculosis gallbladder has calculi in the main water), it is advisable to supplement diagnostic endoscopy (ERCP – endoscopic retrograde cholangiopancreatography) or MRCP- spiral three-dimensional examination of bile ducts MRI.

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Acute cholecystitis is usually calms spontaneously without treatment.Conservative treatment obuhavata giving fluids, painkillers, antibiotics with careful monitoring of patients.Thus the acute inflammation calms down but there remains the problem of calculus in the lumen of the gallbladder.If the situation does not soothe should consider the need for surgical treatment.Surgical treatment is indicated when the abstention complications.

Given that problems often occur again in their calming planned surgical treatment.The method of choice is laparoscopic cholecystectomy.Cholecystectomy is the definitive treatment of patients with acute cholecystitis.In the seventies it was common clinical practice for these patients first hospitalized for pharmacological treatments, with the intention of “cooling” of inflammation, to elective surgery done a few weeks later.At the end of the seventies this concept was changed in the early open cholecystectomy, which means the operation within the first 36-72 hours of the onset of symptoms.With the introduction of laparoscopic cholecystectomy, early nineties, the question of timing is once again becoming current.At the beginning of acute cholecystitis regarded as a contraindication for laparoscopic cholecystectomy, because it was accompanied by a large percentage of conversion or translation of laparoscopic surgery in the open, with a longer duration of operation compared to conventional open surgery.However, with increasing experience in loparoskopske cholecystectomy these problems have been overcome, so that today more and more prospective studies indicate the benefits of laparoscopic cholecystectomy compared to open surgery, as well as “early” laparoscopy, compared to “delayed” surgery acute inflamed gallbladder.

Chronic calculous cholecystitis


It occurs due to obstruction povremeneih duction channels gallbladder after which there is acute inflammation.When the concrement return to gallbladder inflammation calm down.Repeated inflammation process and remediation occurring scarring that can go from very mild to very pronounced so that the gallbladder becomes the scar packed konkramenata.

The most common symptom of chronic zapaljnja gallbladder concrements pain under the right rib arch or biliary colic, which usually occurs after heavy, fatty meals.The pain is sudden and lasts for several hours, with different intensity and usually accompanied by nausea and vomiting along with the characteristic spreading to the right shoulder blade.Ultrasonography is a sovereign diagnostic tool in the hands of an experienced diagnostician.The most adequate treatment is laparoskopko odrstanjivanje gallbladder.