Cholelithiaisis

Welcome to Today’s Episode!

In this episode, we’ll explore gallstones—risk factors like obesity, diabetes, and rapid weight loss, and how they can cause symptoms like pain and obstruction. We’ll discuss when surgery is needed, including laparoscopic cholecystectomy, and alternative treatments like ursodeoxycholic acid. 

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Transcript

Welcome to today’s episode, where we’ll explore gallstones. Gallstones are more prevalent in women than in men, and their incidence increases with age, particularly in those over 60.

Obesity is a significant risk factor, especially for women. Rapid weight loss after bariatric surgery can also increase the risk of developing symptomatic gallstones. Other risk factors include diabetes, glucose intolerance, insulin resistance, and tobacco use. Women with high carbohydrate intake and elevated dietary glycemic load are at a greater risk of needing cholecystectomy. High triglyceride levels can also negatively affect gallbladder motility, contributing to gallstone formation.

Individuals with Crohn's disease are at an increased risk for gallstones due to disrupted bile salt absorption, which reduces bile solubility. Certain medications, such as clofibrate, octreotide, and ceftriaxone, can promote gallstone formation, and the risk is further heightened by using glucagon-like peptide-1 receptor agonists. Extended fasting lasting more than five to ten days can lead to biliary sludge or microlithiasis, which usually resolves with refeeding but may lead to gallstones or biliary symptoms. During pregnancy, particularly in obese women or those with insulin resistance, there is an increased risk of gallstones and symptomatic gallbladder issues. Hormone replacement therapy also raises the risk of gallbladder disease and the potential need for cholecystectomy, although transdermal therapy carries a lower risk than oral forms.

Based on their chemical composition, gallstones are categorized as cholesterol or calcium bilirubin stones. Cholelithiasis is often asymptomatic and is frequently discovered during routine imaging, surgery, or autopsy. When symptoms do occur, they may include biliary or episodic gallbladder pain. Factors that increase the likelihood of symptoms include being female, younger, aware of existing gallstones, and having larger or multiple stones. In some cases, small intestinal obstruction caused by gallstone ileus or Bouveret syndrome—where a stone obstructs the pylorus or duodenum—can be the first indication of cholelithiasis.

For treatment, non-steroidal anti-inflammatory drugs, such as diclofenac, can relieve biliary pain. Laparoscopic cholecystectomy is the preferred option for symptomatic gallbladder disease. Generally, there’s no need for preventive cholecystectomy in asymptomatic patients unless specific conditions are met, such as a calcified gallbladder, gallstones measuring 3 cm or larger, polyp greater than 3cm, if the patient is Native American, and a candidate for bariatric surgery or cardiac transplantation.

It's important to note that cholecystectomy may increase the risk of cancers in the esophagus, proximal small intestine, and colon, as well as hepatocellular carcinoma, due to increased duodenogastric reflux and altered bile exposure in the intestines. 

For pregnant patients experiencing biliary pain, a conservative approach is usually recommended. However, laparoscopic cholecystectomy can be performed for those with recurrent pain or acute cholecystitis, ideally during the second trimester.

In cases of gallstone ileus, enterolithotomy is typically sufficient as treatment. Ursodeoxycholic acid, a bile salt, can dissolve some cholesterol stones when taken orally for up to two years and may be an option for patients who refuse cholecystectomy. It is most effective for individuals with a functioning gallbladder and multiple small "floating" gallstones. However, about half of patients may experience a recurrence of gallstones within five years after stopping treatment. Additionally, ursodeoxycholic acid and higher-fat diets can help reduce the risk of gallstone formation related to rapid weight loss.

That’s all for today’s episode. Thanks for listening to AudioBoards. Stay tuned for more educational content in our next episode!

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