![]() ![]() Jaundice may be present on physical examination. The symptoms may occur after a fatty meal and may be associated with nausea or vomiting or fever. Intense pain in the right upper quadrant of the abdomen that may radiate to the right flank, back, or shoulder is typical of biliary colic due to gallstones. illustration Synonym: biliary calculus Symptoms Either type of stone may cause biliary symptoms such as pain or inflammation of the gallbladder the two types of stones differ in that cholesterol stones are nonradiopaque and may on occasion be dissolved by medication, whereas calcium-containing radiopaque stones are not amenable to chemical dissolution and are therefore visible on plain x-rays of the abdomen. Cholesterol stones are about four times as common as calcium-containing stones (also known as pigment stones). Gallstones typically are made either of crystallized cholesterol deposits or calcium crystals ionized with bilirubin. They may cause pain in the right upper quadrant of the abdomen (biliary colic) or they may be clinically silent. Gallstones are found in about 15% of men and 30% of women in the U.S., i.e. See Black gallstone, Brown gallstone, Soluble fiber.Ī concretion formed in the gallbladder or bile ducts. gallstone Gastroenterology A concrement in the gallbladder or the cystic duct Epidemiology 10% of adults have gallstones–GS ↑ with age ♀:♂ = 2:1 highest in Scandinavia, Chile, Native Americans ↑ risk with childbearing, ERT, OCs, obesity, rapid weight loss Types Cholesterol, bilirubin, calcium salts cholesterol GSs constitute 75% of total in Western nations up to 80% of the volume is cholesterol non-cholesterol GSs are either black or brown GSs Clinical Biliary colic, recurrent upper-quadrant pain fatty food intolerance, while suggestive, is nonspecific GSs may be associated with acute cholecystitis which causes severe abdominal pain, N&V, fever, leukocytosis Diagnosis Ultrasonography, cholescintigraphy, cholecystography Management Laparoscopic cholecystectomy, percutaneous dissolution of gallstones by MTBE–methyl- tert-butyl ether, via a percutaneous transcutaneous catheter, shock-wave lithotripsy. The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. (See also discussion of surgery at gallbladder.) For those patients unable to withstand cholecystectomy (gallbladder removal) but who still require drainage, cholecystostomy is indicated. In most cases the gallbladder is removed and a tube is inserted to establish drainage of bile that has been dammed up by the stone. Laparoscopic surgery is the usual method of treatment and is performed as soon as the patient is able to withstand it. ursodiol is a drug that can dissolve gallstones and reduce the need for surgery. Treatment may also include insertion of a nasogastric tube for the purpose of gastric suction to relieve distention in the upper gastrointestinal tract. meperidine, which does not have this side effect, is the preferred medication for pain. ![]() morphine is usually not given to relieve the pain because it increases spasm of the biliary sphincters. The pain is located in the upper right quadrant of the abdomen and radiates as far as the scapula. When a gallstone travels through or obstructs a bile duct it can cause biliary colic, with severe pain. This condition should be corrected by surgery before the liver is damaged or problems with infection ensue. The most common complication of gallstones occurs when one of the stones escapes from the gallbladder and travels along the common bile duct, where it may lodge, blocking the flow of bile to the intestine and causing obstructive jaundice. X-rays will generally reveal the presence of gallstones, either directly or by use of a dye introduced into the gallbladder ( cholecystography). There may be indigestion and nausea, especially after eating fatty foods. The usual symptoms, however, are vague discomfort and pain in the upper abdomen. They may be present for years without causing trouble. Gallstones are most common in women after pregnancy, and in both men and women past age 35. ![]() The cause is unknown, although there is evidence of a connection between gallstones and obesity an excess of cholesterol in the bile appears to be of major importance. A stonelike mass ( calculus) in the gallbladder the presence of gallstones is known medically as cholelithiasis.
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