Gallstone Disease: An Overview


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Gallstone disease is one of the most common gastrointestinal disorders of adult life. The incidence of gallstone formation increases with age and is seen more frequently in women than in men, at a ratio of 4:1.

Gallstones in history

The earliest known gallstone dates back to the twenty-first Egyptian Dynasty (1085-945 BC), having been discovered in the mummy of a priestess of Amen. This ancient specimen was unfortunately destroyed in the bombing of England during the second world war. Gallstones or cholelithiasis were first described in the 5th century by the Greek physician Alexander Trallianus, who wrote about stones within the bile ducts. Carl Langenbuch of Berlin was credited to have performed the first cholecystectomy or the surgical removal of the gallbladder in 1882.

Gallstone formation

Gallstones are formed from the constituents of bile. Bile is produced in the liver from cholesterol and is concentrated in the gallbladder. The three major components of bile are cholesterol, bile salts, and lecithin. Conditions that affect the relative concentrations of these components give rise to lithogenic or stone-forming bile. Bile containing excess cholesterol relative to bile salts and lecithin is predisposed to gallstone formation.

Symptoms of gallstones

Majority of individuals with gallstone disease are asymptomatic. Approximately 20 percent of patients with gallstones eventually develop symptoms, mostly biliary colic, or the right upper abdominal pain due to contraction of the gallbladder against a stone impacted in the cystic duct. A common complication of gallstone disease is acute cholecystitis, which is an inflammation of the gallbladder.

Ultrasound of the gallbladder is the gold standard for the diagnosis of gallstone disease. It has the advantage of being safe, economical, non-invasive, and highly accurate.

Treatment of gallstones

Cholecystectomy should be performed in most patients with documented and symptomatic gallstone disease. The operative risk for open cholecystectomy is very low. Rapid popularization and widespread acceptance of laparoscopic cholecystectomy has relegated open cholecystectomy to those patients with complicated biliary pathology. The overall cost of laparoscopic cholecystectomy has gone down and is now comparable to that of open cholecystectomy. The main advantages of laparoscopic cholecystectomy are shorter hospital stay and faster resumption of work.