Cholelithiasis / Gallstones Treatment
Gallstones classification:
Gallstones are classified into cholesterol or calcium bilirubinate stones.
CHOLELITHIASIS (Gallstones) Causes & Risk Factors:
more common in women
cholelithiasis attributable to hemolysis in sickle cell disease
Obesity- risk factor especially in women
Rapid weight loss increases risk of symptomatic gallstone.
Diabetes mellitus, insulin resistance & glucose intolerance- risk factors for gallstones.
High dietary glycemic load & high intake of carbohydrate- in women increase the risk of cholecystectomy.
Hypertriglyceridemia- promote gallstone formation (impairing gallbladder motility).
Gallbladder disease increases in men in hepatitis C virus infection & cirrhosis.
Cholecystectomy increased risk of cirrhosis & NAFLD.
High incidence of gallsones in Crohn disease.
Drugs can cause gallstones- ceftriaxone, clofibrate, & octreotide.
Over 5–10 days (Prolonged fasting)- formation of microlithiasis (biliary “sludge”)- resolves with refeeding- lead to biliary symptoms or gallstones.
Pregnancy (in obese women) & with insulin resistance- increases risk of gallstones.
Hormone replacement therapy- increase the risk of need for cholecystectomy & gallbladder disease, (lower in transdermal than oral).
Mediterranean diet, low-carbohydrate diet, cardiorespiratory fitness & physical activity may help to prevent gallstones.
Coffee protect against gallstones in womens.
Polyunsaturated & monounsaturated fats & High intake of magnesium reduces risk of gallstones in mens.
Particularly in women diet rich in fruits and vegetables, high in fiber & use of statin- reduce risk of cholecystectomy.
Nonsteroidal anti-inflammatory drugs like Aspirin may protect against gallstone.
CHOLELITHIASIS (Gallstones) Symptoms:
Mostly asymptomatic discovered in routine radiography, surgery, autopsy,etc.
Classic biliary- “episodic gallbladder pain”- infrequent episodes- steady severe pain- at right upper quadrant or epigastrium & radiation to right scapula.
In cholelithiasis- may be initial feature- small intestinal obstruction by “gallstone ileus”/ Bouveret syndrome when obstructing stone in pylorus or duodenum.
CHOLELITHIASIS (Gallstones) Investigations:
Ultrasonography detect gallstones.
CT, Xray, etc
CHOLELITHIASIS (Gallstones) Treatment:
I/M Diclofenac 50–75 mg if necessary to relieve biliary pain.
Tablet Ursodeoxycholic acid (UDCA) (a bile salt) 8–13 mg/kg/day (300mg BD) use up to 2 years- dissolves some cholesterol gallstones in patients, who refuse cholecystectomy, less than 3 cm, non calcified GB.
Treatment of choice is Laparoscopic cholecystectomy for symptomatic gallbladder disease.
May increase the risk of esophageal, colonic adenocarcinomas, proximal small intestinal, & hepatocellular carcinoma by changes in intestinal exposure to bile & increased duodenogastric reflux after cholecystectomy.
Read more https://drrakeshukeymd.com/general-question-answer-drugs/
Follow us on Facebook- https://www.facebook.com/DrRakeshUkeyMDmedicine