or bile duct.
Gallbladder and biliary tract disorders: includes
choledocholithiasis, cholangitis, and gallstone ileus
Gallbladder and biliary tract disorders are common and frequently painful
conditions that usually require surgery and may be life-threatening.
Usually they often accompany calculus deposition and inflammation.
Gallbladder and duct diseases usually occur in middle age. They are
more common in women, but incidence in both sexes becomes equal after age
or chronic inflammation of the gallbladder is usually associated with a
gallstone impacted in the cystic duct, causing painful distention of the
gallbladder. Prognosis is good with treatment. The acute form
is most common during middle age; the chronic form, among the elderly.
of the bile duct. It is commonly associated with choledocholithiasis
(calculi in the common bile duct) and may follow percutaneous (performed
through the skin) transhepatic cholangiography (radiography of the bile
ducts). Widespread inflammation may cause fibrosis and stenosis of
the common bile duct and biliary radicles. Prognosis for the rare
condition is poor- stenosing or primary sclerosing cholangitis is almost
or calculi in the gallbladder (gallstones), results from changes in bile
components. It is the leading biliary tract disease, affecting over
20 million Americans, and accounts for the third most common surgical procedure
performed in the United States. (Cholecystectomy)
involves small bowel obstruction by a gallstone. Usually, the gallstone
travels through a fistula between the gallbladder and small bowel and lodges
at the ileocecal valve. Prognosis is good with surgery. Gallstone
ileus is most common in the elderly.
Cause: The exact cause of gallstone formation is unknown,
but abnormal metabolism of cholesterol and bile salts is a likely cause.
Risk factors include:
–A high calorie, high cholesterol diet, associated with obesity
–Elevated estrogen levels from oral contraceptives, postmenopausal
therapy, and pregnancy.
–Diabetes mellitus, ileal disease, hemolytic disorders, liver disease,
How gallstones form: Bile is made continuosly by the liver
and is concentrated and stored in the gallbladder until needed by the duodenum
to help digest fat. Changes in the composition of bile or in the
absorptive ability of the gallbladder epithelium allow gallstones to form.
In acute cholecystitis, acute cholelithiasis, and choledocholithiasis:
–a classic attack with severe midepigastric or right upper quadrant
pain radiating to the back or referred to the right scapula, frequently
after meal rich in fats.
–recurring fat intolerance
–belching that leaves a sour taste in the mouth
–diaphoresis (profuse perspiration)
–chills and low-grade fever
–possible jaundice and clay colored stools with common duct obstruction.
–weakness and fatigue
–possible jaundice and related itching
–high fever and chills
In gallstone ileus:
–absent bowel sounds (in complete bowel obstruction)
–intermittent colicky pain over several days
–nausea and vomiting
Surgery, usually elective, is the treatment of choice for gallbladder
and duct disease.
A nonsurgical treatment for choledocholithiasis involves insertion of
a flexible catheter, formed around a T tube, through the sinus tract into
the common bile duct. Guided by fluoroscopy, the doctor directs the
catheter toward the stone. The doctor then threads a Dormia basket
through the catheter, opens and twirls it to entrap the calculi, then closes
and withdraws the basket.
Chenodiol, a drug that dissolves radiolucent calculi,, provides an alternative
for patients who are poor surgical risks or who refuse surgery. The
use of chenodiol is limited by the need for prolonged treatment, the high
incidence of adverse effects, and the frequency of calculi re-formation
after treatment is stopped.
Lithotripsy: is the breakup of gallstones through ultrasonic waves,
is an investigational procedure with good results in many cases.