Gall stones: a fundamental clinical review

Authors

  • Muhammad Nouman Iqbal Department of Medicine, Multan Medical and Dental College, Multan, Punjab, Pakistan
  • Muhammad Arslan Iqbal Department of Medicine, Multan Medical and Dental College, Multan, Punjab, Pakistan
  • Rukhsar Javaid Department of Medicine, Nishtar Medical University, Multan, Punjab, Pakistan
  • Muhammad Waseem Abbas Department of Medicine, Nishtar Medical University, Multan, Punjab, Pakistan

DOI:

https://doi.org/10.18203/2320-6012.ijrms20192938

Keywords:

Bile, Cholesterol, Gall bladder, Jaundice, Leukocytosis

Abstract

Formation of stones in the gall bladder is known as cholelithiasis. About 10% to 20% of Western population are suffering from gall stones and this percentage is increasing day by day. Biochemically gall stones are classified into black pigment stones, brown pigment stones and cholesterol stones. Gall stones can be anatomically located at two possible sites; in the gall bladder known as cholelithiasis and in the common bile duct known as choledocholithiasis. Gall stones may present with symptoms known as symptomatic gallstones or without symptoms known as asymptomatic gallstones. The major causes of gallstones are high cholesterol diet, low bile salt levels, decreased gall bladder motility etc. Obesity, female gender, family history, rapid weight loss and vitamin B12 or folic acid deficiency are considered as important risk factors in the development of gall stones. The clinical presentations include acute cholecystitis and febrile illness with pain and tenderness in the right upper quadrant (Murphy sign). Generalized body weakness and weight loss are considered as generalized symptoms of gallstones. The complications include cholangitis, empyema of gall bladder, pancreatitis, abscess formation, porcelain gall bladder and gall bladder perforation. The differential diagnosis of gall stones is carried out based on endoscopy, ALT and AST serum levels. Non-surgical treatment for gall stones is oral dissolution therapy. The standard surgical treatment for gall stones is cholecystectomy.

References

Fitzgerald JEF, Fitzgerald LA, Maxwell-Armstrong CA, Brooks AJ. Recurrent gallstone ileus: time to change our surgery?. J Dig Dis. 2009;10(2):149-51.

Kaechele V, Wabitsch M, Thiere D, Kessler AL, Haenle MM, Mayer H, et al. Prevalence of gallbladder stone disease in obese children and adolescents: Influence of the degree of obesity sex and pubertal development. J Pediatr Gstroenterol Nutr. 2006;42(1):66-77.

Wesdrop I, Bosman D, de Graaff A, Aronson D, vanderBlif FM, Taminiau J. Clinical presentations and predisposing factors of cholelithiasis and sludge in children. J Pediatr Gastroenterol Nutr. 2000;31(4):411-7.

Rome Group for the Epidemiology and Prevention of Cholelithiasis (GREPCO). The Epidemiology of gallstone disease in Rome, Italy. Prevalence data in men. Hepatology. 1988;8(4):904-6.

Singh V, Trikha B, Nain CK, Singh K, Bose SM. Epidemiology of gallstone disease in Chandigarh: A community-based study. J Gastroenterol Hepatol. 2001;16(5):560-3.

Van Erpecum KJ. Biliary lipids, water and cholesterol gallstones. Biol Cell. 2005;97(11):815-22.

Venneman NG, van Erpecum KJ. Pathogenesis of gallstones Gastroenterol Clin North Am. 2010;39(2):171-83.

Friedman GD, Raviola CA, Fireman B. Prognosis of gallstones with mild or no symptoms: 25 years of follow-up in a health maintenance organization. J Clin Epidemiol. 1989;42(2):127-36.

Russo MW, Wei JT, Thiny MT, Gangarosa LM, Brown A, Ringel Y, et al. Digestive and liver diseases statistics. Gastroenterology. 2004;126(5):1448-53.

Dowling RH. Review: pathogenesis of gallstones. Alimentary Pharmacol Therapeut. 2000;14(Suppl 2):39-47.

Van Erpecum KJ, van Berge Henegouwen GP, Stoelwinder B, Stolk MF, Eggink WF, Govaert WH. Cholestrol and pigment gallstone disease: comparison of the reliability of three bile tests for differenciation between two stone types. Scand J Gastroenterol. 1988;23(8):948-54.

Vitek L, Carey MC. Enterohepatic cycling of bilirubin as a cause of black pigment gallstones in adult life. Eur J Clin Invest. 2003;33(9):799-810.

Ontiveros AG, Hinojosa JC, Extremera BG, Moral JMD. Differences in gallstone structure in primary common bile duct lithiasis and gallbladder lithiasis. Klin Wochenschr. 1990;68(10):496-502.

Mukaihara S. Chemical analysis of gallstones: classification and composition of human gallstones. Arch Jpn Chir. 1981;50(3):476-500.

Stolk MF, Van Erpecum KJ, Peeters TL, Samsom M, Smout AJ, Akkermans LM, et al. Interdigestive gallbladder emptying, antroduodenal motility, and motilin release patterns are altered in cholesterol gallstone patients. Dig Dis Sci. 2001;46(6):1328-34.

Lee Dk, Tarr PI, Haigh WG, Lee SP. Detection and identification of bacterial gene sequences in mixed cholesterol gallstone by amplification of 16S rRNA genes. Gastroenterology. 1997;108:860-4.

SlideShare. Available at: http://image.slidesharecdn.com/pathogenesis-of-gallstones-a-genetic-perspective3394/95/pathogenesis-of-gallstones-a-genetic-perspective-3-728.jpg?cb=1280130544. Accessed 10th July 2018.

Meshikhes AW. Asymptomatic gallstones in the laparoscopic era. J R Coll Surg Edinb. 2002;47(6):742-8.

Beckingham IJ. Gallstone disease. Br Med J. 2001;322(7278):91-4.

Gore RM, Yaghmai V, Newmark GM, Berlin JW, Miller FH. Imaging benign and malignant disease of the gallbladder. Radiol Clin North Am. 2002;40(6):1307-23.

Amaral JF, Thompson WR. Gallbladder disease in the morbidly obese. Am J Surg. 1985;149(4):551-7.

Tsai CJ, Leitzmann MF, Willett WC, Giovannucci EL. The effect of long-term intake of cis unsaturated fats on the risk for gallstone disease in men: a prospective cohort study. Ann Intern Med. 2004;141(7):514-22.

Leitzmann MF, Rimm EB, Willett WC, Spiegelman D, Grodstein F, Stampfer MJ, et al. Recreational physical activity and the risk of cholecystectomy in women. N Engl J Med. 1999;341(11):777-84.

Portincasa P, Moschetta A, Palasciano G. Cholesterol gallstone disease. Lancet. 2006;368(9531):230-9.

Maclure KM, Hayes KC, Colditz GA, Stampfer MJ, Speizer FE, Willett WC. Weight, diet and the risk of symptomatic gallstones in middle-aged women. N Engl J Med. 1989;321(9):563-9.

Heaton KW, Braddon FEM, Mountford RA, Hughes AO, Emmett PM. Symptomatic and silent gallstones in the community. Gut. 1991;32(3):316-20.

Chiapponi C, Wirth S, Siebeck M. Acute gallbladder perforation with gallstones spillage in a cirrhotic patient. World J Emerg Surg. 2010 Dec;5(1):11.

Chan T, Yaghoubian A, Rosing D, Lee E, Lewis RJ, Stabile BE, et al; Total bilirubin is a useful predictor of persisting common bile duct stone in gallstone pancreatitis. Am Surg. 2008;74(10):977-80.

Dai XZ, Li GQ, Zhang F, Wang XH, Zhang CY. Gallstone ileus: Case report and literature review. World J Gastroenterol. 2013;19(33):5586-9.

Canfield AJ, Hetz SP, Schriver jp Servis HT, Hovenga TL, Cirangle PT, et al. Biliary dyskinesia: a study of more than 200 patients and review of the literature. J Gastrointest Surg. 1998;2(5):443-8.

Brunetti JC. Cholelithiasis imaging. Available at: http://emedicine.medscape.com/ article/366246-overview#a23. Accessed 15th July 2018.

Heuman DM, Mihas AA, Allen J. Cholelithiasis. Available at: http://emedicine. medscape.com/article/175667-overview. Accessed 21st July 2018.

Tait N, Little JM. The treatment of gall stones. BMJ. 1995;311(6997):99-105.

Hellstern A, Leuschner U, Benjaminov A, Ackermann H, Heine T, Festi D, et al. Dissolution of gallbladder stones with methyl tert-butyl ether and stone recurrence: a European study. Dig Dis Sci. 1998;43(5):911-20.

Kallien G, Lange K, Stange EF, Scheibner J. The pravastatin-induced decrease of biliary cholesterol secretion is not directly related to an inhibition of cholesterol synthesis in humans. Hepatology. 1999;30(1):14-20.

Berger MY, Olde Hartman TC, Bohnen AM. Abdominal symptoms: do they disappear after cholecystectomy? Surg Endosc. 2003;17(11):1723-8.

Park PO, Bergstrom M, Ikeda K, Fritscher-Ravens A, Swain P. Experimental studies of transgastric gallbladder surgery: cholecystectomy and cholecystogastric anastomosis (videos). Gastrointest Endosc. 2005;61(4):601-6.

Downloads

Published

2019-06-28

How to Cite

Iqbal, M. N., Iqbal, M. A., Javaid, R., & Abbas, M. W. (2019). Gall stones: a fundamental clinical review. International Journal of Research in Medical Sciences, 7(7), 2869–2874. https://doi.org/10.18203/2320-6012.ijrms20192938

Issue

Section

Review Articles