Cholelithiasis - Gallstone Disease

Gallstone disease is rather common. It means the presence of stones (“gallstones”) or “sludge” inside the gallbladder. These gallstones are formed because of precipitation of the “bile salts”, which are contained in the bile produced by the liver. The abnormal precipitation is usually a result of inefficient/suboptimal metabolism of fat within the liver cells. Gallstones are formed in patients who may have rapidly lost or gained weight, in premenopausal, overweight women, but they may very well develop in essentially anyone. It is interesting that gallstone disease tends to develop in younger ages lately, especially in young women.

The presence of gallstones is significant because of the complications it may cause. After eating, especially fatty foods, the gallbladder contracts vigorously, so bile can rapidly pour out of the gallbladder, move to the duodenum (i.e.: the first part of the intestine), mix with the ingested food, and digestion starts taking place. When gallstones are present, one of them may very well move towards the outlet of the gallbladder with its vigorous contraction and occlude it. This will cause increase of the pressure within the gallbladder and further contraction of the gallbladder in order to overcome the occlusion of its outlet. This series of events cause the symptoms of acute onset of pain in the upper part of the abdomen (biliary colic), nausea and vomiting. If the occlusion of the gallbladder outlet persists, then severe inflammation and infection will take place (acute cholecystitis).

While all the above occur when the stones are large enough to occlude the gallbladder outlet, there is an even far dangerous complication that may develop. If the gallstones are small, then they may make it through the gallbladder outlet, but then occlude at the outlet of the pancreas at its junction with the duodenum. This will then cause pressure increase within the pancreas followed by a potentially severe inflammation of the pancreas, called “acute pancreatitis”. This condition may at times prove to be very severe (requiring long stays in the ICU), or even lethal.

The treatment of gallstone disease is the surgical removal of the gallbladder (cholecystectomy), which takes place laparoscopically, usually in an outpatient setting (“one-day-surgery”). It is important to note that in the unfortunate development of acute pancreatitis, as the first presentation of gallstone disease, the number-one priority is the resolution of pancreatitis and laparoscopic cholecystectomy takes place at a later stage, during the same hospitalization.