General information and pathophysiology
• 80% of gallstones are cholesterol stones and 20% are pigment stones (calcium bilirubinate). In fact, most stones are mixed, but named according to the weighted component.
• Bile; It undergoes nucleation and crystallization with the contribution of mucus, glycoprotein and bacteria. Gallbladder hypomotility facilitates this process and first sludge and then petrification develops in the crystallized bile.
10-15% of cholesterol stones and 50% of pigment stones are radiopaque and can be seen on direct radiography.
• The most important factor in the formation of cholesterol stones is the increase in the amount of cholesterol in the bile.
Conditions that increase biliary cholesterol secretion: Estrogen, obesity, fibrate use.
Conditions causing bile salt deficiency: Crohn's disease, ileal resection and advanced age.
• Pigment stones may be black or brown.
Black pigment stones are seen in cases of increased indirect bilirubin (hemolysis, hypersplenism, ineffective erythropoiesis).
Brown pigment stones are due to chronic stasis and infection. Primary bile duct stones are therefore often brown pigment stones.
Clinic
• The most specific symptom is biliary colic. It is characterized by severe pain, nausea and vomiting radiating to the interscapular area and right scapula, especially after meals.
• If there is obstruction in the bile duct, jaundice and high bilirubin can be seen. Otherwise, no signs of cholestasis are expected.
• Stones located in the sac infundibulum or cystic duct may press on the common bile duct and cause obstructive icterus, this situation is defined as Mirizzi syndrome.
• Cholecystitis should be considered if fever, chills and leukocytosis are present, and cholangitis should be considered if there is additional jaundice.
Diagnosis
• Abdominal USG is the first and best method to be chosen.
Treatment
• Prophylactic surgical treatment is applied in symptomatic cases, stones larger than 3 cm, and in the presence of a porcelain sac. (laparoscopic cholecystectomy)
• Lithotripsy may be preferred in cases where surgery cannot be performed.
• Ursodeoxycholic acid can be used in medical treatment, but the results are not very successful and it is not effective especially in radiopaque, calcified stones, pigment stones, stones larger than 1.5 cm.