Formation of stones within the gall bladder, also known as gall stones, is a condition that can cause many problems. Certain people are at increased risk, and a common saying among clinicians is people who have the "4 F's" get them the most: fat, fertile, female and forty. Other risk factors, such as being of Hispanic descent, being pregnant, or having a history of recent weight loss, also play a role. Several complications of gall stone disease are important to be aware of.
Pain
The most common symptom reported by patients of gall stone disease is pain, also known as "biliary colic." It is related to obstruction of the cystic duct, which is the route by which bile leaves the gall bladder, by gallstones, and has identifiable characteristics. It is located in the right upper quadrant of the abdomen (underneath the right nipple), is intermittent and has associated nausea and vomiting.
Cholecystitis
This occurs when the stones block the cystic duct and bile cannot be excreted. The buildup of bile usually causes the inflammation that is the cause of symptoms such as the pain of biliary colic, which is severe and constant, and also includes abdominal tenderness, fever and chills. The pain radiates to the back or to the patient's right shoulder. The symptoms usually occur after a meal high in fat, which is a stimulus for the gall bladder to release bile.
Gallstone Pancreatitis
Pancreatitis is inflammation of the pancreas and is usually very painful and can be quite severe. The pancreas releases enzymes into the small intestine via the pancreatic duct, and the pancreatic duct usually joins the biliary ducts at a junction called the common bile duct. This is where the bile from the biliary ducts and the enzymes from the pancreas meet and enter the intestine together. When a gall stone is passed and travels downstream, it can get lodged in the common bile duct. This causes a backflow of bile and enzymes back into the pancreas. Pancreatic enzymes can be quite powerful and toxic to tissue, and as a result, the pancreas can be damaged from this backflow.
Symptoms include severe pain around the right upper quadrant or the epigastric area of the abdomen, nausea and vomiting, increased heart rate, low blood pressure and blue discolorations around the belly button or the patient's flanks. Lab values such as increased amylase and lipase enzymes (found in the pancreas) are very suggestive of this complication.
Mirizzi Syndrome
This is basically a form of jaundice caused by cystic duct obstruction by a gallstone, which can in turn obstruct other ducts originating from the liver. The obstruction of the liver ducts may cause jaundice, as well as superimposed infection, and if allowed to continue, cirrhosis can eventually result. Patients will have right upper quadrant abdominal pain and jaundice, and liver enzymes will be elevated on laboratory tests.
Gallstone Ileus
Sometimes inflammation of the gallbladder (cholecystitis) can result in the formation of a communication between the gallbladder and small intestine known as a fistula. The gallstones can enter the intestines via the fistula and, if large enough, can cause obstruction. Without the use of imaging such as x-ray or ultrasonography, it is hard to make the diagnosis, and it is predominantly found in patients older than age 65 years. Obstructive symptoms include nausea and vomiting, pain in the abdomen and constipation, and the pain can be intermittent in nature owing to the stone's being dislodged and then getting lodged again.
References
- Sleisinger and Fordtran's Gastrointestinal and Liver Disease, 8th edition; Feldman; 2006
- Surgical Clinics of North America; Complications of Gallstones: The Mirizzi Syndrome, Gallstone Ileus, Gallstone Pancreatitis, Complications of 'Lost' Gallstones. Zaliekas J, Munson J; volume 88, Issue 6 (December 2008)
