Gallstone disease natural history, complications and prognosis: Difference between revisions

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{{Gallstone disease}}
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==Overview==
==Overview==
Gallstones develop in many people without causing symptoms. The chance of symptoms or complications from gallstones is about 20%. Nearly all patients (99%) who have gallbladder surgery do not have their symptoms return.


== Natural History, Complications and Prognosis ==
Gallstone disease patients should not undergo an elective [[cholecystectomy]] until symptoms develop, since almost 55% of patients will remain [[asymptomatic]]. Also, the [[Complication (medicine)|complications]] of [[asymptomatic]] gallstones are almost negligible unless symptoms develop. The complications of gallstone disease include [[acute cholecystitis]], [[Jaundice|obstructive jaundice]], [[acute cholangitis]] and [[acute pancreatitis]]. The prognosis after [[Cholecystectomy|laparoscopic cholecystectomy]] is excellent with [[morbidity]] and [[Mortality rate|mortality]] rates being as low as 0.5 and 10% respectively.
'''Asymptomatic stones:'''
==Natural History, Complications, and Prognosis==
16-26% of patients develop gallstone-related symptoms in 10 years. Prophylactic cholecystectomy ''not'' indicated UNLESS increased risk of gallbladder (gb) cancer:
 
:*Pima Indian
===Natural History===
:*Calcified gb
*Gallstone disease usually develops in the third decade of life, and can start asymptomatically.<ref name="pmid4015212">{{cite journal |vauthors=McSherry CK, Ferstenberg H, Calhoun WF, Lahman E, Virshup M |title=The natural history of diagnosed gallstone disease in symptomatic and asymptomatic patients |journal=Ann. Surg. |volume=202 |issue=1 |pages=59–63 |year=1985 |pmid=4015212 |pmc=1250837 |doi= |url=}}</ref>
:*gb Polyp >10 mm
*Symptoms of [[biliary colic]] may develop such as [[abdominal pain]], [[fever]] and, [[jaundice]].
:*Gallstones >2.5 cm
*If left untreated, only 10% of patients with gallstone disease may progress to develop symptoms.
:*Salmonella carrier
 
===Complications===
*Common complications of gallstone disease include:<ref name="pmid8480871">{{cite journal |vauthors=Friedman GD |title=Natural history of asymptomatic and symptomatic gallstones |journal=Am. J. Surg. |volume=165 |issue=4 |pages=399–404 |year=1993 |pmid=8480871 |doi= |url=}}</ref>
**[[Acute cholecystitis]]
**[[Gallbladder]] [[perforation]]
**[[Jaundice|Obstructive jaundice]]
**[[Choledocholithiasis]] with or without [[acute cholangitis]]
**[[Gallbladder]] [[fistula]]
**[[Cholangiocarcinoma]]
**[[Pancreatitis|Gallstone pancreatitis]]
**[[Gallstone ileus]]


Diagrams shown below are courtesy of [http://www.wikisurgery.com Wikisurgery.com]
===Prognosis===
<div align="center">
*Elective [[cholecystectomy]] has a [[Mortality rate|mortality]] rate and [[morbidity]] rate of 0.5% and 10% respectively.<ref name="pmid26895902">{{cite journal |vauthors=Julliard O, Hauters P, Possoz J, Malvaux P, Landenne J, Gherardi D |title=Incisional hernia after single-incision laparoscopic cholecystectomy: incidence and predictive factors |journal=Surg Endosc |volume=30 |issue=10 |pages=4539–43 |year=2016 |pmid=26895902 |doi=10.1007/s00464-016-4790-4 |url=}}</ref>
<gallery heights="145" widths="125">
*Emergent [[cholecystectomy]] has a [[Mortality rate|mortality]] rate and [[morbidity]] rate of  3-5% and 30-50% respectively.
Image:STEP2330 acute cholecystitis.jpg
*The risk of developing an [[incisional hernia]] after a [[laparoscopic cholecystectomy]] is about 8% in patients over 50 years of age.
Image:STEP2334 perforation of gallbladder.jpg
*Patients with gallstones in the [[gallbladder]] have an associated [[choledocholithiasis]] (stone in the [[common bile duct]]) in 10-15% of the time.
Image:STEP2335 local inflammation around gall bladder.jpg
Image:STEP2336 perforation of gallbladder.jpg
Image:STEP2341.empyema and mucocele of gallbladder.jpg
Image:STEP2346 gallbladder fistula.jpg
Image:STEP2350chronic cholecystitis and carcinoma.jpg
</gallery>
</div>
===Symptomatic stones===
38-50% of patients have pain recurrence/year after 1 episode biliary colic. 1-2% of patients have complication rate/year.


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
{{WS}}


[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Hepatology]]
[[Category:Hepatology]]
[[Category:Surgery]]
[[Category:Surgery]]
[[Category:Abdominal pain]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:Primary care]]
{{WH}}
{{WS}}

Latest revision as of 21:48, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Overview

Gallstone disease patients should not undergo an elective cholecystectomy until symptoms develop, since almost 55% of patients will remain asymptomatic. Also, the complications of asymptomatic gallstones are almost negligible unless symptoms develop. The complications of gallstone disease include acute cholecystitis, obstructive jaundice, acute cholangitis and acute pancreatitis. The prognosis after laparoscopic cholecystectomy is excellent with morbidity and mortality rates being as low as 0.5 and 10% respectively.

Natural History, Complications, and Prognosis

Natural History

  • Gallstone disease usually develops in the third decade of life, and can start asymptomatically.[1]
  • Symptoms of biliary colic may develop such as abdominal pain, fever and, jaundice.
  • If left untreated, only 10% of patients with gallstone disease may progress to develop symptoms.

Complications

Prognosis

References

  1. McSherry CK, Ferstenberg H, Calhoun WF, Lahman E, Virshup M (1985). "The natural history of diagnosed gallstone disease in symptomatic and asymptomatic patients". Ann. Surg. 202 (1): 59–63. PMC 1250837. PMID 4015212.
  2. Friedman GD (1993). "Natural history of asymptomatic and symptomatic gallstones". Am. J. Surg. 165 (4): 399–404. PMID 8480871.
  3. Julliard O, Hauters P, Possoz J, Malvaux P, Landenne J, Gherardi D (2016). "Incisional hernia after single-incision laparoscopic cholecystectomy: incidence and predictive factors". Surg Endosc. 30 (10): 4539–43. doi:10.1007/s00464-016-4790-4. PMID 26895902.

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