-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