Gallstones and Biliary Tract Disease

Abstract

December 2007

Section 4 Gastroenterology

VI Gallstones and Biliary Tract Disease

Kimberly M. Persley , M.D.
Clinical Assistant Professor of Medicine, University of Texas Southwestern Medical Center at Dallas

Rajeev Jain , M.D., F.A.C.P.
Clinical Assistant Professor of Medicine, University of Texas Southwestern Medical Center at Dallas

Cholelithiasis and biliary tract diseases constitute a major health problem in the United States. In one epidemiologic study of persons 30 years of age and older, new gallstones were found to develop in 2.2% of men and 2.9% of women over a 5-year period. In the United States, gallstones occur in approximately 10% of persons older than 40 years, but the prevalence is significantly higher in women, increasing to 20% to 25% in women older than 50 years. This chapter reviews the formation of the two principal types of stone, the cholesterol stone and the pigment stone, that form in the gallbladder and biliary tract. The risk factors for cholesterol and pigment gallstone formation are presented in a table, and the mechanism of gallstone formation is illustrated. Obstruction of the cystic duct by an impacted gallstone produces acute inflammation of the gallbladder, referred to as acute cholecystitis. Cholelithiasis is present in 90% to 95% of patients with acute cholecystitis, and most patients have had previous attacks of biliary colic, the pain associated with symptomatic gallstone disease. The diagnosis, differential diagnosis, treatment, and complications of acute cholecystitis are presented. Diagnosis and treatment of chronic cholecystitis, asymptomatic cholelithiasis, choledocholithiasis, and Mirizzi syndrome are also discussed. A small percentage of patients with chronic cholelithiasis and its complications or other chronic diseases of the biliary ducts experience associated chronic inflammation or a stricturing process in the biliary tree. The diagnostic overview of chronic biliary tract disease is presented, and the following specific presentations are discussed: common bile duct stricture, primary sclerosing cholangitis, recurrent pyogenic cholangitis, choledochal cyst, and sphincter of Oddi dysfunction. This chapter contains 104 references.

WebMD Professional Publishing, P.O. Box 1819, Danbury CT 06813 (800-545-0554 or 203-790-2087)