Gallstone disease history and symptoms: Difference between revisions

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{{Gallstone disease}}
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==Overview==
==Overview==
Gallstone disease can manifest in a number of ways. Most patients have a history of [[obesity]], [[Pregnancy|multiple pregnancies]], use of [[Oral contraceptive|oral contraceptive pills]], [[Ageing|age]] of 40 years old and over, female and of Caucasian or Native American race. Some patients may be in a physical state that favors the development of gallstones but don't develop them, some patients may have gallstones, but are [[asymptomatic]]. These gallstones are detected incidentally. Some may have gallstones and experience biliary colic, [[Nausea and vomiting|nausea]], [[Nausea and vomiting|vomiting]] and [[diarrhea]], whilst others will have complications due to gallstones, such as [[acute cholecystitis]] and [[acute pancreatitis]].
==History and Symptoms ==


==History and Symptoms==
===History===
Gallstones usually remain asymptomatic initially.<ref>{{cite web |url=http://www.emedicine.com/med/topic836.htm#section~clinical |title=Cholelithiasis |accessdate=2007-08-25 |work=emedicine from WebMD}}</ref> They start developing symptoms once the stones reach a certain size (>8mm).<ref>{{cite web |url=http://www.nlm.nih.gov/medlineplus/ency/article/000273.htm#Symptoms%20Medline%20Plus |title=Gallstones |accessdate=2007-08-25 |work=Medline Plus}}</ref> A main symptom of gallstones is commonly referred to as a gallstone "attack", also known as '''biliary colic''', in which a person will experience intense pain in the upper abdominal region that steadily increases for approximately thirty minutes to several hours. A victim may also encounter pain in the back, ordinarily between the shoulder blades, or pain under the right shoulder. In some cases, the pain develops in the lower region of the abdomen, nearer to the pelvis, but this is less common.
* Obtaining history is an important aspect of making a diagnosis of gallstone disease.<ref name="pmid2368790">{{cite journal |vauthors=Diehl AK, Sugarek NJ, Todd KH |title=Clinical evaluation for gallstone disease: usefulness of symptoms and signs in diagnosis |journal=Am. J. Med. |volume=89 |issue=1 |pages=29–33 |year=1990 |pmid=2368790 |doi= |url=}}</ref><ref name="pmid11711412">{{cite journal |vauthors=Johnson CD |title=ABC of the upper gastrointestinal tract. Upper abdominal pain: Gall bladder |journal=BMJ |volume=323 |issue=7322 |pages=1170–3 |year=2001 |pmid=11711412 |pmc=1121646 |doi= |url=}}</ref>
====Biliary colic====
'''Biliary colic''' is [[pain]] associated with irritation of the viscera secondary to [[cholecystitis]] and gallstones.  Unlike renal colic, the phrase 'biliary colic' refers to the actual [[cholelithiasis]].
* The areas of focus should be on onset, duration, and progression of symptoms such as:
 
**[[Obesity]]
Though unlike renal colic, the phrase 'biliary colic' refers to the actual cholelithiasis.  Although it is frequently described as
**Eating fatty foods
a [[colic]], the pain is steady, starts rapidly and lasts at least 30 minutes and up to several hours.  Many patients complain of right upper quadrant pain, rt flank pain, or even mid chest pain with cholelithiasis. There may be
**[[Parity (medicine)|Multiparity]]
irradiation to the back and shoulders and other concomitant symptoms such as [[vomiting]] and [[diarrhea]]. Fatty foods
**[[Aging|Age over 40]]
can provoke biliary pain, but this association is relatively non-specific.
**Female
 
**[[Oral contraceptive|Oral contraceptive pill]]
Biliary pain can be associated with objective findings (dilation of the biliary tract, elevation of plasma liver enzyme
**Caucasian or Native American race
concentration, elevation of bilirubin, gamma-GT and alkaline phosphatase).
===Common Symptoms===
=====Causes=====
*The majority of patients with gallstone disease are [[asymptomatic]].<ref name="pmid2368790">{{cite journal |vauthors=Diehl AK, Sugarek NJ, Todd KH |title=Clinical evaluation for gallstone disease: usefulness of symptoms and signs in diagnosis |journal=Am. J. Med. |volume=89 |issue=1 |pages=29–33 |year=1990 |pmid=2368790 |doi= |url=}}</ref><ref>{{cite web |url=http://www.nlm.nih.gov/medlineplus/ency/article/000273.htm#Symptoms%20Medline%20Plus |title=Gallstones |accessdate=2007-08-25 |work=Medline Plus}}</ref><ref name="pmid13848582">{{cite journal |vauthors=LUND J |title=Surgical indications in cholelithiasis: prophylactic choleithiasis: prophylactic cholecystectomy elucidated on the basis of long-term follow up on 526 nonoperated cases |journal=Ann. Surg. |volume=151 |issue= |pages=153–62 |year=1960 |pmid=13848582 |pmc=1613279 |doi= |url=}}</ref>
Biliary pain is most frequently caused by obstruction of the [[common bile duct]] or the [[cystic duct]] by a [[gallstone]]. However,
*Patients start developing symptoms once the stones reach a certain size (>8mm):
the presence of [[gallstones]] is a frequent incidental finding and does not always necessitate treatment,
**[[Abdominal pain|Right upper quadrant pain]] or '''biliary colic''': intense [[pain]] in the upper [[abdominal]] region
in the absence of identifiable disease. Furthermore, biliary pain may be associated with functional disorders of the
*** The [[pain]] steadily increases for approximately thirty minutes to several hours.
biliary tract, so called acalculous biliary pain, and can even be found in patients post-cholecystectomy (removal
*** [[Pain]] is sometimes referred to the middle of the back or the tip of the right shoulder.  
of the gallbladder), possibly as a consequence of dysfunction of the [[biliary tree]] and the sphincter of oddi.
**[[Nausea and vomiting|Nausea]]
=====Differential Diagnosis=====
**[[Nausea and vomiting|Vomiting]]
*Amoebic liver abscess
**[[Diarrhea]]
*Perforated peptic ulcer
*Upper small bowel obstruction.
=====Complications=====
The more serious complication is total blockage of the bile duct which leads to [[jaundice]], which if it is not corrected naturally or by a surgical procedure can be fatal as it causes [[liver]] damage.
 
The presence of gallstones can lead to infection of the gall bladder (cholecystitis) or the biliary tree
(cholangitis) or acute inflammation of the pancreas (pancreatitis). Rarely, an impacted gallstone can obstruct
the bowel, causing [[gallstone ileus]] (mechanical [[ileus]]).
 
Biliary pain in the absence of gallstones may severely impact the patient's quality of life, even in the absence
of disease progression.
=====Presentation=====
This condition causes crescendos of severe pain in the [[right upper abdomen]] and sometimes through to the upper [[back]] and/or right shoulder.  The pain relates to the obstruction of the passage of bile and can be associated with eating fatty foods.  There is usually an inflammatory component to the pain as the characteristic colic is not completely relieved between crescendos.
 
Often, these attacks occur after a particularly fatty meal and almost always happen at night.
=====Treatment=====
These attacks are intensely painful, similar to that of a [[kidney stone]] attack. One way to alleviate the abdominal pain is to drink a full glass of water at the start of an attack to regulate the bile in the [[gallbladder]], but this does not work in all cases. Another way is to take magnesium followed by a bitter liquid such as [[coffee]] or [[swedish bitters]] an hour later. Bitter flavors stimulate bile flow. A study has found lower rates of gallstones in coffee drinkers.<ref>{{cite web |url=http://jama.ama-assn.org/cgi/content/abstract/281/22/2106t |title=A Prospective Study of Coffee Consumption and the Risk of Symptomatic Gallstone Disease in Men |accessdate=2007-08-25 |work=The Journal of the American Medical Association}}</ref>


Pain management is an important part of treating biliary colic.  Treatment is often with [[NSAIDs]] such as [[ketorolac]] (Toradol) and [[diclofenac]] (Voltaren).  [[Hyoscine butylbromide]] (Buscopan) is occasionally used but is less effective than analgesics.<ref>{{cite web |url=http://www.bestbets.org/bets/bet.php?id=882 |title=BestBets: Buscopan (hyoscine butylbromide) in biliary colic. |format= |work= |accessdate=}}</ref>
===Less Common Symptoms===
 
Less common symptoms include:<ref name="pmid12802649">{{cite journal |vauthors=Berger MY, Olde Hartman TC, Bohnen AM |title=Abdominal symptoms: do they disappear after cholecystectomy? |journal=Surg Endosc |volume=17 |issue=11 |pages=1723–8 |year=2003 |pmid=12802649 |doi=10.1007/s00464-002-9154-6 |url=}}</ref>
====Other symptoms====
*[[Chest pain]]
Other symptoms include
*Fullness after eating or early [[satiety]]
*[[Jaundice]]
*Frequent [[Burping|belching]]
*[[Nausea]] and [[vomiting]]
*[[Diarrhea]]
*[[Bleeding]] caused by continuous vomiting
*[[Dehydration]] caused by the nausea and diarrhea.
*Abdominal bloating
*Intolerance of fatty foods
*Belching
*Indigestion.
If the above symptoms coincide with chills, [[low-grade fever|lowgrade fever]], yellowing of the skin or eyes, and/or clay-colored stool, a doctor should be consulted immediately.<ref name="nih_gall">{{cite web |url=http://digestive.niddk.nih.gov/ddiseases/pubs/gallstones/index.htm#symptoms |title=Gallstones |accessdate=2007-08-25 |work=National Digestive Diseases Information Clearinghouse}}</ref>
 
Some people who have gallstones are asymptomatic and do not feel any pain or discomfort. These gallstones are called "silent stones" and do not affect the [[gallbladder]] or other internal organs. They do not need treatment.<ref name="nih_gall"/>


==References==
==References==
{{reflist|2}}
{{Reflist|2}}
 
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[[Category:Gastroenterology]]
[[Category:Hepatology]]
[[Category:Surgery]]

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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

Gallstone disease can manifest in a number of ways. Most patients have a history of obesity, multiple pregnancies, use of oral contraceptive pills, age of 40 years old and over, female and of Caucasian or Native American race. Some patients may be in a physical state that favors the development of gallstones but don't develop them, some patients may have gallstones, but are asymptomatic. These gallstones are detected incidentally. Some may have gallstones and experience biliary colic, nausea, vomiting and diarrhea, whilst others will have complications due to gallstones, such as acute cholecystitis and acute pancreatitis.

History and Symptoms

History

  • Obtaining history is an important aspect of making a diagnosis of gallstone disease.[1][2]

Common Symptoms

Less Common Symptoms

Less common symptoms include:[5]

References

  1. ↑ 1.0 1.1 Diehl AK, Sugarek NJ, Todd KH (1990). "Clinical evaluation for gallstone disease: usefulness of symptoms and signs in diagnosis". Am. J. Med. 89 (1): 29–33. PMID 2368790.
  2. ↑ Johnson CD (2001). "ABC of the upper gastrointestinal tract. Upper abdominal pain: Gall bladder". BMJ. 323 (7322): 1170–3. PMC 1121646. PMID 11711412.
  3. ↑ "Gallstones". Medline Plus. Retrieved 2007-08-25.
  4. ↑ LUND J (1960). "Surgical indications in cholelithiasis: prophylactic choleithiasis: prophylactic cholecystectomy elucidated on the basis of long-term follow up on 526 nonoperated cases". Ann. Surg. 151: 153–62. PMC 1613279. PMID 13848582.
  5. ↑ Berger MY, Olde Hartman TC, Bohnen AM (2003). "Abdominal symptoms: do they disappear after cholecystectomy?". Surg Endosc. 17 (11): 1723–8. doi:10.1007/s00464-002-9154-6. PMID 12802649.

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