Topic: Splenomegaly, cholecystitis, portal hypertension
Question: Describe the etiology, clinical features and management of cholelithiasis.
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Etiology:
- Gallstones (choleliths) forming in the gallbladder or bile ducts, usually consisting of cholesterol or bilirubin
- Risk factors: female gender, increasing age, family history, obesity, rapid weight loss, certain medications, metabolic disorders like cirrhosis
Clinical Features:
- Asymptomatic (in many cases):
- Silent gallstones may be discovered incidentally.
- Symptomatic:
- Biliary Colic:
- Sudden, severe right upper quadrant pain.
- Radiates to the back or right shoulder.
- Triggered by fatty meals.
- Complications:
- Cholecystitis (inflammation of the gallbladder).
- Choledocholithiasis (stones in the common bile duct).
- Gallstone pancreatitis.
- Murphy’s Sign:
- Inspiratory arrest due to pain upon palpation of the gallbladder.
- Biliary Colic:
Management:
- Conservative Management for Asymptomatic Gallstones:
- Observation without intervention.
- Periodic monitoring for symptoms or complications.
- Medical Management for Symptomatic Patients:
- Pain Control:
- Nonsteroidal anti-inflammatory drugs (NSAIDs).
- Antispasmodics.
- Dissolution Therapy:
- Ursodeoxycholic acid for small cholesterol stones.
- Prevention of Complications:
- Lifestyle modifications (low-fat diet, weight loss).
- Management of Complications:
- Antibiotics for cholecystitis.
- Endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis.
- Surgery for severe cases.
- Pain Control:
- Surgical Management:
- Cholecystectomy:
- Laparoscopic or open procedure.
- Commonly performed for symptomatic or complicated cases.
- Endoscopic Techniques:
- Endoscopic removal of stones from the common bile duct (ERCP).
- Cholecystectomy:
- Complications Management:
- Infection control with antibiotics.
- Drainage procedures for abscesses.
- Supportive care for pancreatitis.
- Postoperative Care:
- Pain management.
- Early ambulation.
- Monitoring for complications.
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