Gallstones

Introduction Gallstone disease, also known as biliary stone disease or cholelithiasis, is a common disease of the biliary system. It is a general term for gallstones and bile duct stones (also divided into intrahepatic and extrahepatic). Gallstones should be based on prevention, and should be treated immediately after onset. There are two types of treatments, non-surgical and surgical. According to the chemical composition of the stone, gallstones can be divided into three types: cholesterol stones, bile pigment stones and mixed stones. Most patients with gallstones are mixed stones with cholesterol stones. The specific formation of gallstones has not yet been fully understood. At present, it is closely related to various factors such as lipid metabolism, cholesterol supersaturation, abnormal nucleation process, abnormal gallbladder function, bacteria and gene fragments.

Cause

As a general rule of stone formation, they have basic processes such as precipitation, precipitation, nucleation and accumulation of bile components. The pathogenesis includes several factors. First, the cholesterol or calcium in the bile must be supersaturated. Second, the solute must be nucleated from the solution and precipitated as solid crystals. Third, the crystal must be aggregated and fused to form stones, crystallizing. The substance grows and accumulates in the mucus, which is distributed throughout the gallbladder wall, and the gallbladder emptying is damaged to facilitate the formation of gallstones.

The causes of gallstones are very complex, some are unchangeable factors, such as: increasing age, female, ethnic, genetic, and family history; some are acquired factors, some of which can be reversed, such as: pregnancy, obesity, low fiber, High calorie diet structure, long-term fasting, certain drugs such as ceftriaxone, lipid-lowering drugs, oral contraceptives, rapid weight loss (>1.5kg/wk), metabolic syndrome, special diseases, etc.

Irreversible factors:

Age of onset:

The incidence of gallstones increases with age. If it occurs in childhood, it is more related to hemolysis or congenital biliary tract disease. The peak age of onset is 40 to 50 years old.

Sex differences in the incidence:

Ultrasound diagnosis results in male to female incidence ratio of about 1:2, female gallstones with cholesterol stones, high incidence of female cholesterol stones and estrogen can increase cholesterol secretion in bile, reduce total bile acid and activity, and progesterone affect gallbladder Contraction, causing bile stasis.

The incidence of genes and family history of gallstones is significantly different between races, suggesting that genetic factors are one of the pathogenesis of cholelithiasis.

Reversible factors:

1. Relationship between onset and pregnancy:

Pregnancy can promote the formation of gallstones, and the number of pregnancies is positively correlated with the incidence of gallstones. As the increase in estrogen during pregnancy changes the bile composition, it can increase the saturation of cholesterol in the bile; while the emptying of the gallbladder during pregnancy is slow; the changes in body weight and diet during pregnancy and postpartum also affect the bile composition, changing the intestinal bile The liver circulation promotes the formation of cholesterol crystals.

2. Relationship between onset and obesity:

Clinical and epidemiological studies have shown that obesity is an important risk factor for the incidence of cholesterol gallstones in the gallbladder, and the incidence of obese people is three times that of normal weight.

3. Incidence and dietary factors:

Eating habits are the main factors affecting the formation of gallstones. The incidence of gallstones in patients with low-fiber and high-calorie foods is significantly increased. Because this type of food increases bile cholesterol saturation. With the improvement of living standards in China, the incidence of gallstones has occupied the main position of cholelithiasis, and it is mainly composed of cholesterol stones.

4 other factors:

Certain drugs can cause the formation of gallstones, but if the medication is short, the stones can disappear; rapid weight loss (>1.5kg/wk), such as unreasonable weight loss methods, can lead to the formation of gallstones; metabolic syndrome such as diabetes In patients with hyperlipidemia, the incidence of gallstones is elevated; there are also some special diseases, such as abnormal calcium and phosphorus metabolism caused by parathyroid diseases, which can also cause gallstones.

an examination

Imaging examination is currently the main means of diagnosis of gallstones, ultrasound is preferred.

For functional gallbladder, ultrasound diagnosis can accurately find the gallstones in the gallbladder, whether the gallbladder wall is thickened and uniform, and whether the gallbladder function is abnormal. The results are often accurate and reliable. However, for full-filled gallstones, due to the lack of comparison of liquid bile, the diagnostic reliability of ultrasound is insufficient, and further examinations are needed to participate, such as CT examination.

Differential diagnosis

diagnosis:

Gallstones with a history of acute attacks are generally difficult to make a diagnosis based on clinical manifestations. However, if there is no history of acute attacks, the diagnosis depends mainly on auxiliary examination. B-ultrasound can correctly diagnose gallstones, showing the light inside the gallbladder and the sound behind it. Shadow, the correct rate of diagnosis can reach 95%, oral gallbladder angiography can show the gallstone shadow in the gallbladder, in the gallbladder bile obtained in duodenal drainage (ie beta bile), found cholestasis or cholesterol crystals, help diagnosis.

Differential diagnosis:

(1) Liver diseases: such as viral hepatitis, cirrhosis, etc.

(2) Gastrointestinal diseases: such as gastrointestinal dysfunction, peptic ulcer, high appendicitis and right colon disease.

(3) biliary tract diseases: such as biliary dysfunction, gallbladder tumors, gallbladder polypoid lesions and biliary parasites.

(4) Others: such as right pyelonephritis, herpes zoster and radiculitis.

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