Gall Stone Disease

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Gall stone disease

Until the sixth decade, 20% female and 10% of men suffer from gallstones and its 

prevalence increases with age, although it is generally always in women. In 

Western societies, most found the stone is a stone of cholesterol or calcium 

bilirubin-cholesterol mixtures. Pathogenesis is not completely understood. 

however, factors which could form the bile faklor litogenik include an increase in 

cholesterol content, reduced bile acid and bile stasis. In most cases, gallstones 

are asymptomatic and only 10% have symptoms after 5 years. Gallstones cause three 

major disorders: cholecystitis, biliary colic and koledokolitiasis.

Cholecystitis

Gallstone impaction in the cystic duct is a common cause of cholecystitis. Less 

common causes of infection include Salmonella typhi or primer such as Ascaris 

lumbricoides, trauma, surgery, chemotherapy and TPN.

The clinical

Symptoms: right upper quadrant pain, often with spread to the right shoulder, 

nausea, vomiting and fever.

Sign: RUQ tenderness pedestal, tenderness of the gallbladder that can be shown on 

inspiration (Mark Murphy), gallbladder usually can not be touched, and jaundice in 

a minority of patients.

• FBC investigations usually show a leukocytosis • Abdominal X-rays showed stones 

radioopak on a minority of cases and sometimes a sentinel-loop or the presence of 

air in the biliary branches • U.S. showed gall bladder stones and darts mucosal 

thickening • Skaning radio-isotopic (HIDA; PIPIDA) is useful in finding the cystic 

duct obstruction dart.

Complications Empyema, gangrene and perforation of the gallbladder, pancreatitis, 

abscess perihepatik, piemia port and septikemi.

At first supportive management with iv fluids, analgesics and antibiotics, such as 

amoxicillin and tobramycin. Cholecystectomy is performed after the patient is 

stable, although the selected treatment time of surgery is done early or delayed 

cholecystectomy (interval) is still controversial and depends on the condition and 

age of the patient. Percutaneous cholecystectomy

may be indicated in patients with severe pain.

Biliary colic

This situation is usually caused by impaction of a stone in the cystic duct.

The clinical

Symptoms: Pain that persists in the epigastrium or right upper quadrant are 

usually intensified during 2-3 hours before it subsided.

Pain is more than 6 hours of support in cholecystitis. Often found nausea and 

vomiting.

Investigation Diagnosis is made clinically most especially because of gallstones 

is frequent. Many patients with gallstones and dyspepsia was not helped by 

cholecystectomy and in many patients, abdominal discomfort caused by IBS (hepatic 

flexure syndrome) • transient increase of bilirubin and alkaline phosphatase 

support the diagnosis of biliary colic biliary • Scintigraphy can show if the 

cystic duct obstruction carried out during the attack.

Provide management of analgesia until the attack passes. Morphine increases 

sphincter of Oddi pressure and should be avoided. Cholecystectomy is indicated in 

patients who underwent surgery powerful. In patients who are not strong or refuse 

surgery, therapy can be administered by the acid dissolution of gallstones 

ursodeoksikolat for patients with radiolucent stones of less than 1.5 cm in 

diameter and with a rnasih gall bladder function at oral kolesistograti. Complete 

dissolution occurred approximately 30% at 12 months.

KOLEDOKOLITIASIS

Koledokus duct stones most often derived from gallbladder stones, but can form in 

the bile ducts due to biliary stricture, cholangitis or primary or secondary 

sklerotika in Caroli disease.

Clinical picture can be asymptomatic

Symptoms include biliary colic, intermittent or constant pain in the right upper 

quadrant, nausea and vomiting.

Signs: fluctuating jaundice, right upper quadrant tenderness and a palpable 

gallbladder in 15% of cases. Fever and rigor indicates cholangitis.

Investigas! • FBC and LFT show a leukocytosis shows an increase of bilirubin, 

alkaline phosphatase and gamma GT; not infrequently found a slight increase of 

transaminases • Often tedadi elongation PT • Abdominal X-rays may show an opaque 

or a rare stone, showing air in the biliary branches • U.S. can demonstrate 

dilated biliary branches, but not as sensitive in identifying stones in the CBD 

which usually require ERCP or PTC.

Penyullt pancreatitis, cholangitis, septikemi, and hepatic abscess secondary 

sklerotika cholangitis or biliary cirrhosis.

First of all give the management of analgesia, iv fluids and antibiotics (eg 

amoxicillin or tobramycin). Removal of the stone best with ERCP, sphincterotomy 

and extraction with a Dormia basket or balloon. Large stones can be dissolved or 

reduced in size by methyl-tert-butyl-ether or mono-octanion given through a tube 

nasobitiaris. Stone fragmentation by mechanical lithotripsy may prove useful as an 

alternative.

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