Gallstones:
Gallstones are the condition known as cholelithiasis. Cholelithiasis is a condition involving stones within the gallbladder. Now it's important to note that a majority of patients that have gallstones are asymptomatic which means that they don't have any active symptoms. The prevalence of gallstones increases with age.
As gallstones travel through the biliary tree, the biliary tree includes the gallbladder and some of the ducts that lead to the gallbladder and lead out of the gallbladder.
Bile pathway:
The gallbladder receives bile from the liver; two hepatic ducts lead to a common hepatic duct and the gallbladder stores bile. That bile is release through the cystic duct and ultimately into the common bile duct. Then they move into the duodenum or the first part of the small intestine.
Types of gallstones:
It includes four types:
- Cholelithiasis
- Cholecystitis
- Choledocholithiasis
- Cholangitis, Ascending Cholangitis, or Acute Cholangitis
1. What is Cholelithiasis ?:
In the condition of cholelithiasis, stones are present in the gallbladder. They remain in the gallbladder.
What are the signs and symptoms of Cholelithiasis?
Often patients are asymptomatic. The most common symptom is pain. The pain may radiate to the right scapula (or the right shoulder blade). Pain is describe as dull but intense and it's a constant pain. It occurs after eating fatty and greasy foods. The reason for this is that the gallbladder contains bile when a person eats fatty and greasy foods the Gallbladder contracts to release the bile that helps to digest fats. So the gallbladder is contracting on the stone that's why a person feels pain and it is going to be intermittent. The pain slowly goes away or slowly gets better. That pain lasts for one to five hours. Other symptoms are Bloating, belching, and indigestion.
2. What is Cholecystitis? :
When the stones start to move into the cystic duct this condition is known as cholecystitis. The gallbladder is trying to release bile into the common bile duct and into the small intestine. a stone in the cystic duct they won't be able to do that. So this leads to inflammation of the gallbladder that's called cystitis. itis means inflammation and cholecyst refers to the gallbladder.
What are the signs and symptoms of acute Cholecystitis?
The most important symptom is pain. The pain is more localized and radiates to the right scapula. Pain lasts about six hours. In this condition Murphy’s sign is positive.
Another symptom is Nausea and vomiting, fevers and chills due to inflammation of the gallbladder, Tachycardia, diaphoresis and sweating.
3. What is Choledocholithiasis? :
If that stone continues to move through the biliary tree it can eventually enter into the common bile duct. And once it does that anything that's trying to be release for instance bile from the gallbladder or anything from the liver is going to be block. This condition is known as choledocholithiasis.
What are the sign and symptoms of Choledocholithiasis?
Choledocholithiasis symptoms are the same as acute cholecystitis. In this condition Murphy’s sign is negative. The pain nausea and vomiting but they also have some additional signs and symptoms including jaundice. So jaundice is that yellowing of the skin and the eyes. This is due to hyperbilirubinemia. So high levels of bilirubin in the blood increase over hours to days.
Why jaundice occurs in Choledocholithiasis?
The reason is bilirubin starts to increase because the liver takes bilirubin from the blood, conjugates it, and then releases it. But the common bile duct is blocked the body is not able to release that bilirubin and ultimately jaundice occurs. This jaundice may fluctuate and this stone can move up and down if it moves up some bilirubin can leave and escape and this can help reduce bilirubin levels. That’s why jaundice can actually improve. This stone can go up and down like a ball and can cause blocking of the common bile duct at some times and unblocking of the common bile duct at other times. There is a Fluctuation in jaundice.
Urine and stool changes can occur this is also due to the bilirubin that cannot go through the common bile duct and get into the gastrointestinal system. Stools become clay-color because bilirubin goes into the gastrointestinal system and gets modified by bacteria within your gastrointestinal tract. It also causes very dark urine (tea color).
Other symptoms include Pruritus, which is an itching sensation due to the retention of bile salts. Its symptoms also include an enlarged gallbladder. Fever and chills and hypotension along with liver inflammation.
4. What is Cholangitis, Ascending Cholangitis, or Acute Cholangitis?
There is a bacterial infection due to blockage of the common bile duct. So, Bacteria can grow in the cystic duct and cause an infection in the biliary tree which is known as cholangitis.
What are the sign and symptoms of Cholangitis?
It includes RUQ tenderness (severe), Jaundice, fever and chill, Hypotension, and altered mental status.