Gallstone Disease

Gallstone Disease 

(cholelithiasis), a disease of man characterized by stone formation in the gallbladder, or more rarely in the bile ducts.

Stones are differentiated according to their composition as homogenous (of cholesterin, pigments, lime, or protein) or mixed. The number of stones, their weights, and their shapes vary within wide limits. Gallstones are formed when there is precipitation and crystallization of major components of bile, caused by disturbance of the stability of the colloidal system that bile represents. A large role in maintaining the stability of this system of bile belongs to its component cholesterin and bile acids, and especially to the ratio between their concentrations (the cholate-cholesterin ratio, equal in normal bile to approximately 25). When the bile is saturated with bilirubin (in hemolytic jaundice), it precipitates in the form of pure, pigmented stones. The formation of gallstones occurs most often as a result of metabolic disorder, which may be favored by hereditary predisposition and peculiarities of nutrition (such as excessive food rich in cholesterol). Often gallstone disease is combined with other metabolic disorders (such as obesity, gout, diabetes mellitus, or familial hypercholesterolemia). Retardation of the bile flow (cholestasis) and gallbladder inflammation are significant in disrupting the stability of the colloidal system of the bile.

Sometimes stones in the gallbladder do not produce any disease symptoms and are revealed accidentally during an X-ray examination. The manifestations of gallstone disease are largely conditioned by accompanying inflammatory changes in the gallbladder (cholecystitis) and bile ducts (cholangitis) and by the passage of the stone along the bile pathways, causing an attack of biliary (hepatic) colic and jaundice. An attack of colic arises when there is a considerable increase of pressure in the gallbladder (in excess of 300-330 mm water gauge) or the bile duct (over 270-300 mm water gauge) owing to the sudden appearance of an obstacle to bile evacuation (a spasm or blockage by a stone). The course of gallstone disease depends on the accompaniment of infection, the expression and duration of obstruction (obturation) of the bile pathways, and the affection of the liver, pancreas, heart, and so forth. An X-ray examination using contrasting substances is essential for the diagnosis of gallstone disease.

There are no medications capable of inducing solution of the stones within the gallbladder. In order to prevent future lithogenesis and attacks of biliary colic, sensible and regular nutrition, judicious physical exertion (which promotes normal bile secretion), and the taking of bile-expelling agents are prescribed. When there is an attack spasmolytic agents are prescribed; if there is accompanying infection, antibiotics and sulfanilamide preparations are used. When there are frequent attacks and certain complications, surgical operation is indicated.

REFERENCES

Smirnov, A. V. “Bolezni zhelchnykh putei.” In Bolezni organov pishchevareniia. Leningrad, 1966. Pages 461-74.
Shvarts, L. S. “Zhelchnokamennaia bolezn’.” In Mnogotomnoe rukovodstvo po vnutrennim bolezniam, vol. 5. Moscow, 1965. Pages 543-611.
Gubergrits, A. la. Bolezni zhelchnykh putei. Moscow, 1963.

A. S. MUKHIN