Signs and Symptoms of Cholelithiasis

Signs and symptoms of insufficient bile production include:

• Craving fatty/fried food 
• Not feeling fully satisfied after eating
• Immense sugar cravings 
• Itchy skin and dry eyes
• Hives, sneezing
• Bloating, indigestion, burping, belching, flatulence  

While many people may have gallstones and be asymptomatic, typical signs, symptoms and clinical presentations of acute symptomatic cholelithiasis are:

• Pain in upper abdomen, sometimes radiating to just below the right axilla
• Frequent"attacks" or sudden sharp pain after eating a fatty meal that may last moments to several hours
• Intermittent pain on the right, below the ribcage
• Bloating
• Nausea
• Vomiting 
• Belching
• Gas
• Indigestion
• Sweating, chills, low grade fever
• Jaundice 
• Clay-colored stools 

Typical signs and symptoms of Bouveret Syndrome are:

• Nausea
• Uncontrollable vomiting and/or hematemesis
• Upper abdominal pain and distention
• Dehydration 
• Fever
• Weight loss
• Melena (tarry, black, blood filled stools)

"Bouveret Syndrome." Cinahl Information Systems, Glendale, CA, 5 Dec. 2014. Web. 13 Oct. 2015.

Gallstones (Cholelithiasis). (2015, January 20). Retrieved October 13, 2015.

 Savitsky, D. (14). Gallstones (M. Chwistek, Ed.). 20070420. Retrieved September 9, 15, from Nursing Reference Center.

Tweed, V. (n.d.). Gallstones: HEALING FOODS & REMEDIES. Better Nutrition. Retrieved September 9, 15 from Nursing Reference Center.

Diagnosis of Cholelithiasis

How is cholelithiasis diagnosed?

Once asked about medical history, family history and current symptoms, the healthcare provider may conduct a physical exam by palpating the upper right quadrant of the patient's abdomen and looking for a positive Murphy Sign. The provider may then order blood tests and imaging to be done. Some ways physicians can get images of potential gallstones are:

• Abdominal ultrasound
• Magnetic resonance cholangiopancreatography (MRCP)
• Hepatobiliary scintigraphy (HIDA) scan
• Abdominal CT scan
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Cholecystogram

This image is an ultrasound depicting a large gallstone. 

These tests are important in the diagnosis of cholelithiasis because they tell the provider if a gallstone is present, where it is, and if it is in a dangerous spot or not. The provider can then decide the best course of action. 

"Bouveret Syndrome." Cinahl Information Systems, Glendale, CA, 5 Dec. 2014. Web. 13 Oct. 2015.

Gallstones (Cholelithiasis). (2015, January 20). Retrieved October 13, 2015.

 Savitsky, D. (14). Gallstones (M. Chwistek, Ed.). 20070420. Retrieved September 9, 15, from Nursing Reference Center.

Etiology and Pathophysiology of Gallstones

Gallstones arrise when there is a buildup of calcium, cholesterol salts and bilirubin salts in a crystalline structure. Another reported cause is when the gallbladder does not void itself completely of bile often enough, likely leading to a buildup of these substances.

There are 3 categories of gallstones;

Cholesterol-

• 80% of gallstones in the United States are primarily composed of cholesterol, lending to evidence of our high cholesterol diets compromising our health. The bile becomes too thick and concentrated and can buildup in the bladder. 

Calcium, bilirubin and pigment gallstones-

• Also called "black pigment gallstones" due to their jet black hue
• These stones make up 10-20% of gallstone occurrences in the United States.
• Bilirubin is secreted into gallbladder by liver cells, form precipitates with calcium that are insoluble ("calcium bilirubinate"), which form stones.

Mixed Stones-

• These are gallstones that are made of cholesterol, but have calcium participates in the mix. 

One complication that may arise from the presence of gallstones is Bouveret Syndrome. Bouveret Syndrome, in short, is when a large gallstone obstructs the pyloric sphincter (or any length of the duodenum), making it impossible for gastric contents to move on through the duodenum and then to the rest of the small intestine.

According to Cinahl Information Systems, fewer than 1% of individuals with gallstones develop Bouveret syndrome, but can be quite deadly if let untreated. Mortality in patients with Bouveret syndrome has been reported to be as high as 20% of confirmed cases. 

"Bouveret Syndrome." Cinahl Information Systems, Glendale, CA, 5 Dec. 2014. Web. 13 Oct. 2015.

Gallstones (Cholelithiasis). (2015, January 20). Retrieved October 13, 2015.

 Savitsky, D. (14). Gallstones (M. Chwistek, Ed.). 20070420. Retrieved September 9, 15, from Nursing Reference Center.

Photo can be traced back to this weird little website: http://www.foamem.com/2014/05/29/emu-monthly-may-2014/ (if you scroll pretty far down)