10-15% of the U.S. population have gallstones.
Its prevalence is approximately 27% in Hispanic individuals.
People from Central and South America who have Hispanic ethnicity and individuals with American Indian ancestry have the highest prevalence of cholelithiasis.
Studies have shown that 10% of those with gallstones will develop symptoms within 5 years of diagnosis, and 20% within 20 years.
Gallstones are solid particles that form from bile in the gallbladder.
Bile contains several different substances, including cholesterol and bilirubin, a waste product of normal breakdown of blood cells in the liver, and it is stored in the gallbladder until needed.
Gallstones may result from increased saturation of cholesterol or bilirubin, or from bile stasis.
Gallstones may result from increased saturation of cholesterol or bilirubin, or from bile stasis.
With a high-fat, high-cholesterol meal, the gallbladder contracts and injects bile into the small intestine via the common bile duct to assist in the digestive process.
Risk factors for gallstones include: age greater than 40 years, female gender, rapidly losing or gaining weight, increased weight, and pregnancy.
There are two types of gallstones: 1) cholesterol stones and 2) pigment stones.
Cholesterol stones make up approximately 80% of all gallstones.
Bilirubin and calcium can combine to form calcium bilirubinate salts which may grow and become pigmented gallstones.
Calcium bilirubinate salts may act as a nucleus ting factor for the precipitation of biliary cholesterol facilitating the formation of cholesterol gallstones.
Cholesterol stones form when there is excess cholesterol in the bile, and pigment stones form when there is excess bilirubin in the bile.
Gallstones may be a result from increased saturation of cholesterol or bilirubin, or from bile stasis.
Lower concentrations of bile acids or phospholipids in bile reduce cholesterol solubility and lead to microcrystal formation.
Gallstones can vary in size, from a grain of sand to golf ball size.
It is common to have many smaller stones, but a single larger stone or any combination of sizes is possible.
If stones are very small, they may form a sludge or slurry.
Gallstones may cause symptoms based on their size and their number, however neither factor can predict whether symptoms will occur or their severity.
Gallstones within the gallbladder are often asymptomatic.
More than 70% of people with gallstones are asymptomatic and are diagnosed incidentally during ultrasound.
Studies have shown that 10% of those with gallstones will develop symptoms within 5 years of diagnosis, and 20% within 20 years.
Gallstones may cause pain when the gallbladder responds to a fatty meal, and if the stones move out of the gallbladder symptoms may be precipitated.
If their movement leads to blockage of any of the ducts connecting the gallbladder, liver, or pancreas with the intestine, serious complications may result.
Blockage of a duct can cause bile or digestive enzymes to be trapped in the duct.
This can cause inflammation and ultimately severe pain, infection, organ damage and even cause death.
Up to 20% of adults in the United States may have gallstones, but only 1% to 3% develop symptoms.
Hispanics, Native Americans, and Caucasians of Northern European descent at highest risk for gallstones.
African Americans are at lower risk.
Most common among obese, middle-aged women.
Cholesterol gallstones promoted by biliary cholesterol hypersecretion, gallbladder stasis, precipitation of biliary cholesterol, increased intestinal input of dietary or biliary cholesterol and genetics.
Increased bilirubin production is associated with increased risk of gallstones.
The elderly and men are more likely to experience serious complications from gallstones.
Women who have been pregnant or on birth control pills or on hormone/estrogen therapy are at higher risk for the development of gallstones.
Risk factors for gallbladder disease such as obesity, weight loss, pregnancy, and drinking less than 1 to 2 alcoholic drinks per day do not explain the differences in racial or ethnic prevalence of cholelithiasis.
Women who have gallstones have a higher mean body mass index compared with those with out stones.
Men with gall stones hace a mean BMI of 28.3 versus 26.5 for those without gall stones.
A diet high in fat or low in fiber may explain a significant fraction of the risk associated with cholelithiasis.
Substantial weight loss, particularly with bariatric surgery is associated with the development of gall stones
Congenital hemolytic anemia‘s, especially thalassemia and sickle cell disease are a common cause of gallstones, particularly in children.
Gall stones are 2 to 3 times more common in women.
The difference between the genders in cholelithiasis diminishes with age and the risk of developing cholelithiasis increases with age.
Associated with rapid loss of weight, elevated blood triglyceride levels, and Crohn’s disease.
Black pigment gallstones occur when there is increased destruction of red blood cells, and brown pigment gallstones occur when there is slow flow and infection of bile.
Most common symptoms are biliary colic and cholecystitis.
Gallstones do not cause intolerance to fatty foods, belching, abdominal distention, or gas.
Complications of gallstones include cholangitis, gangrene, jaundice, pancreatitis, sepsis, fistula, and ileus.
Gallbladder sludge may be associated with symptoms and complications of gallstones, but usually does not cause problems.
The best single test for diagnosing gallstones is transabdominal ultrasound.
Diagnosis can also be confirmed by endoscopic ultrasound, magnetic resonance cholangio-pancreatography (MRCP), cholescintigraphy (HIDA scan), endoscopic retrograde cholangio-pancreatography (ERCP), liver and pancreatic blood tests, duodenal drainage, oral cholecystogram (OCG), and intravenous cholangiogram (IVC).
Managed primarily with observation or by cholecystectomy.
Uncommonly, sphincterotomy, extraction of gallstones, dissolution with oral agents, and extra-corporeal shock-wave lithotripsy are employed.
Prevention of cholesterol gallstones is possible with oral medications.
Oral therapy with chenodeoxycholic acid and/or ursodeoxycholic acid has been used to dissolve cholesterol gallstones.
Stones may recur when treatment is stopped.
Bile acid therapy may be of value to prevent stones in certain circumstances such as following bariatric surgery.