Gallstone disease history and symptoms: Difference between revisions
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==Overview== | ==Overview== | ||
The diagnosis of uncomplicated gallstone disease is made in a patient who may be asymptomatic or experiencing biliary colic with a normal physical examination and normal laboratory tests including complete blood count, aminotransferases, bilirubin, alkaline phosphatase, amylase, and lipase. The | The diagnosis of uncomplicated gallstone disease is made in a patient who may be asymptomatic or experiencing biliary colic with a normal physical examination and normal laboratory tests including [[complete blood count]], [[aminotransferases]], [[bilirubin]], [[alkaline phosphatase]], [[amylase]], and [[lipase]]. The next step should be to image these patients to determine if there are gallbladder stones or sludge. Typically, the evaluation begins with a transabdominal [[ultrasound]] since it is the most sensitive modality for detecting gallbladder stones. If the transabdominal ultrasound is negative in a patient with biliary colic, additional studies that may help with the diagnosis include endoscopic ultrasound (EUS) and bile [[microscopy]]. Most patients are females over the age of 40 whom have had multiple children and tend to have a [[Body mass index|BMI]] over 25. <ref name="pmid2368790">{{cite journal |vauthors=Diehl AK, Sugarek NJ, Todd KH |title=Clinical evaluation for gallstone disease: usefulness of symptoms and signs in diagnosis |journal=Am. J. Med. |volume=89 |issue=1 |pages=29–33 |year=1990 |pmid=2368790 |doi= |url=}}</ref> | ||
==History and Symptoms== | ==History and Symptoms== | ||
The majority of patients with gallstone disease are asymptomatic.<ref>{{cite web |url=http://www.emedicine.com/med/topic836.htm#section~clinical |title=Cholelithiasis |accessdate=2007-08-25 |work=emedicine from WebMD}}</ref> They start developing symptoms once the stones reach a certain size (>8mm).<ref>{{cite web |url=http://www.nlm.nih.gov/medlineplus/ency/article/000273.htm#Symptoms%20Medline%20Plus |title=Gallstones |accessdate=2007-08-25 |work=Medline Plus}}</ref>A gallstone "attack", also known as '''biliary colic''' is described as intense pain in the upper abdominal region that steadily increases for approximately thirty minutes to several hours with pain in the back, ordinarily between the shoulder blades, or pain under the right shoulder (Collins' sign). This occurs when the disease symptomatizes. Eventually, the pain subsides. A positive history for obesity, multiparity and age over 40 is suggestive of gallstones.<ref name="pmid2368790">{{cite journal |vauthors=Diehl AK, Sugarek NJ, Todd KH |title=Clinical evaluation for gallstone disease: usefulness of symptoms and signs in diagnosis |journal=Am. J. Med. |volume=89 |issue=1 |pages=29–33 |year=1990 |pmid=2368790 |doi= |url=}}</ref> | The majority of patients with gallstone disease are [[asymptomatic]].<ref>{{cite web |url=http://www.emedicine.com/med/topic836.htm#section~clinical |title=Cholelithiasis |accessdate=2007-08-25 |work=emedicine from WebMD}}</ref> They start developing symptoms once the stones reach a certain size (>8mm).<ref>{{cite web |url=http://www.nlm.nih.gov/medlineplus/ency/article/000273.htm#Symptoms%20Medline%20Plus |title=Gallstones |accessdate=2007-08-25 |work=Medline Plus}}</ref>A gallstone "attack", also known as '''biliary colic''' is described as intense pain in the upper abdominal region that steadily increases for approximately thirty minutes to several hours with pain in the back, ordinarily between the shoulder blades, or pain under the right shoulder (Collins' sign). This occurs when the disease symptomatizes. Eventually, the pain subsides. A positive history for [[obesity]], [[Parity (medicine)|multiparity]] and age over 40 is suggestive of gallstones.<ref name="pmid2368790">{{cite journal |vauthors=Diehl AK, Sugarek NJ, Todd KH |title=Clinical evaluation for gallstone disease: usefulness of symptoms and signs in diagnosis |journal=Am. J. Med. |volume=89 |issue=1 |pages=29–33 |year=1990 |pmid=2368790 |doi= |url=}}</ref> | ||
===History=== | ===History=== | ||
Patients with gallstones may have a positive history of: | Patients with gallstones may have a positive history of: | ||
*Obesity | *[[Obesity]] | ||
*Eating fatty foods | *Eating fatty foods | ||
*Multiparity | *[[Parity (medicine)|Multiparity]] | ||
*Age over 40 | *[[Aging|Age over 40]] | ||
*Female | *Female | ||
*Caucasian or Native American <ref name="pmid11711412">{{cite journal |vauthors=Johnson CD |title=ABC of the upper gastrointestinal tract. Upper abdominal pain: Gall bladder |journal=BMJ |volume=323 |issue=7322 |pages=1170–3 |year=2001 |pmid=11711412 |pmc=1121646 |doi= |url=}}</ref> | *Caucasian or Native American <ref name="pmid11711412">{{cite journal |vauthors=Johnson CD |title=ABC of the upper gastrointestinal tract. Upper abdominal pain: Gall bladder |journal=BMJ |volume=323 |issue=7322 |pages=1170–3 |year=2001 |pmid=11711412 |pmc=1121646 |doi= |url=}}</ref> | ||
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3.Symptomatic gallstones, characterized by episodes of biliary colic (symptoms are listed below) | 3.Symptomatic gallstones, characterized by episodes of biliary colic (symptoms are listed below) | ||
4.Complicated cholelithiasis | 4.Complicated [[Gallstone disease|cholelithiasis]] | ||
===Common Symptoms of Biliary Colic=== | ===Common Symptoms of Biliary Colic=== | ||
Common symptoms of gallstones include: | Common symptoms of gallstones include: | ||
*Right upper quadrant pain | *[[Abdominal pain|Right upper quadrant pain]] | ||
*Nausea | *[[Nausea and vomiting|Nausea]] | ||
*Vomiting | *[[Nausea and vomiting|Vomiting]] | ||
*Diarrhea<ref name="pmid13848582">{{cite journal |vauthors=LUND J |title=Surgical indications in cholelithiasis: prophylactic choleithiasis: prophylactic cholecystectomy elucidated on the basis of long-term follow up on 526 nonoperated cases |journal=Ann. Surg. |volume=151 |issue= |pages=153–62 |year=1960 |pmid=13848582 |pmc=1613279 |doi= |url=}}</ref> | *[[Diarrhea]]<ref name="pmid13848582">{{cite journal |vauthors=LUND J |title=Surgical indications in cholelithiasis: prophylactic choleithiasis: prophylactic cholecystectomy elucidated on the basis of long-term follow up on 526 nonoperated cases |journal=Ann. Surg. |volume=151 |issue= |pages=153–62 |year=1960 |pmid=13848582 |pmc=1613279 |doi= |url=}}</ref> | ||
===Less Common Symptoms of Biliary Colic=== | ===Less Common Symptoms of Biliary Colic=== | ||
Less common symptoms of gallstones include | Less common symptoms of gallstones include | ||
*Chest pain | *[[Chest pain]] | ||
*Fullness after eating/early satiety | *Fullness after eating/early [[satiety]] | ||
*Belching<ref name="pmid12802649">{{cite journal |vauthors=Berger MY, Olde Hartman TC, Bohnen AM |title=Abdominal symptoms: do they disappear after cholecystectomy? |journal=Surg Endosc |volume=17 |issue=11 |pages=1723–8 |year=2003 |pmid=12802649 |doi=10.1007/s00464-002-9154-6 |url=}}</ref> | *[[Burping|Belching]]<ref name="pmid12802649">{{cite journal |vauthors=Berger MY, Olde Hartman TC, Bohnen AM |title=Abdominal symptoms: do they disappear after cholecystectomy? |journal=Surg Endosc |volume=17 |issue=11 |pages=1723–8 |year=2003 |pmid=12802649 |doi=10.1007/s00464-002-9154-6 |url=}}</ref> | ||
==References== | ==References== | ||
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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
The diagnosis of uncomplicated gallstone disease is made in a patient who may be asymptomatic or experiencing biliary colic with a normal physical examination and normal laboratory tests including complete blood count, aminotransferases, bilirubin, alkaline phosphatase, amylase, and lipase. The next step should be to image these patients to determine if there are gallbladder stones or sludge. Typically, the evaluation begins with a transabdominal ultrasound since it is the most sensitive modality for detecting gallbladder stones. If the transabdominal ultrasound is negative in a patient with biliary colic, additional studies that may help with the diagnosis include endoscopic ultrasound (EUS) and bile microscopy. Most patients are females over the age of 40 whom have had multiple children and tend to have a BMI over 25. [1]
History and Symptoms
The majority of patients with gallstone disease are asymptomatic.[2] They start developing symptoms once the stones reach a certain size (>8mm).[3]A gallstone "attack", also known as biliary colic is described as intense pain in the upper abdominal region that steadily increases for approximately thirty minutes to several hours with pain in the back, ordinarily between the shoulder blades, or pain under the right shoulder (Collins' sign). This occurs when the disease symptomatizes. Eventually, the pain subsides. A positive history for obesity, multiparity and age over 40 is suggestive of gallstones.[1]
History
Patients with gallstones may have a positive history of:
- Obesity
- Eating fatty foods
- Multiparity
- Age over 40
- Female
- Caucasian or Native American [4]
Gallstone disease can be categorized as having 4 different stages,
1.The lithogenic state, in which conditions favor gallstone formation
2.Asymptomatic gallstones
3.Symptomatic gallstones, characterized by episodes of biliary colic (symptoms are listed below)
4.Complicated cholelithiasis
Common Symptoms of Biliary Colic
Common symptoms of gallstones include:
Less Common Symptoms of Biliary Colic
Less common symptoms of gallstones include
- Chest pain
- Fullness after eating/early satiety
- Belching[6]
References
- ↑ 1.0 1.1 Diehl AK, Sugarek NJ, Todd KH (1990). "Clinical evaluation for gallstone disease: usefulness of symptoms and signs in diagnosis". Am. J. Med. 89 (1): 29–33. PMID 2368790.
- ↑ "Cholelithiasis". emedicine from WebMD. Retrieved 2007-08-25.
- ↑ "Gallstones". Medline Plus. Retrieved 2007-08-25.
- ↑ Johnson CD (2001). "ABC of the upper gastrointestinal tract. Upper abdominal pain: Gall bladder". BMJ. 323 (7322): 1170–3. PMC 1121646. PMID 11711412.
- ↑ LUND J (1960). "Surgical indications in cholelithiasis: prophylactic choleithiasis: prophylactic cholecystectomy elucidated on the basis of long-term follow up on 526 nonoperated cases". Ann. Surg. 151: 153–62. PMC 1613279. PMID 13848582.
- ↑ Berger MY, Olde Hartman TC, Bohnen AM (2003). "Abdominal symptoms: do they disappear after cholecystectomy?". Surg Endosc. 17 (11): 1723–8. doi:10.1007/s00464-002-9154-6. PMID 12802649.