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==Overview==
==Overview==
==Natural History, Complications, and Prognosis==
===Natural History===


Gallstones develop in many people without causing [[Symptom|symptoms]]. The chance of symptoms or [[Complication (medicine)|complications]] from gallstones is about 20%. Nearly all patients (99%) who have [[Cholecystectomy|gallbladder surgery]] do not have their symptoms return.<ref name="pmid7110244">{{cite journal |vauthors=Gracie WA, Ransohoff DF |title=The natural history of silent gallstones: the innocent gallstone is not a myth |journal=N. Engl. J. Med. |volume=307 |issue=13 |pages=798–800 |year=1982 |pmid=7110244 |doi=10.1056/NEJM198209233071305 |url=}}</ref>


==Natural History, Complications, and Prognosis==


===Natural History===
*Gallstone disease is typically asymptomatic. 16-26% of patients develop gallstone-related symptoms in 10 years. [[Prophylaxis|Prophylactic]] [[cholecystectomy]] is not indicated unless symptoms develop or there is an increased risk of [[gallbladder cancer]]:<ref name="pmid7110244">{{cite journal |vauthors=Gracie WA, Ransohoff DF |title=The natural history of silent gallstones: the innocent gallstone is not a myth |journal=N. Engl. J. Med. |volume=307 |issue=13 |pages=798–800 |year=1982 |pmid=7110244 |doi=10.1056/NEJM198209233071305 |url=}}</ref>
:*Pima Indian
:*[[Calcification|Calcified]] gallbladder
:*Gallbladder [[polyp]] >10 mm
:*Gallstones >2.5 cm
:*[[Salmonella]] [[carrier]]


===Complications===
===Complications===
*Common complications of gallbladder disease include:
*Common complications of gallbladder disease include:
**Acute [[cholecystitis]]
**Gall bladder perforation
**[[Jaundice|Obstructive jaundice]]
**[[Jaundice|Obstructive jaundice]]
**Acute [[cholecystitis]]
**Gallbladder perforation
**[[Choledocholithiasis]] with or without acute [[cholangitis]]  
**[[Choledocholithiasis]] with or without acute [[cholangitis]]  
**Gallbladder fistula
**Cholangiocarcinoma
**[[Pancreatitis|Gallstone pancreatitis]]
**[[Pancreatitis|Gallstone pancreatitis]]
**[[Gallstone ileus]]<ref name="pmid8480871">{{cite journal |vauthors=Friedman GD |title=Natural history of asymptomatic and symptomatic gallstones |journal=Am. J. Surg. |volume=165 |issue=4 |pages=399–404 |year=1993 |pmid=8480871 |doi= |url=}}</ref>
**[[Gallstone ileus]]<ref name="pmid8480871">{{cite journal |vauthors=Friedman GD |title=Natural history of asymptomatic and symptomatic gallstones |journal=Am. J. Surg. |volume=165 |issue=4 |pages=399–404 |year=1993 |pmid=8480871 |doi= |url=}}</ref>
Diagrams shown below:<br> Source:medicalassessmentonline<ref name="urlGallbladder disease">{{cite web |url=http://medicalassessmentonline.com/terms.php?R=142&L=G |title=Gallbladder disease |format= |work= |accessdate=}}</ref>
<div align="center">
<gallery heights="145" widths="125">
Image:STEP2330 acute cholecystitis.jpg
Image:STEP2334 perforation of gallbladder.jpg
Image:STEP2335 local inflammation around gall bladder.jpg
Image:STEP2336 perforation of gallbladder.jpg
Image:STEP2341.empyema and mucocele of gallbladder.jpg
Image:STEP2346 gallbladder fistula.jpg
Image:STEP2350chronic cholecystitis and carcinoma.jpg
</gallery>
</div>
===Symptomatic stones===
Occasionally, gallstones can be symptomatic and this manifests as pain in the right upper quadrant, known as biliary colic, accompanied by nausea, vomiting and diarrhea. The patients whom experience an episode of  pain recurrence ([[Gallstone disease history and symptoms|biliary colic]]) once per year are around 38-50%.<ref name="pmid20492328">{{cite journal |vauthors=Festi D, Reggiani ML, Attili AF, Loria P, Pazzi P, Scaioli E, Capodicasa S, Romano F, Roda E, Colecchia A |title=Natural history of gallstone disease: Expectant management or active treatment? Results from a population-based cohort study |journal=J. Gastroenterol. Hepatol. |volume=25 |issue=4 |pages=719–24 |year=2010 |pmid=20492328 |doi=10.1111/j.1440-1746.2009.06146.x |url=}}</ref>


===Prognosis===
===Prognosis===
The [[prognosis]] in patients with Gallstone disease is dependent upon the occurence and severity of complications. The category of patients whom refuse or are unfit for surgery will remain asymptomatic 45% of the time, whilst 55% will have varying degrees of complications.<ref name="pmid26895902">{{cite journal |vauthors=Julliard O, Hauters P, Possoz J, Malvaux P, Landenne J, Gherardi D |title=Incisional hernia after single-incision laparoscopic cholecystectomy: incidence and predictive factors |journal=Surg Endosc |volume=30 |issue=10 |pages=4539–43 |year=2016 |pmid=26895902 |doi=10.1007/s00464-016-4790-4 |url=}}</ref>
The [[prognosis]] in patients with Gallstone disease is dependent upon the occurence and severity of complications. The category of patients who refuse or are unfit for surgery will remain asymptomatic 45% of the time, whilst 55% will have varying degrees of complications.<ref name="pmid26895902">{{cite journal |vauthors=Julliard O, Hauters P, Possoz J, Malvaux P, Landenne J, Gherardi D |title=Incisional hernia after single-incision laparoscopic cholecystectomy: incidence and predictive factors |journal=Surg Endosc |volume=30 |issue=10 |pages=4539–43 |year=2016 |pmid=26895902 |doi=10.1007/s00464-016-4790-4 |url=}}</ref>


==References==
==References==

Revision as of 19:54, 7 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Overview

Natural History, Complications, and Prognosis

Natural History

Complications

Prognosis

The prognosis in patients with Gallstone disease is dependent upon the occurence and severity of complications. The category of patients who refuse or are unfit for surgery will remain asymptomatic 45% of the time, whilst 55% will have varying degrees of complications.[2]

References

  1. Friedman GD (1993). "Natural history of asymptomatic and symptomatic gallstones". Am. J. Surg. 165 (4): 399–404. PMID 8480871.
  2. Julliard O, Hauters P, Possoz J, Malvaux P, Landenne J, Gherardi D (2016). "Incisional hernia after single-incision laparoscopic cholecystectomy: incidence and predictive factors". Surg Endosc. 30 (10): 4539–43. doi:10.1007/s00464-016-4790-4. PMID 26895902.

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