Gallstone disease history and symptoms
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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 majority of patients with gallstone disease are asymptomatic and are mostly females over the age of 40 whom have had multiple children and tend to have a BMI over 25.
History and Symptoms
- The majority of patients with [disease name] are asymptomatic.
OR
- The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
- Symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
History
Patients with [disease name]] may have a positive history of:
- [History finding 1]
- [History finding 2]
- [History finding 3]
Common Symptoms
Common symptoms of [disease] include:
- [Symptom 1]
- [Symptom 2]
- [Symptom 3]
Less Common Symptoms
Less common symptoms of [disease name] include
- [Symptom 1]
- [Symptom 2]
- [Symptom 3]
Overview
The majority of patients with gallstone disease are asymptomatic.
History and Symptoms
The majority of patients with gallstone disease are asymptomatic.[1] They start developing symptoms once the stones reach a certain size (>8mm).[2]The hallmark of gallstone disease is a gallstone "attack", also known as biliary colic that 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. A positive history of obesity, multiparity and age over 40 with is suggestive of gallstones.[3]
History
Patients with gallstones may have a positive history of:
- Obesity
- Multiparity
- Age over 40
- Female
- Caucasian or Native American [4]
Common Symptoms
Common symptoms of gallstones include:
- Right upper quadrant pain
- Nausea
- Vomiting[5]
Less Common Symptoms
Less common symptoms of gallstones include
- Chest pain
- Fullness after eating/early satiety
- Belching[6]
Biliary pain can be associated with objective findings (dilation of the biliary tract, elevation of plasma liver enzyme concentration, elevation of bilirubin, gamma-GT and alkaline phosphatase).
Causes
Biliary pain is most frequently caused by obstruction of the common bile duct or the cystic duct by a gallstone. However, the presence of gallstones is a frequent incidental finding and does not always necessitate treatment, in the absence of identifiable disease. Furthermore, biliary pain may be associated with functional disorders of the biliary tract, so called acalculous biliary pain, and can even be found in patients post-cholecystectomy (removal of the gallbladder), possibly as a consequence of dysfunction of the biliary tree and the sphincter of oddi.
Differential Diagnosis
- Amoebic liver abscess
- Perforated peptic ulcer
- Upper small bowel obstruction.
Complications
The more serious complication is total blockage of the bile duct which leads to jaundice, which if it is not corrected naturally or by a surgical procedure can be fatal as it causes liver damage.
The presence of gallstones can lead to infection of the gall bladder (cholecystitis) or the biliary tree (cholangitis) or acute inflammation of the pancreas (pancreatitis). Rarely, an impacted gallstone can obstruct the bowel, causing gallstone ileus (mechanical ileus).
Biliary pain in the absence of gallstones may severely impact the patient's quality of life, even in the absence of disease progression.
Presentation
This condition causes crescendos of severe pain in the right upper abdomen and sometimes through to the upper back and/or right shoulder. The pain relates to the obstruction of the passage of bile and can be associated with eating fatty foods. There is usually an inflammatory component to the pain as the characteristic colic is not completely relieved between crescendos.
Often, these attacks occur after a particularly fatty meal and almost always happen at night.
Other symptoms
Other symptoms include
- Jaundice
- Nausea and vomiting
- Diarrhea
- Bleeding caused by continuous vomiting
- Dehydration caused by the nausea and diarrhea.
- Abdominal bloating
- Intolerance of fatty foods
- Belching
- Indigestion.
If the above symptoms coincide with chills, low grade fever, yellowing of the skin or eyes, and/or clay-colored stool, a doctor should be consulted immediately.[7]
Some people who have gallstones are asymptomatic and do not feel any pain or discomfort. These gallstones are called "silent stones" and do not affect the gallbladder or other internal organs. They do not need treatment.[7]
References
- ↑ "Cholelithiasis". emedicine from WebMD. Retrieved 2007-08-25.
- ↑ "Gallstones". Medline Plus. Retrieved 2007-08-25.
- ↑ 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.
- ↑ 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.
- ↑ 7.0 7.1 "Gallstones". National Digestive Diseases Information Clearinghouse. Retrieved 2007-08-25.