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Gallstone disease (cholelithiasis) – pathogenesis, prevention and contemporary methods of imaging diagnosis
Bistra Ivanova Velchovska, Zhenya Nikolaeva Zhekova-Maradzhieva, Atanas Nikolaev Uzunov, Evgenia Leninova Ivanova, Desislava Metodieva Petrova, Mariana Zhivkova Yordanova, Georgi Nikolaev Valchev

Last modified: 2016-11-08


Cholelithiasis is a metabolic disorder, leading to stone formation in the bile ducts and gallbladder. The stones are classified by their composition as cholesterol, pigment, and mixed.

The condition prefers overweight individuals, with a stationary way of life, diabetics, women on oral contraceptives. There is a female predilection with a 3,5:1 ratio.

The disease has several forms. The latent one is devoid of complaints – stones are an incidental finding. The acute form manifests with right upper quadrant pain. The biliary colic is typical – it comes in fits of right subcostal pain, nausea, and frequently vomiting. Complications are frequent – gallbladder and bile duct inflammation, biliary obstruction, gallbladder perforation, and biliary peritonitis.

Accurate diagnosis requires a compound approach. Anamnesis of biliary colic initiates it. Abdominal ultrasonography is the fastest and most accesible imaging method for finding gallstones. It can also demonstrate the gallbladder itself – whether it is enlarged, inflamed, or folded. Additional methods include magnetic resonance imaging (MRI), computed tomography (CT), and some hybrid techniques. Given ambiguous data of cholelithiasis, the latter can be confirmed by endoscopic retrograde cholangio-pancreatography (ERCP) – an endoscope is introduced to the level of the papilla of Vater, and contrast is injected into it. The biliary pathways used to also be imaged by percutaneous transhepatic cholangiography – a dated technique.

Prophylaxis includes avoiding risk factors of alimentary nature and undergoing periodic control ultrasonographies, especially in individuals with a family history of gallstones. This is crucial, as chronic cholecystitis, derived from lithiasis, can lead to precancerosis.