Jestrel Eunice P.

Bautista

Introduction
Cholelitiasis
commonly known as gallstones or biliary lithiasis , refers to the formation of stones in the bile ducts , especially in the gallbladder . Are accretions of solids that can be as small as grains of sand or, in exceptional cases, so great that occupy the entire gallbladder. Most, however, are usually intermediate size i.e. less than 20 mm, about one inch. Most of these crystals, about 80% - are constituted by crystals of cholesterol , the rest colored pigmented black crystals.

Classes of gallstones
There are two main types of gallstones: Those of cholesterol , composed mostly by the substance, representing about 80% of all cases diagnosed in the United States . The pigment, consisting mostly of calcium salts of bile pigments and other compounds, which account for 20% of diagnosed cases. Since most patients have cholesterol gallstones, they can be treated without resorting to surgery. The type of calculation is significant since only the cholesterol gallstones can be treated by non- surgical

Classification
Gallstones are generally composed of a mixture of cholesterol, calcium bilirubinate, protein and mucin. Depending on their predominant compounds are classified as: Cholesterol stones are the most common in industrialized countries. Calculations black pigment, calcium bilirubinate basically formed from hemolysis. Brown pigment stones are formed from bacterial or helminth infections in the biliary system, are common in Asian populations. Mixed calculations, consist essentially of small amounts of calcium salts and bilirubinate. The widespread use of abdominal ultrasound for the study of abdominal pain, pelvic disease and altered liver enzymes, has led to the accidental identification of gallstones in many patients without typical symptoms of this disease. About 30% of these cases will develop symptoms throughout their lives, at a rate of 1.5-2% per year. Symptomatic patients with untreated gallstones have a higher probability of recurrence of symptoms and complications such as cholecystitis , pancreatitis or choledocholithiasis .

Epidemiology
Cholelithiasis is more common in women than men with a ratio of 4-1, and there are factors that predispose to disease like obesity , making contraceptives , the dyslipidemia , the diabetes.

Risk Factors
The 4 F: fatty , female , forty , fertility (obesity, woman, about 40 years of childbearing age). The main risk factors for the development of gallstones are: Age: more common after age 40, about 20% of adults from this age and 30% in those over 70 years. Female. Pregnancy, especially for the development of cholesterol gallstones usually are asymptomatic forms of cholelithiasis and biliary sludge as both calculations under 10 mm usually disappear after delivery. Oral contraceptives and hormone replacement therapy with estrogen, in this case with a higher risk in women under 40 years and those receiving a higher dose of 50 micrograms of estrogen. Other drugs such as fibrates and ceftriaxone . Family history of gallstones. Obesity . Rapid weight loss. Parenteral nutrition. Diabetes Mellitus . Cirrhosis of the liver . Crohn's Disease .

Symptoms
There are many persons who have gallstones have no symptoms. When symptoms are evident, the person carrying gallstones may experience: Severe pain in the upper abdomen followed (upper right quadrant), the pain may spread to the chest , shoulders and back and is sometimes confused with the symptoms of a heart attack. Indigestion , nausea or vomiting. Cholangitis . Pancreatitis . Fistulas . Drilling.

Abdominal pain and tenderness in the right side of the abdomen when the gallbladder is inflamed. Jaundice , chills and fever when gallstones block the passage of bile . It is observed that when liquid is clogged can be a pain attack. This pain in the abdomen, is increasing, lasting about half an hour to several hours.

Complications of gallstones
In many patients, the calculations remain "silent," ie asymptomatic and present little problem of importance. However, the longer were present, the greater the likelihood of causing complications. In a particular patient, the likelihood that an upset calculation is silent about 3% per year. So after 20 years most of the people who have asymptomatic stones will eventually experience symptoms. Once appeared, symptoms persist. And if the problem affects older people, treatment can be much more difficult, especially if you have other medical problems. As size increases, the calculations can clog the outlet orifice of the gallbladder and thereby lead to serious disorders character. Obstruction may start gradually or occasionally, accompanied by inflammation of the gallbladder (cholecystitis chronic), and end in total obstruction, acute inflammation of the gallbladder ( cholecystitis ), requiring surgery table. In the gallbladder Biliary colic . Acute cholecystitis and chronic. Empyema . Mucocele . Carcinoma . In the bile ducts Jaundice obstructive. Pancreatitis . Cholangitis . In the intestine Ileus by gallstones.

Diagnosis
Most gallstones can be described using simple techniques and painless. Patients who complain of abdominal pain or gastrointestinal upset often receive specific tests for diagnosing the presence of gallstones. Often, just a radiograph of the abdomen to discover ordinary calculations, especially if they are rich in calcium.

There are other more sensitive technique, called, ultrasonography , with which there is a picture or photograph of the gallbladder and bile ducts, allowing the physician to determine if there are any present calculation, whatever their class. This method is the most widely used, not to emit radiation. A third technique is called cholecystography and requires prior swallowing pills containing dyes. The dye passes from the bloodstream into the gallbladder and highlights the contours of this so that they can be detected by X-ray calculations. When suspected bile duct stones in more complicated procedures are necessary. In ERCP ( Endoscopic retrograde cholangiopancreatography ) is inserted into the small intestine a flexible tube which is passed to the bile duct, then is injected into the duct a colorant and a radiograph is taken. When using the technique called CPT ( cholangiography percutaneous transhepatic), cross the abdomen with a very thin needle that is passed through the duct of the liver. Dye is then injected and an x-ray is taken.

Treatments
If gallstones does cause symptoms should be surgical treatment, a cholecystectomy (removal of the gallbladder ). Although the gallbladder is an important organ, it is essential to life. Many patients with gallstones, or complications resulting from such calculations, undergo surgical removal of the gallbladder (cholecystectomy), operation without serious danger that is one of the most commonly practiced worldwide. In the United States , is over 500,000 times per year. Surgical risk increases with age and if the patient has other diseases. Gallbladder removed, bile flows directly from the liver to the small intestine. The effect on digestion can be little or no. However, some patients may not disappear flatosidad symptoms, pain, abdominal distention by gas or nausea. There is an oral medication, ursodeoxycholic acid , which dissolves cholesterol stones and in many cases can be used safely and effectively as a substitute for surgical removal of the gallbladder. Ursodeoxycholic acid is a bile acid naturally reduces the concentration of cholesterol in bile and dissolves slowly in many cases the calculations, according to their size, within 6-24 months. Many people with cholesterol stones and in whom there is no obstruction of the inlet or outlet of bile in the gallbladder, are amenable to treatment with ursodeoxycholic. The drug was extremely well tolerated, with rare reported cases of diarrhea, which is usually mild and transient. It has been widely used and tested in Europe , Asia and the United States. Another possibility is surgery to replace the exploration of using for research. The lithotripsy extracorporeal shock wave is a new technique that uses sound waves to fragment finely external origin gallstones. The fragments are then dissolved with ursodeoxycholic acid administered orally, although some may pass outside calculations spontaneously. No less than half of the patients undergoing these non-surgical procedures, leaving intact gallstones not experience recurrence within 5 years of observation. Among those who did have

recurrence, only a small percentage manifest symptoms, as evidenced by a recent study. And for the latter, re-treatment provides relief.