Cholelithiasis: Definition and Terminology
Cholelithiasis specifically refers to the presence of gallstones (calculi) within the gallbladder, not inflammation. The term describes the stone formation itself, while inflammation of the gallbladder is termed cholecystitis 1, 2.
Key Terminology Distinctions
The terminology is anatomically and pathologically specific:
- Cholelithiasis = gallstones in the gallbladder 3, 1, 2
- Cholecystitis = inflammation of the gallbladder (which may or may not be caused by stones) 1, 4, 2
- Choledocholithiasis = stones in the common bile duct 5, 3, 6
- Cholangitis = inflammation of the bile duct 5, 1
Clinical Context
Cholelithiasis can exist with or without inflammation. Approximately 80% of patients with gallstones remain asymptomatic throughout their lives, meaning they have cholelithiasis without any inflammatory process 3. When stones cause obstruction or irritation leading to gallbladder wall inflammation, the patient then has both cholelithiasis (the stones) and cholecystitis (the inflammation) 1, 2.
The presence of gallstones produces diverse histopathological changes in the gallbladder mucosa, including acute inflammation, chronic inflammation, glandular hyperplasia, and other changes, but these inflammatory responses are secondary to the stone presence, not part of the definition of cholelithiasis itself 7.
Diagnostic Implications
Ultrasonography is the gold standard for diagnosing cholelithiasis, with 90-95% sensitivity for detecting gallstones 5, 3, 2. The ultrasound findings that distinguish simple cholelithiasis from acute cholecystitis include:
- Cholelithiasis alone: presence of stones, no wall thickening, no pericholecystic fluid 5
- Acute cholecystitis: stones plus gallbladder wall thickening (>3mm), pericholecystic fluid, gallbladder distension, positive sonographic Murphy's sign 5, 3, 1
Laboratory findings also differ: patients with uncomplicated cholelithiasis typically have normal liver function tests, while those with complications (cholecystitis, choledocholithiasis) often show elevated white blood cell count, liver enzymes, and bilirubin 5, 3, 1.