What is Cholelithiasis (Gallstones)?

From the Guidelines

Cholelithiasis is the medical term for gallstones, which are hardened deposits that form in the gallbladder, and can be categorized into silent gallstones (asymptomatic disease), disease that causes uncomplicated biliary pain (symptomatic disease), and complications of gallstone disease. These stones develop when substances in bile, primarily cholesterol and bilirubin, crystallize and solidify 1. The gallbladder is a small organ beneath the liver that stores bile, which helps digest fats. Gallstones can vary in size from tiny grains to golf ball-sized masses and may cause no symptoms (asymptomatic cholelithiasis) or lead to severe pain and complications (symptomatic cholelithiasis).

Some key points to consider about cholelithiasis include:

• The categorization of disease allows clinicians and patients to choose the treatment most appropriate to the specific patient, with options including expectant management, nonsurgical therapy, and surgical approach 1
• Expectant management delays treatment, posing a dilemma as it may avoid unnecessary intervention but also risks adverse consequences by not preventing future complications 1
• Nonsurgical therapy, such as oral bile acids or extracorporeal shock-wave lithotripsy, is generally limited to gallstones with a diameter less than 1.5 cm and whose content is primarily cholesterol, but has limited efficacy and is not widely used 1
• Surgical removal of the gallbladder (cholecystectomy) is a common treatment for symptomatic gallstones, typically performed laparoscopically.

The most appropriate treatment for cholelithiasis depends on the symptoms and category of disease, with asymptomatic gallstones often requiring no treatment, and symptomatic cases may require surgical removal of the gallbladder. Common symptoms include sudden, intense pain in the upper right abdomen, pain between the shoulder blades or in the right shoulder, nausea, vomiting, and in some cases, jaundice if stones block the bile ducts. Risk factors include being female, over 40 years old, obesity, rapid weight loss, pregnancy, certain medications, and family history. Medications like ursodeoxycholic acid can dissolve certain types of gallstones but are less commonly used than surgery due to lower effectiveness and high recurrence rates.

From the FDA Drug Label

Cholelithiasis is not explicitly defined in the provided text, however, the context suggests it refers to the formation of gallstones. The term Cholelithiasis is not directly defined, but based on the context, it can be inferred to be related to gallstone formation or gallstones.

• Gallstone formation is mentioned as a condition being treated or prevented with ursodiol therapy.
• The text discusses the incidence of gallstone formation in different patient groups and the effects of ursodiol on this incidence. However, without a direct definition, it's difficult to provide a more specific answer. 2

From the Research

Definition and Prevalence of Cholelithiasis

• Cholelithiasis is a common and frequent condition worldwide, with a high prevalence rate in Western countries 3.
• It affects approximately 15% of the US population, with rising trends in obesity and metabolic syndrome contributing to an increase in diagnosis 4.
• The prevalence of gallstone disease varies widely by region, and has increased in recent years due to changes in lifestyle, such as reduced motor activity and changes in diet 5.

Risk Factors and Pathogenesis

• Multiple risk factors are associated with cholesterol gallstones, including genetics, dietary habits, lifestyle changes, comorbid conditions, and various drugs 3.
• The pathogenesis of cholelithiasis is suggested to be multifactorial, developing from complex interactions between genetic and environmental factors 5.
• Factors such as corticosteroids and oral contraceptives may contribute to the development of cholelithiasis 5.

Symptoms and Complications

• The classic presentation of cholelithiasis includes right upper quadrant pain, referred pain to the right supraclavicular region and/or shoulder, nausea, and vomiting 4.
• Complications of cholelithiasis include cholecystitis, cholangitis, and gallbladder cancer 3, 4.
• Lack of physical examination findings does not rule out a diagnosis of cholelithiasis, and laboratory tests such as white blood cell count, liver enzymes, amylase, and lipase may assist in diagnosis 4.

Diagnosis and Treatment

• Ultrasonography is the gold standard for diagnosis of cholelithiasis 4.
• Management is dependent on severity and frequency of symptoms, and may include lifestyle and dietary modifications, medication management, and surgical or non-surgical treatments 3, 4.
• Bile acid dissolution therapy, such as ursodiol and chenodiol, is a safe and effective non-surgical treatment for highly selected patients with cholesterol gallstone disease 6, 7.
• Laparoscopic cholecystectomy is recommended for individuals with severe and/or recurrent symptoms 4.