-IBIS-1.5.0-
tx
digestive system
cholelithiasis/biliary colic
diagnoses

definition and etiology

definition:
Gallstones are precipitated bile in the gall bladder. They may be soft or may be hard and even jagged. If they block the duct, the pain is generally exquisite. The pain of a gall bladder attack is termed biliary colic.

etiology:
Bile salts are formed in the liver from cholesterol. Some cholesterol is also secreted with the salts. When considering stone formation, one must review solubility of fats and water, saturation points and so on. Cholesterol, lecithin, and bile salts form micelles (tiny globules) which are soluble in water. Under certain conditions, stones precipitate out and can become problematic.

Gallstones are thought to be caused by:
• a high concentration of bile
• increased cholesterol in bile
• inflamed epithelium in the bladder and ducts which allow inappropriate absorption of water and nutrients, causing precipitation of stones on the walls

signs and symptoms

signs and symptoms:
• right upper quadrant abdominal pain
• pain referred to the lower tip of the right scapula
• pain after eating fat or oil
• palpatory pain under the liver where the gall bladder lies

lab findings: during or soon after attacks, may see:
• increased WBC count
• increased serum bilirubin or urine bile
• increased amylase and lipase in serum
• fluctuating evidence of biliary obstruction (increased serum bile acids, cholesterol, AST (mild), ALT, alk. phos. (300% of normal), and steatorrhea

course and prognosis

This is often a chronic condition, but may be ameliorated in some patients by addressing the inciting factors for stone formation. The characteristic pattern is long asymptomatic periods with occasional acute attacks of colic.

The most common complication is cholecystitis.

see: cholecystitis

differential diagnosis

• costochondral (anterior rib) injury or strain
• gastrointestinal ulcer
• low grade infection of the gallbladder
• other gastrointestinal complaints
• renal colic
• cardiac complaints


footnotes