Cholelithiasis: Presentation and Management

Abstract

Cholelithiasis affects approximately 15% of the US population. Rising trends in obesity and metabolic syndrome have contributed to an increase in diagnosis of cholelithiasis. There are several risk factors for cholelithiasis, both modifiable and nonmodifiable. Women are more likely to experience cholelithiasis than are men. Pregnancy, increasing parity, and obesity during pregnancy further increase the risk that a woman will develop cholelithiasis. The classic presentation of persons experiencing cholelithiasis, specifically when gallstones obstruct the common bile duct, is right upper quadrant pain of the abdomen that is often elicited upon palpation during physical examination and documented as a positive Murphy's sign. Referred pain to the right supraclavicular region and/or shoulder, nausea, and vomiting are also frequently reported by persons with cholelithiasis. Cholelithiasis can result in complications, including cholecystitis (inflammation of the gallbladder) and cholangitis (inflammation of the bile duct). Lack of physical examination findings does not rule out a diagnosis of cholelithiasis. Laboratory tests such as white blood cell count, liver enzymes, amylase, and lipase may assist the clinician in diagnosing cholelithiasis; however, ultrasonography is the gold standard for diagnosis. Management is dependent on severity and frequency of symptoms. Lifestyle and dietary modifications combined with medication management, such as use of gallstone dissolution agents, may be recommended for persons who have a single symptomatic episode. If symptoms become severe and/or are recurrent, laparoscopic cholecystectomy is recommended. It is recommended that individuals with an established diagnosis of cholelithiasis be referred to a surgeon and/or gastroenterologist within 2 weeks of initial presentation regardless of severity or frequency of symptoms.

Predictive Value of Homeostasis Model Assessment of Insulin Resistance, Visceral Fat Index, and Prepregnancy Body Mass Index in Gestational Metabolic Syndrome

“…However, there was no significant difference between the GMS pregnant women and the healthy pregnant women in HOMA-IR, VAI, and prepregnancy BMI positive detection rate. is is basically consistent with the research results of Jorquera [24] and Littlefield [25]. Clinically, prepregnancy BMI is often used to predict and evaluate the occurrence of GMS.…”

Association of apolipoprotein B XbaI (rs693) polymorphism and gallstone disease risk based on a comprehensive analysis

“…Gallbladder disease (GD) is a highly prevalent condition affecting up to 15 % of the population with a significant health care burden in the United States [ 1 – 3 ]. Approximately 10–20 % of the population will develop GD in their lifetime [ 4 ], and women are more than twice as likely as men to develop the disease [ 5 ]. Based on current information using ultrasound surveys, ethnicity is a known risk factor; specifically, the highest rate of GD is found in Hispanic people from central and south American heritage [ 2 , 3 ].…”

“…Other factors that affect the hepatic production of cholesterol, stasis/inflammation, bile acid production, or intestinal absorption of cholesterol and bile acids also contribute to GD development. Increasing evidence also points to genetic factors as being important for GD development [ 4 , 7 ].…”

Effect and related mechanism of Yinchenhao decoction on mice with lithogenic diet‑induced cholelithiasis

“…Cholelithiasis is a prevalent gastrointestinal disease that has a prevalence of ~10-15% in developed countries and ~13% in China (1,2). However, this rate is increasing on an annual basis mainly due to dietary and lifestyle changes (3). Cholelithiasis is caused by multiple factors, including cholesterol supersaturation in the bile, abnormal gallbladder function and impairments in enterohepatic bile acid circulation, where cholesterol supersaturation is a necessary condition for the onset of disease (4).…”