List of Risk Factors for Gallstones

List of Risk Factors for Gallstones The list of risk factors mentioned for Gallstones in various sources includes: •

Age - especially over 60

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Obesity

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Dieting

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Gastric bypass surgery - stomach reduction surgery

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Race - High risk for Native Americans

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Native Americans

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Pima Indians

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Mexican-Americans

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Gender - women twice as likely

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Cholesterol-lowering drugs

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Diabetes

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Rapid weight loss

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Fasting

Gallstones Risk Factors: Book Excerpts •

Cholelithiasis - risk factors - Cholelithiasis

Risk factors discussion: Dieting and Gallstones: NIDDK (Excerpt) Overweight people are at greater risk of developing gallstones that people of average weight. However, people who are considering a diet program requiring very low intake of calories each day should be aware that during rapid or substantial weight loss, a person's risk of developing gallstones is increased. (Source: excerpt from Dieting and Gallstones: NIDDK) Dieting and Gallstones: NIDDK (Excerpt) Why obesity is a risk factor for gallstones is unclear. But researchers believe that in obese people, the liver produces too much cholesterol. The excess cholesterol leads to supersaturation in the gallbladder. (Source: excerpt from Dieting and Gallstones: NIDDK) Dieting and Gallstones: NIDDK (Excerpt) People who lose a lot of weight rapidly are at greater risk for developing gallstones. Gallstones are one of the most medically important complications of voluntary weight loss. The relationship of dieting to gallstones has only recently received attention. One major study found that women who lost from 9 to 22 pounds (over a 2-year period) were 44 percent more likely to develop gallstones than women who did not lose weight. Women who lost more than 22 pounds were almost twice as likely to develop gallstones. Other studies have shown that 10 to 25 percent of obese people develop gallstones while on a very-low-calorie diet. (Very-low-calorie diets are usually defined as diets containing 800 calories a day or less. The food is often in liquid form and taken for a prolonged period, typically 12 to 16

weeks.) The gallstones that developed in people on very-low-calorie diets were usually silent and did not produce any symptoms. However, about a third of the dieters who developed gallstones did have symptoms, and a proportion of these required gallbladder surgery. In short, the likelihood of a person developing symptomatic gallstones during or shortly after rapid weight loss is about 4 to 6 percent. This estimate is based on reviewing just a few clinical studies, however, and is not conclusive. (Source: excerpt from Dieting and Gallstones: NIDDK) Dieting and Gallstones: NIDDK (Excerpt) Researchers believe dieting may cause a shift in the balance of bile salts and cholesterol in the gallbladder. The cholesterol level is increased and the amount of bile salts is decreased. Going for long periods without eating (skipping breakfast, for example), a common practice among dieters, also may decrease gallbladder contractions. If the gallbladder does not contract often enough to empty out the bile, gallstones may form. (Source: excerpt from Dieting and Gallstones: NIDDK) Dieting and Gallstones: NIDDK (Excerpt) Gallstones are common among obese patients who lose weight rapidly after gastric bypass surgery. (In gastric bypass surgery, the size of the stomach is reduced, preventing the person from overeating.) One study found that more than a third (38 percent) of patients who had gastric bypass surgery developed gallstones afterward. Gallstones are most likely to occur within the first few months after surgery. (Source: excerpt from Dieting and Gallstones: NIDDK) Smoking and Your Digestive System: NIDDK (Excerpt) Several studies suggest that smoking may increase the risk of developing gallstones and that the risk may be higher for women. However, research results on this topic are not consistent, and more study is needed. (Source: excerpt from Smoking and Your Digestive System: NIDDK) Gallstones: NWHIC (Excerpt) Risk factors for gallstones include obesity ; a large clinical study showed that being even moderately overweight increases one's risk for developing gallstones. This is probably true because obesity tends to cause excess cholesterol in bile, low bile salts, and decreased gallbladder emptying. Very low calorie, rapid weight-loss diets, and prolonged fasting, seem to also cause gallstone formation. No clear relationship has been proven between diet and gallstone formation. However, low-fiber, high-cholesterol, high protein diets, and diets high in starchy foods have been suggested as contributing to gallstone formation. (Source: excerpt from Gallstones: NWHIC) Gallstones: NWHIC (Excerpt) Those who are most likely to develop gallstones are: •

Women between 20 and 60 years of age. They are twice as likely to develop gallstones than men.

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Men and women over age 60.

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Pregnant women or women who have used birth control pills or estrogen replacement therapy.

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Native Americans. They have the highest prevalence of gallstones in the United States. A majority of Native American men have gallstones by age 60. Among the Pima Indians of Arizona, 70 percent of women have gallstones by age 30.

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Mexican-American men and women of all ages.

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Men and women who are overweight.

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People who go on "crash" diets or who lose a lot of weight quickly.

(Source: excerpt from Gallstones: NWHIC)

Risks factors for Gallstones: medical news summaries: The following medical news items are relevant to risk factors for Gallstones: •

All about obesity

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More news »

About risk factors: Risk factors for Gallstones are factors that do not seem to be a direct cause of the disease, but seem to be associated in some way. Having a risk factor for Gallstones makes the chances of getting a condition higher but does not always lead to Gallstones. Also, the absence of any risk factors or having a protective factor does not necessarily guard you against getting Gallstones. For general information and a list of risk factors, see the risk center.

Cholelithiasis, cholecystitis, and related disorders: Excerpt from Handbook of Diseases Diseases of the gallbladder and biliary tract are common, typically painful conditions that usually require surgery and may be life-threatening. They’re commonly associated with deposition of calculi and inflammation. (See Common sites of calculus formation.) In most cases, gallbladder and bile duct diseases occur during middle age. Between ages 20 and 50, they’re six times more common in women, but the incidence in men and women becomes equal after age 50. After that, incidence rises with each succeeding decade.

Causes The origin and frequency of gallbladder and biliary tract disease vary with the particular disorder. Cholelithiasis

The presence of stones or calculi (gallstones) in the gallbladder results from changes in bile components. Gallstones are made of cholesterol, calcium bilirubinate, or a mixture of cholesterol and bilirubin pigment. They arise during periods of sluggishness in the gallbladder resulting from pregnancy, use of oral contraceptives, diabetes mellitus, Crohn’s disease, cirrhosis of the liver, pancreatitis, obesity, and rapid weight loss. Cholelithiasis is the fifth leading cause of hospitalization among adults and accounts for 90% of all gallbladder and duct diseases. The prognosis is usually good with treatment unless infection occurs, in which case the prognosis depends on the infection’s severity and response to antibiotics. Cholecystitis

Cholecystitis, an acute or chronic inflammation of the gallbladder, is usually associated with a gallstone impacted in the cystic duct; the inflammation develops behind the obstruction. Cholecystitis accounts for 10% to 25% of all patients requiring gallbladder surgery. The acute form is most common during middle age; the chronic form, among elderly people. The prognosis is good with treatment. Biliary cirrhosis

Primary biliary cirrhosis is a chronic, progressive disease of the liver characterized by autoimmune destruction of the intrahepatic bile ducts and cholestasis. This condition usually leads to obstructive jaundice and pruritus and involves the portal and periportal spaces of the liver. It affects women between the ages of 40 and 60 nine times more often than men. The prognosis is poor without liver transplantation. Cholangitis

An infection of the bile duct, cholangitis is commonly associated with choledocholithiasis and may follow percutaneous transhepatic cholangiography. Predisposing factors include bacterial or metabolic alteration of bile acids. Widespread inflammation may cause fibrosis and stenosis of the common bile duct. The prognosis for this rare condition is poor without stenting or surgery.

Choledocholithiasis

One out of every 10 patients with gallstones develops choledocholithiasis, or gallstones in the common bile duct (sometimes called common duct stones). This occurs when stones passed out of the gallbladder lodge in the hepatic and common bile ducts and obstruct the flow of bile into the duodenum. The prognosis is good unless infection occurs. Cholesterolosis

Cholesterol polyps or cholesterol crystal deposits in the gallbladder’s submucosa may result from bile secretions containing high concentrations of cholesterol and insufficient bile salts. The polyps may be localized or may speckle the entire gallbladder. Cholesterolosis, the most common pseudotumor, isn’t related to widespread inflammation of the mucosa or lining of the gallbladder. The prognosis is good with surgery. Gallstone ileus

Gallstone ileus results from a gallstone lodging in the terminal ileum. It’s more common in elderly people. The prognosis is good with surgery. Postcholecystectomy syndrome

Postcholecystectomy syndrome commonly results from retained or recurrent common bile duct stones, spasm of the sphincter of Oddi, functional bowel disorder, technical errors, or mistaken diagnoses. It occurs in 1% to 5% of all patients whose gallbladders have been surgically removed and may produce right upper quadrant abdominal pain, biliary colic, fatty food intolerance, dyspepsia, and indigestion. The prognosis is good with selected radiologic procedures, endoscopic procedures, or surgery. Complications

Each disorder produces its own set of complications. Cholelithiasis may lead to any of the disorders associated with gallstone formation: cholangitis, cholecystitis, choledocholithiasis, or gallstone ileus. Cholecystitis can progress to gallbladder complications, such as empyema, hydrops or mucocele, or gangrene. Gangrene may lead to perforation, resulting in peritonitis, fistula formation, pancreatitis, limy bile, and porcelain gallbladder. Other complications include chronic cholecystitis and cholangitis. Choledocholithiasis may lead to cholangitis, obstructive jaundice, pancreatitis, and secondary biliary cirrhosis. Cholangitis, especially in the suppurative form, may progress to septic shock and death. Gallstone ileus may cause bowel obstruction, which can lead to intestinal perforation, peritonitis, septicemia, secondary infection, and septic shock.

Cholelithiasis

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Print This Topic Email This Topic Cholelithiasis is the presence of one or more calculi (gallstones) in the gallbladder. In developed countries, about 10% of adults and 20% of people > 65 yr have gallstones. Gallstones tend to be asymptomatic. The most common symptom is biliary colic; gallstones do not cause dyspepsia or fatty food intolerance. More serious complications include cholecystitis; biliary tract obstruction (from stones in the bile ducts or choledocholithiasis), sometimes with infection (cholangitis); and gallstone pancreatitis. Diagnosis is usually by ultrasonography. If cholelithiasis causes symptoms or complications, cholecystectomy is necessary. Risk factors for gallstones include female sex, obesity, increased age, American Indian ethnicity, a Western diet, and a family history. Most disorders of the

biliary tract result from gallstones. Pathophysiology Biliary sludge is often a precursor of gallstones. It consists of Ca bilirubinate (a polymer of bilirubin), cholesterol microcrystals, and mucin. Sludge develops during gallbladder stasis, as occurs during pregnancy or while receiving TPN. Most sludge is asymptomatic and disappears when the primary condition resolves. Alternatively, sludge can evolve into gallstones or migrate into the biliary tract, obstructing the ducts and leading to biliary colic, cholangitis, or pancreatitis. There are several types of gallstones. Cholesterol stones account for > 85% of gallstones in the Western world. For cholesterol gallstones to form, the following is required: •

Bile must be supersaturated with cholesterol. Normally, water-insoluble cholesterol is made water-soluble by combining with bile salts and lecithin to form mixed micelles. Supersaturation of bile with cholesterol most commonly results from excessive cholesterol secretion (as occurs in obesity or diabetes) but may result from a decrease in bile salt secretion (eg, in cystic fibrosis because of bile salt malabsorption) or in lecithin secretion (eg, in a rare genetic disorder that causes a form of progressive intrahepatic familial cholestasis).

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The excess cholesterol must precipitate from solution as solid microcrystals. Such precipitation in the gallbladder is accelerated by mucin, a glycoprotein, or other proteins in bile.

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The microcrystals must aggregate and grow. This is facilitated by the binding effect of mucin forming a scaffold and retention in the gallbladder (impaired contractility from the excess cholesterol in bile).

Black pigment stones are small, hard gallstones composed of Ca bilirubinate and inorganic Ca salts (eg, Ca carbonate, Ca phosphate). Factors that accelerate their development include alcoholic liver disease, chronic hemolysis, and older age. Brown pigment stones are soft and greasy, consisting of bilirubinate and fatty acids (Ca palmitate or stearate). They form during infection, inflammation, and parasitic infestation (eg, liver flukes in Asia). Gallstones grow at about 1 to 2 mm/yr, taking 5 to 20 yr before becoming large enough to cause problems. Most gallstones form within the gallbladder, but brown pigment stones form in the ducts. Gallstones may migrate to the bile duct after cholecystectomy or, particularly in the case of brown pigment stones, develop behind strictures as a result of stasis and infection. Symptoms and Signs About 80% of people with gallstones are asymptomatic. The remainder have symptoms ranging from biliary-type pain (biliary colic) to cholecystitis to lifethreatening cholangitis. Biliary colic is the most common symptom. Stones occasionally may traverse the cystic duct without causing symptoms.

Most gallstone migration, however, leads to cystic duct obstruction, which, even if transient, causes biliary colic. Biliary colic characteristically begins in the right upper quadrant but may occur elsewhere in the abdomen. It is often poorly localized, particularly in diabetics and the elderly. The pain may radiate into the back or down the arm. Episodes begin suddenly, become intense within 15 min to 1 h, remain at a steady intensity (not colicky) for up to 12 h (usually < 6 h), and then gradually disappear over 30 to 90 min, leaving a dull ache. The pain is usually severe enough to send patients to the emergency department for relief. Nausea and some vomiting are common, but fever and chills do not occur unless cholecystitis has developed. Mild right upper quadrant or epigastric tenderness may be present; peritoneal findings are absent. Between episodes, patients feel well. Although biliary-type pain can follow a heavy meal, fatty food is not a specific precipitating factor. Nonspecific GI symptoms, such as gas, bloating, and nausea, have been inaccurately ascribed to gallbladder disease. These symptoms are common, having about equal prevalence in cholelithiasis, peptic ulcer disease, and functional GI disorders. Little correlation exists between the severity and frequency of biliary colic and pathologic changes in the gallbladder. Biliary colic can occur in the absence of cholecystitis. Should colic last > 12 h, particularly if accompanied by vomiting or fever, acute cholecystitis or pancreatitis is likely. Diagnosis •

Ultrasonography

Gallstones are suspected in patients with biliary colic. Abdominal ultrasonography is the method of choice for detecting gallbladder stones; sensitivity and specificity are 95%. Ultrasonography also accurately detects sludge. CT, MRI, and oral cholecystography (rarely available now, although quite accurate) are alternatives (see Testing for Hepatic and Biliary Disorders: Imaging Tests). Endoscopic ultrasonography accurately detects small gallstones (< 3 mm) and may be needed if other tests are equivocal. Laboratory tests usually are not helpful; typically, results are normal unless complications develop. Asymptomatic gallstones and biliary sludge are often detected incidentally when imaging, usually ultrasonography, is done for other reasons. About 10 to 15% of gallstones are calcified and visible on plain x-rays. Prognosis Those with asymptomatic gallstones become symptomatic at a rate of about 2%/yr. The symptom that develops most commonly is biliary colic rather than a major biliary complication. Once biliary symptoms begin, they are likely to recur; pain returns in 20 to 40% of patients/yr, while about 1 to 2% of patients/yr develop complications such as cholecystitis, choledocholithiasis, cholangitis, and gallstone pancreatitis. Treatment •

Laparoscopic cholecystectomy for symptomatic stones

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Expectant for asymptomatic stones; sometimes stone dissolution

Most asymptomatic patients decide that the discomfort, expense, and risk of elective surgery are not worth removing an organ that may never cause clinical illness. However, if symptoms occur, gallbladder removal (cholecystectomy) is indicated because pain is likely to recur and serious complications can develop. Surgery: Surgery can be done with an open or laparoscopic technique. Open cholecystectomy, which involves a large abdominal incision and direct exploration, is safe and effective. Its overall mortality rate is about 0.1% when done electively during a period free of complications. Laparoscopic cholecystectomy is the treatment of choice. Using video endoscopy and instrumentation through small abdominal incisions, the procedure is less invasive than open cholecystectomy. The result is a much shorter convalescence, decreased postoperative discomfort, improved cosmetic results, yet no increase in morbidity or mortality. Laparoscopic cholecystectomy is converted to an open procedure in 2 to 5% of patients, usually because biliary anatomy cannot be identified or a complication cannot be managed. Older age typically increases the risks of any type of surgery. Cholecystectomy effectively prevents future biliary colic but is less effective for preventing atypical symptoms such as dyspepsia. Cholecystectomy does not result in nutritional problems or a need for dietary limitations. Some patients develop diarrhea, often because bile salt malabsorption in the ileum is unmasked. Prophylactic cholecystectomy in asymptomatic patients with cholelithiasis is not warranted except in those with quite large gallstones (> 3 cm) or those with a calcified gallbladder (porcelain gallbladder) because of an increased risk of gallbladder carcinoma. Stone dissolution: For patients who decline surgery or who are at high surgical risk (eg, because of concomitant medical disorders or advanced age), gallbladder stones can sometimes be dissolved by ingesting bile acids orally for many months. The best candidates for this treatment are those with small, radiolucent stones (more likely to be composed of cholesterol) in a functioning nonobstructed gallbladder—normal filling on cholescintigraphy or oral cholecystography or absence of stones in the neck. Ursodeoxycholic acid 8 to 10 mg/kg/day po dissolves 80% of tiny stones < 0.5 cm in diameter within 6 mo. For larger stones (the majority), the success rate is much lower, even with higher doses of ursodeoxycholic acid. Further, after successful dissolution, stones recur in 50% within 5 yr. Most patients are thus not candidates and prefer laparoscopic cholecystectomy. Stone fragmentation (extracorporeal shock wave lithotripsy) to assist stone dissolution and clearance is now unavailable. Ursodeoxycholic acid, however, has value in preventing stone formation in morbidly obese patients who are losing weight rapidly after bariatric surgery or while on a very low calorie diet.

Cholecystitis

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ampulla of Vater biliary cholecystectomy cholecystitis cholescintigraphy cholestasis electrolytes ileus lipase pancreas pancreatitis radionuclide sepsis sphincter of Oddi sphincterotomy ultrasonography

Cholecystitis is inflammation of the gallbladder, usually resulting from a gallstone blocking the cystic duct. •

Gallbladder inflammation usually results from a gallstone blocking the

flow of bile. •

Typically, people have abdominal pain that lasts more than 6 hours, fever, and nausea.

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Ultrasonography can usually detect signs of gallbladder inflammation.

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The gallbladder is removed, often using a laparoscope.

Cholecystitis is the most common problem resulting from gallbladder stones. It occurs when a stone blocks the cystic duct, which carries bile from the gallbladder. Cholecystitis is classified as acute or chronic. Acute Cholecystitis: Acute cholecystitis begins suddenly, resulting in severe, steady pain in the upper abdomen. At least 95% of people with acute cholecystitis have gallstones. The inflammation almost always begins without infection, although infection may follow later. Inflammation may cause the gallbladder to fill with fluid and its walls to thicken. Rarely, a form of acute cholecystitis without gallstones (acalculous cholecystitis) occurs. Acalculous cholecystitis is more serious than other types of cholecystitis. It tends to occur after the following: •

Major surgery

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Critical illnesses such as serious injuries, major burns, and bodywide infections (sepsis)

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Intravenous feedings for a long time

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Fasting for a prolonged time

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A deficiency in the immune system

It can occur in young children, perhaps developing from a viral or another infection. Chronic Cholecystitis: Chronic cholecystitis is gallbladder inflammation that has lasted a long time. It almost always results from gallstones. It is characterized by repeated attacks of pain (biliary colic). In chronic cholecystitis, the gallbladder is damaged by repeated attacks of acute inflammation, usually due to gallstones, and may become thick-walled, scarred, and small. The gallbladder usually contains sludge (microscopic particles of materials similar to those in gallstones), or gallstones that either block its opening into the cystic duct or reside in the cystic duct itself. Symptoms A gallbladder attack, whether in acute or chronic cholecystitis, begins as pain. The pain of cholecystitis is similar to that caused by gallstones (biliary colic) but is more severe and lasts longer—more than 6 hours and often more than 12 hours. The pain peaks after 15 to 60 minutes and remains constant. It usually occurs in the upper right part of the abdomen. The pain may become excruciating. Most people feel a sharp pain when a doctor presses on the upper right part of the abdomen. Breathing deeply may worsen the pain. The pain often extends to the lower part of the right shoulder blade or to the back. Nausea and

vomiting are common. Within a few hours, the abdominal muscles on the right side may become rigid. Fever occurs in about one third of people with acute cholecystitis. The fever tends to rise gradually to above 100.4° F (38° C) and may be accompanied by chills. Fever rarely occurs in people with chronic cholecystitis. In older people, the first or only symptoms of cholecystitis may be rather general. For example, older people may lose their appetite, feel tired or weak, or vomit. They may not develop a fever. Typically, an attack subsides in 2 to 3 days and completely resolves in a week. If the acute episode persists, it may signal a serious complication. A high fever, chills, a marked increase in the white blood cell count, and cessation of the normal rhythmic contractions of the intestine (ileus—see Gastrointestinal Emergencies: Appendicitis) suggest pockets of pus (abscesses) in the abdomen near the gallbladder from gangrene (which develops when tissue dies) or a perforated gallbladder. If people develop jaundice (see Manifestations of Liver Disease: Jaundice) or pass dark urine and light-colored stools, the common bile duct is probably blocked by a stone, causing a backup of bile in the liver (cholestasis). Inflammation of the pancreas (pancreatitis) can develop. It is caused by a stone blocking the ampulla of Vater, near the exit of the pancreatic duct. Acalculous cholecystitis typically causes sudden, excruciating pain in the upper abdomen in people with no previous symptoms or other evidence of a gallbladder disorder. The inflammation is often very severe and can lead to gangrene or rupture of the gallbladder. In people with other severe problems (including people in the intensive care unit for another reason), acalculous cholecystitis may be overlooked at first. The only symptoms may be a swollen (distended), tender abdomen or a fever with no known cause. If untreated, acalculous cholecystitis results in death for 65% of people. Diagnosis Doctors diagnose cholecystitis based mainly on symptoms and results of imaging tests. Ultrasonography is the best way to detect gallstones in the gallbladder. Ultrasonography can also detect fluid around the gallbladder or thickening of its wall, which are typical of acute cholecystitis. Often, when the ultrasound probe is moved across the upper abdomen above the gallbladder, people report tenderness. Cholescintigraphy, another imaging test, is useful when acute cholecystitis is difficult to diagnose. For this test, a radioactive substance (radionuclide) is injected intravenously. A gamma camera detects the radioactivity given off, and a computer is used to produce an image. Thus, movement of the radionuclide from the liver through the biliary tract can be followed. Images of the liver, bile ducts, gallbladder, and upper part of the small intestine are taken. If the radionuclide does not fill the gallbladder, the cystic duct is probably blocked by a gallstone. Liver blood tests are often normal unless the person has an obstructed bile duct.

Other blood tests can detect some complications such as a high level of a pancreatic enzyme (lipase or amylase) in pancreatitis. A high white blood cell count suggests inflammation, an abscess, gangrene, or a perforated gallbladder. Treatment People with acute or chronic cholecystitis need to be hospitalized. They are not allowed to eat or drink and are given fluids and electrolytes intravenously. A doctor may pass a tube through the nose and into the stomach, so that suctioning can be used to keep the stomach empty and reduce fluid accumulating in the intestine if the intestine is not contracting normally. Usually, antibiotics are given intravenously, and pain relievers are given. If acute cholecystitis is confirmed and the risk of surgery is small, the gallbladder is usually removed within 24 to 48 hours after symptoms start. If necessary, surgery can be delayed for 6 weeks or more while the attack subsides. Delay is often necessary for people with a disorder that makes surgery too risky (such as a heart, lung, or kidney disorder). If a complication such as an abscess, gangrene, or perforated gallbladder is suspected, immediate surgery is necessary. In chronic cholecystitis, the gallbladder is usually removed after the acute episode subsides. In acalculous cholecystitis, immediate surgery is necessary to remove the diseased gallbladder. Surgical removal of the gallbladder (cholecystectomy) is usually done using a flexible viewing tube called a laparoscope. After small incisions are made in the abdomen, the laparoscope and other tubes are inserted, and surgical tools are passed through the incisions and used to remove the gallbladder. Pain After Surgery: A few people have new or recurring episodes of pain that feel like gallbladder attacks even though the gallbladder (and the stones) have been removed. The cause is not known, but it may be malfunction of the sphincter of Oddi, the muscles that control the release of bile and pancreatic secretions through the opening of the bile and pancreatic ducts into the small intestine. Pain may occur because pressure in the ducts is increased by sphincter spasms, which hinders the flow of bile and pancreatic secretions. Pain also may result from small gallstones that remain in the ducts after the gallbladder is removed. More commonly, the cause is another problem, such as irritable bowel syndrome or even peptic ulcer disease. Endoscopic retrograde cholangiopancreatography (ERCP) may be necessary to determine if the cause of pain is increased pressure. For this procedure, a flexible viewing tube (endoscope) is inserted through the mouth and into the intestine, and a device to measure pressure is inserted through the tube. If pressure is increased, surgical instruments are inserted into the tube and used to cut and thus widen the sphincter of Oddi. This procedure (called endoscopic sphincterotomy) can relieve symptoms in people who have an abnormality of the sphincter.

Cholecystitis: Introduction Cholecystitis: Inflammation of the gallbladder which concentrates and stores bile. The condition may occur suddenly (acute) or persist over a longer period of time (chronic). More detailed information about the symptoms, causes, and treatments of Cholecystitis is available below.

Symptoms of Cholecystitis Click to Check •

Upper right-side abdominal pain

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Biliary colic - spasmodic upper abdominal pain

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Biliary colic after a fatty meal

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Abdominal discomfort

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Pain under right shoulder blade

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more symptoms...»

See full list of 21 symptoms of Cholecystitis

Treatments for Cholecystitis •

Bed rest

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Antibiotics

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Pain medications

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Hospitalization

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Gallstone treatments - see treatments for gallstones

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more treatments...»

See full list of 7 treatments for Cholecystitis

Home Diagnostic Testing Home medical testing related to Cholecystitis: •

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Bladder & Urinary Health: Home Testing: ○

Home Bladder Testing

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Home Urinary Tract Infection Tests

more...»

Wrongly Diagnosed with Cholecystitis? •

Misdiagnosis of Cholecystitis

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Failure to diagnose Cholecystitis

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Hidden causes of Cholecystitis (possibly wrongly diagnosed)

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Undiagnosed: Cholecystitis

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Cholecystitis: Related Patient Stories •

Help Please - Ideopathic Cholecystitis

Cholecystitis: Deaths Read more about Deaths and Cholecystitis.

Diagnostic Tests for Cholecystitis Test for Cholecystitis in your own home

Click for Tests •

X-rays - to find gallstones

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Ultrasound - to find gallstones

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See tests for gallstones

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more tests...»

Cholecystitis: Complications Read more about complications of Cholecystitis.

Causes of Cholecystitis •

Gallstones

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Bile duct blockage

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Opisthorchiasis - cholecystitis

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Triosephosphate isomerase 1 - cholecystitis

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Bacteriodes

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more causes...»

See full list of 18 causes of Cholecystitis More information about causes of Cholecystitis: •

Underlying causes of Cholecystitis

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Cholecystitis as a complication caused by other conditions

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Cholecystitis as a symptom

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Medical news summaries relating to Causes of Cholecystitis

Disease Topics Related To Cholecystitis Research the causes of these diseases that are similar to, or related to, Cholecystitis: •

Cystic duct stones

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Acute cholecystitis

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Chronic cholecystitis

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Emphysematous cholecystitis

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Acalculous cholecystitis

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Calculous cholecystitis

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Stones in the cystic duct

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more related diseases...»

Symptoms of Cholecystitis The list of signs and symptoms mentioned in various sources for Cholecystitis includes the 21 symptoms listed below: •

Upper right-side abdominal pain

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Biliary colic - spasmodic upper abdominal pain

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Biliary colic after a fatty meal

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Abdominal discomfort

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Pain under right shoulder blade

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Fever

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Nausea

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Vomiting

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Flatulence

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Jaundice

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Itching skin

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Pale stool

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Thickening of gallbladder

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Shrinking of gallbladder

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Gallbladder inflammation

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Severe pain in upper right side of abdomen

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Back pain

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Indigestion

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Yellow skin

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Yellow membranes

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Yellow whites of the eyes

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more information...»

Research symptoms & diagnosis of Cholecystitis: •

Overview -- Cholecystitis

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Diagnostic Tests for Cholecystitis

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Home Diagnostic Testing

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Complications -- Cholecystitis

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Doctors & Specialists

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Misdiagnosis and Alternative Diagnoses

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Hidden Causes of Cholecystitis

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Other Causes -- causes of these or similar symptoms

Cholecystitis: Complications Read information about complications of Cholecystitis.

Cholecystitis Symptoms: Book Excerpts •

Signs and symptoms - Cholelithiasis, cholecystitis, and related disorders

Diagnostic Testing Diagnostic testing of medical conditions related to Cholecystitis: •

X-rays - to find gallstones

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Ultrasound - to find gallstones

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See tests for gallstones

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more tests...»

Research More About Cholecystitis Do I have Cholecystitis? •

Cholecystitis: Introduction

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Cholecystitis: Diagnostic Testing to confirm diagnosis

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Home Diagnostic Testing

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Alternative diagnoses and misdiagnosis for Cholecystitis

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Hidden Causes of Cholecystitis

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Treatments for Cholecystitis

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More about Cholecystitis

Cholecystitis: Medical Mistakes •

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Women's Health Mistakes: ○

Womens Health -- Health Mistakes

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Contraception -- Health Mistakes

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Fertility -- Health Mistakes

more mistakes...»

Cholecystitis: Undiagnosed Conditions Diseases that may be commonly undiagnosed in related medical areas: •

Women's Reproductive Health: diseases that are commonly undiagnosed: ○

Overactive Bladder Syndrome -- Undiagnosed

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PCOS -- Undiagnosed

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Chlamydia -- Undiagnosed

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Pelvic Inflammatory Disease -- Undiagnosed

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Cervical Cancer -- Undiagnosed

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Breast Cancer -- Undiagnosed

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Ovarian Cancer -- Undiagnosed

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Von Willebrand Disease -- Undiagnosed

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more ...»

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more undiagnosed conditions...»

Cholecystitis: Rare Types Rare types of medical conditions and diseases in related medical categories: •

Women's Reproductive Health -- rare types of diseases: ○

Overactive Bladder Syndrome -- Rare Types

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PCOS -- Rare Types

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Chlamydia -- Rare Types

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Pelvic Inflammatory Disease -- Rare Types

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Cervical Cancer -- Rare Types

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Breast Cancer -- Rare Types

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Ovarian Cancer -- Rare Types

○ Von Willebrand Disease -- Rare Types ○ •

more ...»

more rare diseases...»

Cholecystitis: Related Disease Topics More general medical disease topics related to Cholecystitis include: •

Biliary disorder

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Gall bladder conditions

Research More About Cholecystitis •

Cholecystitis: Introduction

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Symptoms: Cholecystitis

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Causes: Cholecystitis

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Treatments: Cholecystitis

List of causes of Cholecystitis Following is a list of causes or underlying conditions (see also Misdiagnosis of underlying causes of Cholecystitis) that could possibly cause Cholecystitis includes: •

Gallstones

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Bile duct blockage

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Opisthorchiasis - cholecystitis

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Triosephosphate isomerase 1 - cholecystitis

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Bacteriodes

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Klebsiella

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Secondary infection from gut organisms

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Inspissation of bile

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Impacted stone

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E-coli

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Typhoid fever - cholecystitis

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Sjogren's Syndrome - cholecystitis

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Bile stasis

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Cholelithiasis

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Hyperlipoproteinemia type 3 - cholecystitis

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Familial hyperlipoproteinemia - cholecystitis

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Edwardsiella tarda infection - cholecystitis

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Ischemia

More causes: see full list of causes for Cholecystitis

Cholecystitis Causes: Book Excerpts •

Differential Diagnosis - Abdominal Masses

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Differential Diagnosis - Abdominal Masses

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Medical causes - Abdominal mass

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Medical causes - Abdominal mass

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Differential Overview - Abdominal/Pelvic Mass

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Causes - Cholelithiasis, cholecystitis, and related disorders

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Medical causes - Abdominal mass

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Principal Causes of Abdominal Masses - Abdominal Masses

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Medical causes - Abdominal mass

Cholecystitis: Related Medical Conditions To research the causes of Cholecystitis, consider researching the causes of these these diseases that may be similar, or associated with Cholecystitis: •

Cystic duct stones

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Acute cholecystitis

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Chronic cholecystitis

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Emphysematous cholecystitis

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Acalculous cholecystitis

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Calculous cholecystitis

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Stones in the cystic duct

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Obstruction of the cystic duct

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Biliary pain

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Acalculous biliary colic

Cholecystitis: Causes and Types

Causes of Broader Categories of Cholecystitis: Review the causal information about the various more general categories of medical conditions: •

Biliary disorder

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Gall bladder conditions

•

more types...»

Cholecystitis as a complication of other conditions: Other conditions that might have Cholecystitis as a complication may, potentially, be an underlying cause of Cholecystitis. Our database lists the following as having Cholecystitis as a complication of that condition: •

Edwardsiella tarda infection

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Opisthorchiasis

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Sjogren's Syndrome

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Typhoid fever

Cholecystitis as a symptom: Conditions listing Cholecystitis as a symptom may also be potential underlying causes of Cholecystitis. Our database lists the following as having Cholecystitis as a symptom of that condition: •

Familial hyperlipoproteinemia

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Hyperlipoproteinemia type 3

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Triosephosphate isomerase 1

Medical news summaries relating to Cholecystitis: The following medical news items are relevant to causes of Cholecystitis: •

Use of estrogen by women with hysterectomies may increase the risk of gallbladder disease

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More news »

Related information on causes of Cholecystitis: As with all medical conditions, there may be many causal factors. Further relevant information on causes of Cholecystitis may be found in: •

Risk factors for Cholecystitis

•

Hidden causes of Cholecystitis

Causes of Cholecystitis: Online Medical Books 16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Cholecystitis. Abdominal Masses: Differential Diagnosis (In a Page: Signs and Symptoms) •

Constipation/inability to pass stool –Most commonly due to dehydration and/or low dietary fiber intake

–Hirschsprung's disease (congenital aganglionic megacolon) –Medications: Narcotics, opiates, or anticholinergic medications –Ogilvie's syndrome (colonic pseudo-obstruction) •

Ascites –May be due to malignancy, nephrotic syndrome, liver disease, or congestive heart failure

 Large or small bowel obstruction  Soft tissue mass –Tumor (e.g., ovarian, uterine, bowel, liver) –Uterine fibroids –Lipoma: Soft, fleshy, mobile, and contained in the subcutaneous tissue of the abdominal wall –Hernia: Bowel sounds may be audible over the mass; incarceration causes pain; strangulation leads to bowel death –Pyloric stenosis: Seen primarily in infants; palpable pyloric olive-shaped mass –Pregnancy –Massive lymphadenopathy (e.g., lymphoma) –Organomegaly (e.g., hepatomegaly, splenomegaly) –Infection: Intra-abdominal or tubo-ovarian abscess –Abdominal aortic aneurysm: Associated with pulsatile mass and hypotension •

Cyst –Mesenteric cysts: Fluid collections in the mesentery; typically benign –Hydatid cyst: Caused by larval form of Echinococcus granulosus; typically found in the liver in patients with history of travel to tropical areas –Dermoid cyst: May be massive due to delayed presentation

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Palpable gallbladder (Courvoisier's sign): Associated with common bile duct obstruction and a distended gallbladder

» READ BOOK EXCERPT ONLINE » Source: In a Page: Signs and Symptoms, 2004 Abdominal Masses: Differential Diagnosis (In A Page: Pediatric Signs and Symptoms) •

Wilms tumor –More common in younger children

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Neuroblastoma –More common in younger children

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Leukemia/lymphoma –Involvement of retroperitoneal nodes, liver, or spleen

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Hepatic tumors –Hepatoblastoma, hepatocellular carcinoma, angiosarcoma, rhabdomyosarcoma of the liver, metastatic disease

Germ cell tumors –Ovarian, teratoma

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Soft tissue sarcoma –Rhabdomyosarcoma •

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Cystic masses –Ovary, renal, mesenteric •

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Benign tumors –Adenomas (especially of liver), hamartomas, pheochromocytoma

Vascular lesions (e.g., hemangioma) •

Renal etiologies –Distended, nonemptying bladder, bladder outlet obstruction –Congenital mesoblastic nephroma –Severe hydronephrosis

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Gynecologic –Ovarian torsion, endometriosis, pelvic inflammatory disease

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Gastrointestinal –Constipation/stool impaction, intestinal obstruction (e.g., Hirschsprung), GI duplication, incarcerated hernia

Pancreatic pseudocyst •

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Rare malignancies in children –Carcinoid tumors, adrenocortical carcinoma, pancreatoblastoma, malignant rhabdoid tumor

Infectious –Abscess, hepatitis, virus (EBV, CMV) causing splenomegaly or hepatomegaly

Structures normally palpable in small children are liver edge, spleen tip (especially with viral illness), aorta, sigmoid colon, and spine

» READ BOOK EXCERPT ONLINE » Source: In A Page: Pediatric Signs and Symptoms, 2007 Abdominal mass: Medical causes (Handbook of Signs & Symptoms (Third Edition)) ❑ Abdominal aortic aneurysm. Abdominal aortic aneurysm may persist for years, producing only a pulsating periumbilical mass with a systolic bruit over the aorta. However, it may become lifethreatening if the aneurysm expands and its walls weaken. In such cases, the patient initially reports constant upper abdominal pain or, less commonly, low back or dull abdominal pain. If the aneurysm ruptures, he’ll report severe abdominal and back pain. After rupture, the aneurysm no longer pulsates. Associated signs and symptoms of rupture include mottled skin below the waist, absent femoral and pedal pulses, lower blood pressure in the legs than in the arms, mild to moderate tenderness with guarding, and abdominal rigidity. Signs of shock — such as tachycardia and cool, clammy skin — appear with significant blood loss. ❑ Cholecystitis.Deep palpation below the liver border may reveal a smooth, firm, sausage-shaped mass. However, with acute inflammation, the gallbladder is usually too tender to be palpated. Cholecystitis can cause severe right upper quadrant pain that may radiate to the right shoulder, chest, or back; abdominal rigidity and tenderness; fever; pallor; diaphoresis; anorexia; nausea;

and vomiting. Recurrent attacks usually occur 1 to 6 hours after meals. Murphy’s sign (inspiratory arrest elicited when the examiner palpates the right upper quadrant as the patient takes a deep breath) is common. ❑ Colon cancer.A right lower quadrant mass may occur with cancer of the right colon, which may also cause occult bleeding with anemia and abdominal aching, pressure, or dull cramps. Associated findings include weakness, fatigue, exertional dyspnea, vertigo, and signs and symptoms of intestinal obstruction, such as obstipation and vomiting. Occasionally, cancer of the left colon also causes a palpable mass. It usually produces rectal bleeding, intermittent abdominal fullness or cramping, and rectal pressure. The patient may also report fremitus and pelvic discomfort. Later, he develops obstipation, diarrhea, or pencil-shaped, grossly bloody, or mucus-streaked stools. Typically, defecation relieves pain. ❑ Crohn’s disease. With Crohn’s disease, tender, sausage-shaped masses are usually palpable in the right lower quadrant and, at times, in the left lower quadrant. Attacks of colicky right lower quadrant pain and diarrhea are common. Associated signs and symptoms include fever, anorexia, weight loss, hyperactive bowel sounds, nausea, abdominal tenderness with guarding, and perirectal, skin, or vaginal fistulas. ❑ Diverticulitis. Most common in the sigmoid colon, diverticulitis may produce a left lower quadrant mass that’s usually tender, firm, and fixed. It also produces intermittent abdominal pain that’s relieved by defecation or passage of flatus. Other findings may include alternating constipation and diarrhea, nausea, a low-grade fever, and a distended and tympanic abdomen. ❑ Gastric cancer.Advanced gastric cancer may produce an epigastric mass. Early findings include chronic dyspepsia and epigastric discomfort, whereas late findings include weight loss, a feeling of fullness after eating, fatigue and, occasionally, coffee-ground vomitus or melena. ❑ Hepatomegaly. Hepatomegaly produces a firm, blunt, irregular mass in the epigastric region or below the right costal margin. Associated signs and symptoms vary with the causative disorder but commonly include ascites, right upper quadrant pain and tenderness, anorexia, nausea, vomiting, leg edema, jaundice, palmar erythema, spider angiomas, gynecomastia, testicular atrophy and, possibly, splenomegaly. ❑ Hernia. The soft and typically tender bulge is usually an effect of prolonged, increased intraabdominal pressure on weakened areas of the abdominal wall. An umbilical hernia is typically located around the umbilicus and an inguinal hernia in either the right or left groin. An incisional hernia can occur anywhere along a previous incision. Hernia may be the only sign until strangulation occurs. ❑ Hydronephrosis. Enlarging one or both kidneys, hydronephrosis produces a smooth, boggy mass in one or both flanks. Other findings vary with the degree of hydronephrosis. The patient may have severe colicky renal pain or dull flank pain that radiates to the groin, vulva, or testes. Hematuria, pyuria, dysuria, alternating oliguria and polyuria, nocturia, accelerated hypertension, nausea, and vomiting may also occur. ❑ Ovarian cyst. A large ovarian cyst may produce a smooth, rounded, fluctuant mass, resembling a distended bladder, in the suprapubic region. Large or multiple cysts may also cause mild pelvic discomfort, low back pain, menstrual irregularities, and hirsutism. A twisted or ruptured cyst may cause abdominal tenderness, distention, and rigidity. ❑ Splenomegaly. The lymphomas, leukemias, hemolytic anemias, and inflammatory diseases are among the many disorders that may cause splenomegaly. Typically, the smooth edge of the

enlarged spleen is palpable in the left upper quadrant. Associated signs and symptoms vary with the causative disorder but usually include a feeling of abdominal fullness, left upper quadrant abdominal pain and tenderness, splenic friction rub, splenic bruits, and a low-grade fever. ❑ Uterine leiomyomas (fibroids). If large enough, these common, benign uterine tumors produce a round, multinodular mass in the suprapubic region. The patient’s chief complaint is usually menorrhagia; she may also experience a feeling of heaviness in the abdomen, and pressure on surrounding organs may cause back pain, constipation, and urinary frequency or urgency. Edema and varicosities of the lower extremities may develop. Rapid fibroid growth in perimenopausal or postmenopausal women needs further evaluation. » READ BOOK EXCERPT ONLINE » Source: Handbook of Signs & Symptoms (Third Edition), 2006 Abdominal mass: Medical causes (Professional Guide to Signs & Symptoms (Fifth Edition)) Abdominal aortic aneurysm

An abdominal aortic aneurysm may persist for years, producing only a pulsating periumbilical mass with a systolic bruit over the aorta. However, it may become life-threatening if the aneurysm expands and its walls weaken. In such cases, the patient initially reports constant upper abdominal pain or, less often, low back or dull abdominal pain. If the aneurysm ruptures, he’ll report severe abdominal and back pain. And after rupture, the aneurysm no longer pulsates. Associated signs and symptoms of rupture include mottled skin below the waist, absent femoral and pedal pulses, lower blood pressure in the legs than in the arms, mild to moderate tenderness with guarding, and abdominal rigidity. Signs of shock—such as tachycardia and cool, clammy skin—appear with significant blood loss. Bladder distention

A smooth, rounded, fluctuant suprapubic mass is characteristic. In extreme distention, the mass may extend to the umbilicus. Severe suprapubic pain and urinary frequency and urgency may also occur. Cholecystitis

Deep palpation below the liver border may reveal a smooth, firm, sausage-shaped mass. However, in acute inflammation, the gallbladder is usually too tender to be palpated. Cholecystitis can cause severe right-upper-quadrant pain that may radiate to the right shoulder, chest, or back; abdominal rigidity and tenderness; fever; pallor; diaphoresis; anorexia; nausea; and vomiting. Recurrent attacks usually occur 1 to 6 hours after meals. Murphy’s sign (inspiratory arrest elicited when the examiner palpates the right upper quadrant as the patient takes a deep breath) is common. Cholelithiasis

A stone-filled gallbladder usually produces a painless right-upper-quadrant mass that’s smooth and sausage-shaped. However, passage of a stone through the bile or cystic duct may cause severe right-upper-quadrant pain that radiates to the epigastrium, back, or shoulder blades. Accompanying signs and symptoms include anorexia, nausea, vomiting, chills, diaphoresis,

restlessness, and low-grade fever. Jaundice may occur with obstruction of the common bile duct. The patient may also experience intolerance of fatty foods and frequent indigestion. Colon cancer

A right-lower-quadrant mass may occur in cancer of the right colon, which may also cause occult bleeding with anemia and abdominal aching, pressure, or dull cramps. Associated findings include weakness, fatigue, exertional dyspnea, vertigo, and signs and symptoms of intestinal obstruction, such as obstipation and vomiting. Occasionally, cancer of the left colon also causes a palpable mass. Usually though, it produces rectal bleeding, intermittent abdominal fullness or cramping, and rectal pressure. The patient may also report fremitus and pelvic discomfort. Later, he develops obstipation, diarrhea, or pencil-shaped, grossly bloody, or mucus-streaked stools. Typically, defecation relieves pain. Crohn’s disease

In Crohn’s disease, tender, sausage-shaped masses are usually palpable in the right lower quadrant and, at times, in the left lower quadrant. Attacks of colicky right-lower-quadrant pain and diarrhea are common. Associated signs and symptoms include fever, anorexia, weight loss, hyperactive bowel sounds, nausea, abdominal tenderness with guarding, and perirectal, skin, or vaginal fistulas. Diverticulitis

Most common in the sigmoid colon, diverticulitis may produce a left-lower-quadrant mass that’s usually tender, firm, and fixed. It also produces intermittent abdominal pain that’s relieved by defecation or passage of flatus. Other findings may include alternating constipation and diarrhea, nausea, low-grade fever, and a distended and tympanic abdomen. Gallbladder cancer

Gallbladder cancer may produce a moderately tender, irregular mass in the right upper quadrant. Accompanying it is chronic, progressively severe epigastric or right-upper-quadrant pain that may radiate to the right shoulder. Associated signs and symptoms include nausea, vomiting, anorexia, weight loss, jaundice, and possibly hepatosplenomegaly. Gastric cancer

Advanced gastric cancer may produce an epigastric mass. Early findings include chronic dyspepsia and epigastric discomfort, whereas late findings include weight loss, a feeling of fullness after eating, fatigue, and occasionally coffee-ground vomitus or melena. Hepatic cancer

Hepatic cancer produces a tender, nodular mass in the right upper quadrant or right epigastric area accompanied by severe pain that’s aggravated by jolting. Other effects include weight loss, weakness, anorexia, nausea, fever, dependent edema, and occasionally jaundice and ascites. A large tumor can also cause a bruit or hum. Hepatomegaly

Hepatomegaly produces a firm, blunt, irregular mass in the epigastric region or below the right costal margin. Associated signs and symptoms vary with the causative disorder but commonly

include ascites, right-upper-quadrant pain and tenderness, anorexia, nausea, vomiting, leg edema, jaundice, palmar erythema, spider angiomas, gynecomastia, testicular atrophy, and possibly splenomegaly. Hydronephrosis

By enlarging one or both kidneys, hydronephrosis produces a smooth, boggy mass in one or both flanks. Other findings vary with the degree of hydronephrosis. The patient may have severe colicky renal pain or dull flank pain that radiates to the groin, vulva, or testes. Hematuria, pyuria, dysuria, alternating oliguria and polyuria, nocturia, accelerated hypertension, nausea, and vomiting may also occur. Ovarian cyst

A large ovarian cyst may produce a smooth, rounded, fluctuant mass, resembling a distended bladder, in the suprapubic region. Large or multiple cysts may also cause mild pelvic discomfort, low back pain, menstrual irregularities, and hirsutism. A twisted or ruptured cyst may cause abdominal tenderness, distention, and rigidity. Pancreatic abscess

Occasionally, pancreatic abscess may produce a palpable epigastric mass accompanied by epigastric pain and tenderness. The patient’s temperature usually rises abruptly but may climb steadily. Nausea, vomiting, diarrhea, tachycardia, and hypotension may also occur. Pancreatic pseudocysts

After pancreatitis, pseudocysts may form on the pancreas, causing a palpable nodular mass in the epigastric area. Other findings include nausea, vomiting, diarrhea, abdominal pain and tenderness, low-grade fever, and tachycardia. Renal cell carcinoma

Usually occurring in only one kidney, renal cell carcinoma produces a smooth, firm, nontender mass near the affected kidney. Accompanying it are dull, constant abdominal or flank pain and hematuria. Other signs and symptoms include elevated blood pressure, fever, and urine retention. Weight loss, nausea, vomiting, and leg edema occur in late stages. Splenomegaly

Lymphomas, leukemias, hemolytic anemias, and inflammatory diseases are among the many disorders that may cause splenomegaly. Typically, the smooth edge of the enlarged spleen is palpable in the left upper quadrant. Associated signs and symptoms vary with the causative disorder but often include a feeling of abdominal fullness, left-upper-quadrant abdominal pain and tenderness, splenic friction rub, splenic bruits, and low-grade fever. Uterine leiomyomas (fibroids)

If large enough, these common, benign uterine tumors produce a round, multinodular mass in the suprapubic region. The patient’s chief complaint is usually menorrhagia; she may also experience a feeling of heaviness in the abdomen, and pressure on surrounding organs may cause back pain, constipation, and urinary frequency or urgency. Edema and varicosities of the lower extremities may develop. Rapid fibroid growth in perimenopausal or postmenopausal women needs further evaluation.

» READ BOOK EXCERPT ONLINE » Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006 Abdominal/Pelvic Mass: Differential Overview (Field Guide to Bedside Diagnosis) Abdominal Mass ❑ Liver enlargement ❑ Spleen enlargement ❑ Fecal mass ❑ Diverticulitis ❑ Colon cancer ❑ Gallbladder enlargement ❑ Pancreatic pseudocyst ❑ Crohn disease ❑ Abdominal aortic aneurysm ❑ Renal enlargement Pelvic Mass ❑ Distended bladder ❑ Pregnant uterus ❑ Salpingitis ❑ Ovarian cyst ❑ Uterine fibromyoma ❑ Ovarian cancer ❑ Endometrial cancer ❑ Ectopic pregnancy ❑ Malignant deposit » READ BOOK EXCERPT ONLINE » Source: Field Guide to Bedside Diagnosis, 2007 Cholelithiasis, cholecystitis, and related disorders: Causes (Handbook of Diseases) The origin and frequency of gallbladder and biliary tract disease vary with the particular disorder. Cholelithiasis

The presence of stones or calculi (gallstones) in the gallbladder results from changes in bile components. Gallstones are made of cholesterol, calcium bilirubinate, or a mixture of cholesterol and bilirubin pigment. They arise during periods of sluggishness in the gallbladder resulting from

pregnancy, use of oral contraceptives, diabetes mellitus, Crohn’s disease, cirrhosis of the liver, pancreatitis, obesity, and rapid weight loss. Cholelithiasis is the fifth leading cause of hospitalization among adults and accounts for 90% of all gallbladder and duct diseases. The prognosis is usually good with treatment unless infection occurs, in which case the prognosis depends on the infection’s severity and response to antibiotics. Cholecystitis

Cholecystitis, an acute or chronic inflammation of the gallbladder, is usually associated with a gallstone impacted in the cystic duct; the inflammation develops behind the obstruction. Cholecystitis accounts for 10% to 25% of all patients requiring gallbladder surgery. The acute form is most common during middle age; the chronic form, among elderly people. The prognosis is good with treatment. Biliary cirrhosis

Primary biliary cirrhosis is a chronic, progressive disease of the liver characterized by autoimmune destruction of the intrahepatic bile ducts and cholestasis. This condition usually leads to obstructive jaundice and pruritus and involves the portal and periportal spaces of the liver. It affects women between the ages of 40 and 60 nine times more often than men. The prognosis is poor without liver transplantation. Cholangitis

An infection of the bile duct, cholangitis is commonly associated with choledocholithiasis and may follow percutaneous transhepatic cholangiography. Predisposing factors include bacterial or metabolic alteration of bile acids. Widespread inflammation may cause fibrosis and stenosis of the common bile duct. The prognosis for this rare condition is poor without stenting or surgery. Choledocholithiasis

One out of every 10 patients with gallstones develops choledocholithiasis, or gallstones in the common bile duct (sometimes called common duct stones). This occurs when stones passed out of the gallbladder lodge in the hepatic and common bile ducts and obstruct the flow of bile into the duodenum. The prognosis is good unless infection occurs. Cholesterolosis

Cholesterol polyps or cholesterol crystal deposits in the gallbladder’s submucosa may result from bile secretions containing high concentrations of cholesterol and insufficient bile salts. The polyps may be localized or may speckle the entire gallbladder. Cholesterolosis, the most common pseudotumor, isn’t related to widespread inflammation of the mucosa or lining of the gallbladder. The prognosis is good with surgery. Gallstone ileus

Gallstone ileus results from a gallstone lodging in the terminal ileum. It’s more common in elderly people. The prognosis is good with surgery.

Postcholecystectomy syndrome

Postcholecystectomy syndrome commonly results from retained or recurrent common bile duct stones, spasm of the sphincter of Oddi, functional bowel disorder, technical errors, or mistaken diagnoses. It occurs in 1% to 5% of all patients whose gallbladders have been surgically removed and may produce right upper quadrant abdominal pain, biliary colic, fatty food intolerance, dyspepsia, and indigestion. The prognosis is good with selected radiologic procedures, endoscopic procedures, or surgery. Complications

Each disorder produces its own set of complications. Cholelithiasis may lead to any of the disorders associated with gallstone formation: cholangitis, cholecystitis, choledocholithiasis, or gallstone ileus. Cholecystitis can progress to gallbladder complications, such as empyema, hydrops or mucocele, or gangrene. Gangrene may lead to perforation, resulting in peritonitis, fistula formation, pancreatitis, limy bile, and porcelain gallbladder. Other complications include chronic cholecystitis and cholangitis. Choledocholithiasis may lead to cholangitis, obstructive jaundice, pancreatitis, and secondary biliary cirrhosis. Cholangitis, especially in the suppurative form, may progress to septic shock and death. Gallstone ileus may cause bowel obstruction, which can lead to intestinal perforation, peritonitis, septicemia, secondary infection, and septic shock. » READ BOOK EXCERPT ONLINE » Source: Handbook of Diseases, 2003 Abdominal mass: Medical causes (Signs & Symptoms: A 2-in-1 Reference for Nurses) Abdominal aortic aneurysm

An abdominal aortic aneurysm may persist for years, producing only a pulsating periumbilical mass with a systolic bruit over the aorta. However, it may become life-threatening if the aneurysm expands and its walls weaken. In such cases, the patient initially reports constant upper abdominal pain or, less often, low back or dull abdominal pain. If the aneurysm ruptures, he’ll report severe abdominal and back pain. After rupture, the aneurysm no longer pulsates. Associated signs and symptoms of rupture include mottled skin below the waist, absent femoral and pedal pulses, lower blood pressure in the legs than in the arms, mild to moderate tenderness with guarding, and abdominal rigidity. Signs of shock — such as tachycardia and cool, clammy skin — appear with significant blood loss. Bladder distention

A smooth, rounded, fluctuant suprapubic mass is characteristic of bladder distention. With extreme distention, the mass may extend to the umbilicus. Severe suprapubic pain and urinary frequency and urgency may also occur. Cholecystitis

With cholecystitis, deep palpation below the liver border may reveal a smooth, firm, sausageshaped mass. However, with acute inflammation, the gallbladder is usually too tender to be palpated. Cholecystitis can cause severe right-upper-quadrant pain that may radiate to the right

shoulder, chest, or back; abdominal rigidity and tenderness; fever; pallor; diaphoresis; anorexia; nausea; and vomiting. Recurrent attacks usually occur 1 to 6 hours after meals. Murphy’s sign (inspiratory arrest elicited when the examiner palpates the right upper quadrant as the patient takes a deep breath) is common. Cholelithiasis

With cholelithiasis, a stone-filled gallbladder usually produces a painless right-upper-quadrant mass that’s smooth and sausage-shaped. However, passage of a stone through the bile or cystic duct may cause severe right-upper-quadrant pain that radiates to the epigastrium, back, or shoulder blades. Accompanying signs and symptoms include anorexia, nausea, vomiting, chills, diaphoresis, restlessness, and low-grade fever. Jaundice may occur with obstruction of the common bile duct. The patient may also experience intolerance to fatty foods and frequent indigestion. Colon cancer

A right-lower-quadrant mass may occur with cancer of the right colon, which may also cause occult bleeding with anemia and abdominal aching, pressure, or dull cramps. Associated findings include weakness, fatigue, exertional dyspnea, vertigo, and signs and symptoms of intestinal obstruction, such as obstipation and vomiting. Occasionally, cancer of the left colon also causes a palpable mass. Usually though, it produces rectal bleeding, intermittent abdominal fullness or cramping, and rectal pressure. The patient may also report fremitus and pelvic discomfort. Later, he develops obstipation, diarrhea, or pencil-shaped, grossly bloody, or mucus-streaked stools. Typically, defecation relieves pain. Crohn’s disease

With Crohn’s disease, tender, sausage-shaped masses are usually palpable in the right lower quadrant and, at times, in the left lower quadrant. Attacks of colicky right-lower-quadrant pain and diarrhea are common. Associated signs and symptoms include fever, anorexia, weight loss, hyperactive bowel sounds, nausea, abdominal tenderness with guarding, and perirectal, skin, or vaginal fistulas. Diverticulitis

Most common in the sigmoid colon, diverticulitis may produce a left-lowerquadrant mass that’s usually tender, firm, and fixed. It also produces intermittent abdominal pain that’s relieved by defecation or passage of flatus. Other findings may include alternating constipation and diarrhea, nausea, low-grade fever, and a distended and tympanic abdomen. Gallbladder cancer

Gallbladder cancer may produce a moderately tender, irregular mass in the right upper quadrant. Accompanying it is chronic, progressively severe epigastric or right-upper-quadrant pain that may radiate to the right shoulder. Associated signs and symptoms include nausea, vomiting, anorexia, weight loss, jaundice and, at times, hepatosplenomegaly.

Gastric cancer

Advanced gastric cancer may produce an epigastric mass. Early findings include chronic dyspepsia and epigastric discomfort, whereas late findings include weight loss, a feeling of fullness, fatigue and, occasionally, coffee-ground vomitus or melena. Hepatic cancer

Hepatic cancer produces a tender, nodular mass in the right upper quadrant or right epigastric area accompanied by severe pain that’s aggravated by jolting. Other effects include weight loss, weakness, anorexia, nausea, fever, dependent edema and, occasionally, jaundice and ascites. A large tumor can also cause a bruit or hum. Hepatomegaly

Hepatomegaly produces a firm, blunt, irregular mass in the epigastric region or below the right costal margin. Associated signs and symptoms vary with the causative disorder but commonly include ascites, right-upper-quadrant pain and tenderness, anorexia, nausea, vomiting, leg edema, jaundice, palmar erythema, spider angiomas, gynecomastia, testicular atrophy and, possibly, splenomegaly. Hydronephrosis

Enlarging one or both kidneys, hydronephrosis produces a smooth, boggy mass in one or both flanks. Other findings vary with the degree of hydronephrosis. The patient may have severe colicky renal pain or dull flank pain that radiates to the groin, vulva, or testes. Hematuria, pyuria, dysuria, alternating oliguria and polyuria, nocturia, accelerated hypertension, nausea, and vomiting may also occur. Ovarian cyst

A large ovarian cyst may produce a smooth, rounded, fluctuant mass, resembling a distended bladder, in the suprapubic region. Large or multiple cysts may also cause mild pelvic discomfort, low back pain, menstrual irregularities, and hirsutism. A twisted or ruptured cyst may cause abdominal tenderness, distention, and rigidity. Pancreatic abscess

Occasionally, pancreatic abscess may produce a palpable epigastric mass accompanied by epigastric pain and tenderness. The patient’s temperature usually rises abruptly but may climb steadily. Nausea, vomiting, diarrhea, tachycardia, and hypotension may also occur. Renal cell cancer

Usually occurring in only one kidney, renal cell carcinoma produces a smooth, firm, nontender mass near the affected kidney. Accompanying it are dull, constant abdominal or flank pain and hematuria. Other signs and symptoms include elevated blood pressure, fever, and urine retention. Weight loss, nausea, vomiting, and leg edema occur in late stages. Splenomegaly

The lymphomas, leukemias, hemolytic anemias, and inflammatory diseases are among the many disorders that may cause splenomegaly. Typically, the smooth edge of the enlarged spleen is palpable in the left upper quadrant. Associated signs and symptoms vary with the causative

disorder but commonly include a feeling of abdominal fullness, left-upper-quadrant abdominal pain and tenderness, splenic friction rub, splenic bruits, and low-grade fever. Uterine leiomyomas (fibroids)

If large enough, a uterine leiomyoma (common, benign uterine tumor) can produce a round, multinodular mass in the suprapubic region. The patient’s chief complaint is usually menorrhagia; she may also experience a feeling of heaviness in the abdomen, and pressure on surrounding organs may cause back pain, constipation, and urinary frequency or urgency. Edema and varicosities of the lower extremities may develop. Rapid fibroid growth in perimenopausal or postmenopausal women needs further evaluation. » READ BOOK EXCERPT ONLINE » Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007 Abdominal Masses: Principal Causes of Abdominal Masses (The Diagnostic Approach to Symptoms and Signs in Pediatrics) 1. Rightupper quadrant 1. Liver 1. Hepatomegaly 2. Hepatic cyst 3. Primary hepatic neoplasms 2. Gallbladder 1. Cholecystitis 2. Hydrops of the gallbladder 3. Biliary tree 1. Choledochal cyst 4. Intestine 1. Pyloric stenosis 2. Duodenal hematoma 3. Duplication 2. Left upper quadrant 1. Spleen 1. Splenomegaly 2. Splenic cyst 3. Neoplasm 3. Epigastric 1. Stomach 1. Bezoar 2. Duplication 2. Pancreas

1. Pancreatic cyst 2. Pancreatic pseudocyst 3. Neoplasm 4. Right/left mid-abdomen 1. Kidney 1. Unilateral 1. Hydronephrosis 2. Multicystic dysplastic kidney 3. Renal vein thrombosis 4. Congenital mesoblastic nephroma 5. Wilms tumor 6. Renal cyst 7. Ectopic kidney 8. Horseshoe kidney 9. Renal or perinephric abscess 2. Bilateral 1. Hydronephrosis 2. Multicystic dysplastic kidney 3. Renal vein thrombosis 4. Polycystic kidney disease 5. Beckwith-Wiedemann syndrome 2. Adrenal 1. Neonatal adrenal hematoma 2. Neuroblastoma 5. Periumbilical 1. Intestine 1. Mesenteric cyst 2. Volvulus 3. Duplication 4. Neoplasm 6. Right lower quadrant 1. Intestine 1. Abscess 2. Intussusception 3. Lymphoma 2. Ovary

1. Cyst 2. Torsion 3. Neoplasm 7. Left lower quadrant 1. Intestine 1. Constipation 2. Ovary (see right lower quadrant) 8. Hypogastrium 1. Bladder 1. Distension/obstruction 2. Uterus 1. Pregnancy 2. Hydrometrocolpos

» READ BOOK EXCERPT ONLINE » Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006 Abdominal mass: Medical causes (Nursing: Interpreting Signs and Symptoms) Abdominal aortic aneurysm.An abdominal aortic aneurysm may exist for years, producing only a pulsating periumbilical mass with a systolic bruit over the aorta. It may become lifethreatening if the aneurysm expands and its walls weaken. In such cases, the patient initially reports constant upper abdominal pain or, less commonly, low back or dull abdominal pain. If the aneurysm ruptures, he'll report severe abdominal and back pain. After rupture, the aneurysm no longer pulsates. Associated signs and symptoms of rupture include mottled skin below the waist, absent femoral and pedal pulses, lower blood pressure in the legs than in the arms, mild to moderate tenderness with guarding, and abdominal rigidity. Signs of shock—such as altered mental status, tachycardia, and cool, clammy skin—appear with significant blood loss. Cholecystitis.Deep palpation below the liver border may reveal a smooth, firm, sausage-shaped mass. With acute inflammation, the gallbladder is usually too tender to be palpated. Cholecystitis can cause severe right upper quadrant pain that may radiate to the right shoulder, chest, or back; abdominal rigidity and tenderness; fever; pallor; diaphoresis; anorexia; nausea; and vomiting. Recurrent attacks usually occur 1 to 6 hours after meals. Murphy's sign (inspiratory arrest elicited when the examiner palpates the right upper quadrant as the patient takes a deep breath) is common. Colon cancer.A right lower quadrant mass may occur with cancer of the right colon, which may also cause occult bleeding with anemia and abdominal aching, pressure, or dull cramps. Associated findings include weakness, fatigue, exertional dyspnea, vertigo, and signs and symptoms of intestinal obstruction, such as obstipation and vomiting. Occasionally, cancer of the left colon also causes a palpable mass. It usually produces rectal bleeding, intermittent abdominal fullness or cramping, and rectal pressure. The patient may also

report fremitus and pelvic discomfort. Later, he develops obstipation, diarrhea, or pencil-shaped, grossly bloody, or mucus-streaked stools. Typically, defecation relieves pain. Crohn's disease.With Crohn's disease, tender, sausage-shaped masses are usually palpable in the right lower quadrant and, at times, in the left lower quadrant. Attacks of colicky right lower quadrant pain and diarrhea are common. Associated signs and symptoms include fever, anorexia, weight loss, hyperactive bowel sounds, nausea, abdominal tenderness with guarding, and perirectal, skin, or vaginal fistulas. Diverticulitis.Most common in the sigmoid colon, diverticulitis may produce a left lower quadrant mass that's usually tender, firm, and fixed. It also produces intermittent abdominal pain that's relieved by defecation or passage of flatus. Other findings may include alternating constipation and diarrhea, nausea, a low-grade fever, and a distended and tympanic abdomen. Gastric cancer.Advanced gastric cancer may produce an epigastric mass. Early findings include chronic dyspepsia and epigastric discomfort, whereas late findings include weight loss, a feeling of fullness after eating, fatigue and, occasionally, coffee-ground vomitus or melena. Hepatomegaly.Hepatomegaly produces a firm, blunt, irregular mass in the epigastric region or below the right costal margin. Associated signs and symptoms vary with the causative disorder but commonly include ascites, right upper quadrant pain and tenderness, anorexia, nausea, vomiting, leg edema, jaundice, palmar erythema, spider angiomas, gynecomastia, testicular atrophy and, possibly, splenomegaly. Hernia.The soft and typically tender bulge is usually an effect of prolonged, increased intraabdominal pressure on weakened areas of the abdominal wall. An umbilical hernia is typically located around the umbilicus and an inguinal hernia in either the right or left groin. An incisional hernia can occur anywhere along a previous incision. Hernia may be the only sign until strangulation occurs. Hydronephrosis.Enlarging one or both kidneys, hydronephrosis produces a smooth, boggy mass in one or both flanks. Other findings vary with the degree of hydronephrosis. The patient may have severe colicky renal pain or dull flank pain that radiates to the groin, vulva, or testes. Hematuria, pyuria, dysuria, alternating oliguria and polyuria, nocturia, accelerated hypertension, nausea, and vomiting may also occur. Ovarian cyst.A large ovarian cyst may produce a smooth, rounded, fluctuant mass, resembling a distended bladder, in the suprapubic region. Large or multiple cysts may also cause mild pelvic discomfort, low back pain, menstrual irregularities, and hirsutism. A twisted or ruptured cyst may cause abdominal tenderness, distention, and rigidity. Splenomegaly.With splenomegaly,the smooth edge of the enlarged spleen is palpable in the left upper quadrant. Associated signs and symptoms vary with the causative disorder but usually include a feeling of abdominal fullness, left upper quadrant abdominal pain and tenderness, splenic friction rub, splenic bruits, and a low-grade fever. Uterine leiomyomas (fibroids).If large enough, these common, benign uterine tumors produce a round, multinodular mass in the suprapubic region. The patient's chief complaint is usually menorrhagia; she may also experience a feeling of heaviness in the abdomen, and pressure on surrounding organs may cause back pain, constipation, and urinary frequency or urgency. Edema and varicosities of the lower extremities may develop. Rapid fibroid growth in perimenopausal or postmenopausal women needs further evaluation. » READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Risks factors for Cholecystitis: medical news summaries: The following medical news items are relevant to risk factors for Cholecystitis: •

Aortic disease warning

•

Use of estrogen by women with hysterectomies may increase the risk of gallbladder disease

•

More news »

About risk factors: Risk factors for Cholecystitis are factors that do not seem to be a direct cause of the disease, but seem to be associated in some way. Having a risk factor for Cholecystitis makes the chances of getting a condition higher but does not always lead to Cholecystitis. Also, the absence of any risk factors or having a protective factor does not necessarily guard you against getting Cholecystitis. For general information and a list of risk factors, see the risk center. Symptoms of Ovarian Cancer

Most women will survive ovarian cancer if it is detected at an early stage. But most cases are detected late. Can women rely on their bodies to tell... Insurance Claim Forms

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Symptoms of Cholecystitis The list of signs and symptoms mentioned in various sources for Cholecystitis includes the 21 symptoms listed below: •

Upper right-side abdominal pain

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Biliary colic - spasmodic upper abdominal pain

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Biliary colic after a fatty meal

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Abdominal discomfort

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Pain under right shoulder blade

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Fever

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Nausea

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Vomiting

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Flatulence

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Jaundice

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Itching skin

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Pale stool

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Thickening of gallbladder

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Shrinking of gallbladder

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Gallbladder inflammation

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Severe pain in upper right side of abdomen

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Back pain

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Indigestion

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Yellow skin

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Yellow membranes

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Yellow whites of the eyes

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more information...»

Research symptoms & diagnosis of Cholecystitis: •

Overview -- Cholecystitis

•

Diagnostic Tests for Cholecystitis

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Home Diagnostic Testing

•

Complications -- Cholecystitis

•

Doctors & Specialists

•

Misdiagnosis and Alternative Diagnoses

•

Hidden Causes of Cholecystitis

•

Other Causes -- causes of these or similar symptoms

Cholecystitis: Complications Read information about complications of Cholecystitis.

Cholecystitis Symptoms: Book Excerpts •

Signs and symptoms - Cholelithiasis, cholecystitis, and related disorders

Diagnostic Testing Diagnostic testing of medical conditions related to Cholecystitis: •

X-rays - to find gallstones

•

Ultrasound - to find gallstones

•

See tests for gallstones

•

more tests...»

Research More About Cholecystitis Do I have Cholecystitis? •

Cholecystitis: Introduction

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Cholecystitis: Diagnostic Testing to confirm diagnosis

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Home Diagnostic Testing

•

Alternative diagnoses and misdiagnosis for Cholecystitis

•

Hidden Causes of Cholecystitis

•

Treatments for Cholecystitis

•

More about Cholecystitis

Cholecystitis: Medical Mistakes •

•

Women's Health Mistakes: ○

Womens Health -- Health Mistakes

○

Contraception -- Health Mistakes

○

Fertility -- Health Mistakes

more mistakes...»

Cholecystitis: Undiagnosed Conditions Diseases that may be commonly undiagnosed in related medical areas:

•

•

Women's Reproductive Health: diseases that are commonly undiagnosed: ○

Overactive Bladder Syndrome -- Undiagnosed

○

PCOS -- Undiagnosed

○

Chlamydia -- Undiagnosed

○

Pelvic Inflammatory Disease -- Undiagnosed

○

Cervical Cancer -- Undiagnosed

○

Breast Cancer -- Undiagnosed

○

Ovarian Cancer -- Undiagnosed

○

Von Willebrand Disease -- Undiagnosed

○

more ...»

more undiagnosed conditions...»

Home Diagnostic Testing Home medical tests related to Cholecystitis: •

•

•

•

Bladder & Urinary Health: Home Testing: ○

Home Bladder Testing

○

Home Urinary Tract Infection Tests

○

Home Cystitis Tests

○

Home Kidney Tests

○

Home Urine Protein Tests (Kidney Function)

○

Home Prostate Cancer Tests

Menopause: Related Home Testing: ○

Home Menopause Tests

○

Home FSH Hormone Tests

○

Home Osteoporosis Testing

Vaginal Health: Home Testing: ○

Home Vaginal Infection Tests

○

Home Vaginal PH Tests

○

Home Yeast Infection Tests

○

Home Candida Kits

○

Home Urinary Tract Infection (UTI) Test Kits

○

Home Bladder Test Kits

Breast Cancer: Related Home Tests: ○

Home Breast Cancer Test Kits

○

Home Breast Lump Detection

•

•

Kidney Health: Home Testing: ○

Home Kidney Testing

○

Home Microalbumin Tests (Kidney)

○

Home Urine Protein Tests (Kidney)

○

Home Urinary Tract Infection Test Kits

more home tests...»

Wrongly Diagnosed with Cholecystitis? The list of other diseases or medical conditions that may be on the differential diagnosis list of alternative diagnoses for Cholecystitis includes: •

Acute Appendicitis

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Alcoholic liver disease

•

Appendicitis/acute appendicitis/chronic appendicitis

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Diabetic Diarrhea

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Diverticular disease and diverticulitis

•

more diagnoses...»

See the full list of 12 alternative diagnoses for Cholecystitis

Cholecystitis: Research Doctors & Specialists •

•

Pregnancy & Fertility Health Specialists: ○

Maternal & Fetal Medicine

○

Obstetrics & Gynecology

○

Reproductive Endocrinology & Infertility

○

Neonatal-Perinatal Medicine

Womens Health Specialists: ○

•

•

Gynecological Oncology

Urinary & Bladder Specialists (Urology): ○

Urology (Urinary Specialists)

○

Urological Surgery (Urinary Surgeons)

○

Kidney Doctors (Nephrologists) -- State Directory

Kidney Health Specialists (Nephrology): ○

Nephrology (Kidney Health)

○

Pediatric Nephrology (Child Kidney Health)

○

Urology (Urinary/Bladder)

○

Kidney Doctors (Nephrologists) -- Local Directory

Cholelithiasis: Introduction Cholelithiasis: Is the presence of gallstones in the gallbladder. More detailed information about the symptoms, causes, and treatments of Cholelithiasis is available below.

Symptoms of Cholelithiasis Click to Check •

Many are asymptomatic

•

Others can cause cholecystitis (inflammation of the gallbladder)

•

Biliary colic (when a stone temporarily lodges in the bile duct)

•

Cholangitis

•

Or pancreatitis

•

more symptoms...»

Read more about symptoms of Cholelithiasis

Treatments for Cholelithiasis •

Supportive measures

•

Pain relief

•

Fluids

•

Surgery

•

more treatments...»

Read more about treatments for Cholelithiasis

Wrongly Diagnosed with Cholelithiasis? •

Misdiagnosis of Cholelithiasis

•

Hidden causes of Cholelithiasis (possibly wrongly diagnosed)

Videos for Cholelithiasis Insurance Claim Forms

"I authorize the release of any medical or other information necessary to process this claim." Do you recognize these words? You should, if... Your Rights as a Patient

Whenever you go to a hospital or clinic for a major procedure or diagnostic test, one of the many forms you are given to sign is an "informed... Stress Reduction

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Cholelithiasis: Related Patient Stories •

Gallbladder removal and GERD

•

Is my illness Gallbladder disease?

•

The Gall stone story....hmmm saga?

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After Gallbladder removal

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Gallbladder removal or not? HELP

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multiple gall stones

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To anyone who has had their gallbladder out

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Gallbladder help

•

gall stones, stomach pain, lump left side under ribcage...

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Gallbladder????

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help now after my thread on gallbladder i'm getting this.

Cholelithiasis: Complications Read more about complications of Cholelithiasis.

Causes of Cholelithiasis •

Sickle cell disease

•

Somatostatinoma

•

Clofibrate

•

Erythropoietic protoporphyria

•

Hypercalcaemia

•

more causes...»

See full list of 12 causes of Cholelithiasis Read more about causes of Cholelithiasis. More information about causes of Cholelithiasis: •

Cholelithiasis as a complication caused by other conditions

•

Cholelithiasis as a symptom

Disease Topics Related To Cholelithiasis Research the causes of these diseases that are similar to, or related to, Cholelithiasis: •

Cholesterol stones

•

Pseudolithiasis

•

Pigment gallstones

•

Haemolytic anemia

•

Erythropoietic protoporphyria

•

Sickle cell anemia

•

Biliary colic

•

more related diseases...»

Medical Textbooks Online about Cholelithiasis Medical Books Excerpts •

Cholelithiasis and related disorders

•

"Professional Guide to Diseases (Eighth Edition)" (2005)

•

[ read ]

•

Cholelithiasis, cholecystitis, and related disorders

•

"Handbook of Diseases" (2003)

•

[ read ]

•

Cholelithiasis

•

"The 5-Minute Pediatric Consult" (2008)

•

[ read ]

•

Colic

•

"The 5-Minute Pediatric Consult" (2008)

•

[ read ]

Book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

Latest Treatments for Cholelithiasis •

Laparotomy

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ERCP

•

Transhepatic cholangiography

•

Invasive radiological drainage

•

IV fluids

Symptoms of Cholelithiasis The list of signs and symptoms mentioned in various sources for Cholelithiasis includes the 5 symptoms listed below: •

Many are asymptomatic

•

Others can cause cholecystitis (inflammation of the gallbladder)

•

Biliary colic (when a stone temporarily lodges in the bile duct)

•

Cholangitis

•

Or pancreatitis

•

more information...»

Research symptoms & diagnosis of Cholelithiasis: •

Overview -- Cholelithiasis

•

Diagnostic Tests for Cholelithiasis

•

Complications -- Cholelithiasis

•

Misdiagnosis and Alternative Diagnoses

•

Hidden Causes of Cholelithiasis

•

Other Causes -- causes of these or similar symptoms

Cholelithiasis: Complications Read information about complications of Cholelithiasis.

Cholelithiasis Symptoms: Book Excerpts •

Signs and symptoms - Cholelithiasis and related disorders

•

Signs and symptoms - Cholelithiasis, cholecystitis, and related disorders

•

Cholelithiasis - signs & symptoms - Cholelithiasis

Research More About Cholelithiasis Do I have Cholelithiasis?

•

Cholelithiasis: Introduction

•

Cholelithiasis: Diagnostic Testing to confirm diagnosis

•

Alternative diagnoses and misdiagnosis for Cholelithiasis

•

Treatments for Cholelithiasis

•

More about Cholelithiasis

Wrongly Diagnosed with Cholelithiasis? The list of other diseases or medical conditions that may be on the differential diagnosis list of alternative diagnoses for Cholelithiasis includes: •

Acute cholecystitis

•

Acute pancreatitis

•

Peptic ulcer disease

•

Appendicitis

•

Acute hepatitis (type of Hepatitis)

•

more diagnoses...»

See the full list of 12 alternative diagnoses for Cholelithiasis

More about symptoms of Cholelithiasis: More information about symptoms of Cholelithiasis and related conditions: •

Other diseases with similar symptoms and common misdiagnoses

•

Tests to determine if these are the symptoms of Cholelithiasis

•

Symptoms that may be caused by complications of Cholelithiasis

•

Underlying causes of Cholelithiasis

•

Risk factors for Cholelithiasis

Medical Books Online about Cholelithiasis Medical Books Excerpts Excerpts of published medical book chapters related to Cholelithiasis are available from published medical books for more detailed information about Cholelithiasis. Medical Books Excerpts •

Cholelithiasis and related disorders

•

"Professional Guide to Diseases (Eighth Edition)" (2005)

•

[ read ]

•

Cholelithiasis, cholecystitis, and related disorders

•

"Handbook of Diseases" (2003)

•

[ read ]

•

Cholelithiasis

•

"The 5-Minute Pediatric Consult" (2008)

•

[ read ]

•

Colic

•

"The 5-Minute Pediatric Consult" (2008)

•

[ read ]

Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

Related videos for Cholelithiasis Insurance Claim Forms

"I authorize the release of any medical or other information necessary to process this claim." Do you recognize these words? You should, if... Your Rights as a Patient

Whenever you go to a hospital or clinic for a major procedure or diagnostic test, one of the many forms you are given to sign is an "informed... Stress Reduction

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See full list of 4 related videos

Patient Surveys for Cholelithiasis •

Patient Profile Survey Take Survey View Results

•

Survey about the symptoms of your Cholelithiasis Take Survey View Results

Symptoms of Cholelithiasis: Online Medical Books 16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the symptoms of Cholelithiasis. Cholelithiasis and related disorders: Signs and symptoms (Professional Guide to Diseases (Eighth Edition)) Although gallbladder disease may produce no symptoms, acute cholelithiasis, acute cholecystitis, choledocholithiasis, and cholesterolosis produce the symptoms of a classic gallbladder attack. Attacks usually follow meals rich in fats or may occur at night, suddenly awakening the patient. They begin with acute abdominal pain in the right upper quadrant that may radiate to the back, between the shoulders, or to the front of the chest; the pain may be so severe that the patient seeks emergency department care. Other features may include recurring fat intolerance, biliary colic, belching, flatulence, indigestion, diaphoresis, nausea, vomiting, chills, low-grade fever, jaundice (if a stone obstructs the common bile duct), and clay-colored stools (with choledocholithiasis). Clinical features of cholangitis include a rise in eosinophils, jaundice, abdominal pain, high fever, and chills; biliary cirrhosis may produce jaundice, related itching, weakness, fatigue, slight weight loss, and abdominal pain. Gallstone ileus produces signs and symptoms of small-bowel obstruction — nausea, vomiting, abdominal distention, and absent bowel sounds if the bowel is completely obstructed. Its most telling symptom is intermittent recurrence of colicky pain over several days. » READ BOOK EXCERPT ONLINE » Source: Professional Guide to Diseases (Eighth Edition), 2005 Cholelithiasis, cholecystitis, and related disorders: Signs and symptoms (Handbook of Diseases) Although gallbladder disease may produce no symptoms, acute cholelithiasis, acute cholecystitis, choledocholithiasis, and cholesterolosis all produce the symptoms of a classic gallbladder attack. Such attacks commonly follow meals rich in fats or may occur at night, suddenly awakening the patient. A gallbladder attack may begin with acute abdominal pain in the right upper quadrant that may radiate to the back, between the shoulders, or to the front of the chest. The pain may be so severe that the patient seeks emergency care. Other signs and symptoms include recurring fat intolerance, biliary colic, belching, flatulence, indigestion, diaphoresis, nausea, vomiting, chills, low-grade fever, jaundice (if a stone obstructs the common bile duct), and clay-colored stool (with choledocholithiasis).

Signs and symptoms of cholangitis include a rise in eosinophils, jaundice, abdominal pain, high fever, and chills. Biliary cirrhosis may produce jaundice, related itching, weakness, fatigue, slight weight loss, and abdominal pain. Gallstone ileus produces signs and symptoms of smallbowel obstruction —nausea, vomiting, abdominal distention, and absent bowel sounds if the bowel is completely obstructed. Its most telling sign is intermittent recurrence of colicky pain over several days. » READ BOOK EXCERPT ONLINE » Source: Handbook of Diseases, 2003 Cholelithiasis: Cholelithiasis - signs & symptoms (The 5-Minute Pediatric Consult) •

Silent gallstones present coincidentally in infancy and preschool-age children.

•

Classic symptoms of right upper quadrant (RUQ) pain (Murphy sign) and vomiting exist only in older children and adolescents.

•

Younger children present with nonspecific symptoms, including obstructive jaundice.

•

Fever is unusual in all age groups and often indicates the development of rare complications in children: ○ Cholecystitis ○ Choledocholithiasis ○ Cholangitis ○ Gallbladder perforation:  Pancreatitis develops in 8% of patients with gallstones and is the most common complication.  Pancreatitis is more common in obese adolescents who have undergone rapid weight reduction, as reported in the adult population.

» READ BOOK EXCERPT ONLINE » Source: The 5-Minute Pediatric Consult, 2008

Cholelithiasis as a Cause of Symptoms or Medical Conditions When considering symptoms of Cholelithiasis, it is also important to consider Cholelithiasis as a possible cause of other medical conditions. The Disease Database lists the following medical conditions that Cholelithiasis may cause: •

Abdominal mass

•

Abdominal pain

•

Alkaline phosphatase liver isoenzyme levels raised (plasma or serum)

•

Bile duct stricture

•

Cholestasis, extrahepatic

•

Ileus

•

Nausea and vomiting

•

Pancreatitis, acute

•

Peritonitis

•

Shoulder pain

- (Source - Diseases Database)

Cholelithiasis as a symptom: For a more detailed analysis of Cholelithiasis as a symptom, including causes, drug side effect causes, and drug interaction causes, please see our Symptom Center information for Cholelithiasis.

Medical articles and books on symptoms: These general reference articles may be of interest in relation to medical signs and symptoms of disease in general: •

Research Alternative Diagnoses for Cholelithiasis

•

More about Cholelithiasis

•

Online Diagnosis

•

Self Diagnosis Pitfalls

•

Pitfalls of Online Diagnosis

•

Symptoms of the Silent Killer Diseases

•

Lesser known silent killer diseases

•

Books on signs and symptoms

Full list of premium articles on symptoms and diagnosis

About signs and symptoms of Cholelithiasis: The symptom information on this page attempts to provide a list of some possible signs and symptoms of Cholelithiasis. This signs and symptoms information for Cholelithiasis has been gathered from various sources, may not be fully accurate, and may not be the full list of Cholelithiasis signs or Cholelithiasis symptoms. Furthermore, signs and symptoms of Cholelithiasis may vary on an individual basis for each patient. Only your doctor can provide adequate diagnosis of any signs or symptoms and whether they are indeed Cholelithiasis symptoms. Insurance Claim Forms

"I authorize the release of any medical or other information necessary to process this claim." Do you recognize these words? You should, if... Your Rights as a Patient

Whenever you go to a hospital or clinic for a major procedure or diagnostic test, one of the many forms you are given to sign is an "informed... Stress Reduction

Stress takes its toll by making us anxious, depressed and not able to function as fully as we'd like. What many don't know is that stress can... Your Health and Your Insurance

Health insurance is important to everyone, especially people with chronic conditions like Crohn's disease and ulcerative colitis. Tune in to... See full list of 4 related videos 16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about diagnostis of Cholelithiasis. Cholelithiasis and related disorders: Diagnosis (Professional Guide to Diseases (Eighth Edition)) Echography and X-rays detect gallstones. Other tests may include the following: ❑ Abdominal computed tomography scan or ultrasound reflects stones in the gallbladder. ❑ Percutaneous transhepatic cholangiography, done under fluoroscopic control, distinguishes between gallbladder or bile duct disease and cancer of the pancreatic head in patients with jaundice. ❑ Endoscopic retrograde cholangiopancreatography visualizes the biliary tree after insertion of an endoscope down the esophagus into the duodenum, cannulation of the common bile and pancreatic ducts, and injection of contrast medium. ❑ HIDA scan of the gallbladder detects obstruction of the cystic duct. ❑ Oral cholecystography shows stones in the gallbladder and biliary duct obstruction. An elevated icteric index and total bilirubin, urine bilirubin, and alkaline phosphatase levels support the diagnosis. The white blood cell count is slightly elevated during a cholecystitis attack. Differential diagnosis is essential because gallbladder disease can mimic other diseases

(myocardial infarction, angina, pancreatitis, pancreatic head cancer, pneumonia, peptic ulcer, hiatal hernia, esophagitis, and gastritis). Serum amylase levels distinguish gallbladder disease from pancreatitis. With suspected heart disease, serial cardiac enzyme tests and electrocardiography should precede gallbladder and upper GI diagnostic tests. » READ BOOK EXCERPT ONLINE » Source: Professional Guide to Diseases (Eighth Edition), 2005 Cholelithiasis, cholecystitis, and related disorders: Diagnosis (Handbook of Diseases) Ultrasonography and X-rays detect gallstones. Specific procedures include the following: ❑ Ultrasonography reflects stones in the gallbladder with 96% accuracy. ❑ Percutaneous transhepatic cholangiography allows imaging under fluoroscopic control to help distinguish between gallbladder or bile duct disease and cancer of the pancreatic head in patients with jaundice. ❑ Endoscopic retrograde cholangiopancreatography visualizes the biliary tree after insertion of an endoscope down the esophagus into the duodenum, cannulation of the common bile and pancreatic ducts, and injection of contrast medium. ❑ Hepatobiliary iminodiacetic acid analogue scan of the gallbladder helps detect obstruction of the cystic duct. ❑ Computed tomography scan, although not routinely used, helps distinguish between obstructive and nonobstructive jaundice. ❑ Plain abdominal X-rays identify calcified but not cholesterol stones with 15% accuracy. ❑ Oral cholecystography shows stones in the gallbladder and biliary duct obstruction. Elevated icteric index and elevated total bilirubin, urine bilirubin, and alkaline phosphatase levels support the diagnosis. White blood cell count is slightly elevated during a cholecystitis attack. Differential diagnosis is essential because gallbladder disease can mimic other diseases (myocardial infarction, angina, pancreatitis, pancreatic head cancer, pneumonia, peptic ulcer, hiatal hernia, esophagitis, and gastritis). Serum amylase levels help distinguish gallbladder disease from pancreatitis. With suspected heart disease, cardiac enzyme testsand an electrocardiogram should precede gallbladder and upper GI diagnostic tests. » READ BOOK EXCERPT ONLINE » Source: Handbook of Diseases, 2003 Insurance Claim Forms

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Symptoms of Cholelithiasis The list of medical symptoms mentioned in various sources for Cholelithiasis may include: •

Many are asymptomatic

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Others can cause cholecystitis (inflammation of the gallbladder)

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Biliary colic (when a stone temporarily lodges in the bile duct)

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Cholangitis

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Or pancreatitis

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more symptoms...»

Symptoms of Cholelithiasis » Note that Cholelithiasis symptoms usually refers to various medical symptoms known to a patient, but the phrase Cholelithiasis signs may often refer to those signs that are only noticable by a doctor.

More Symptoms of Cholelithiasis: More detailed symptom information may be found on the symptoms of Cholelithiasis article. In addition to the above medical information, to get a full picture of the possible signs or symptoms

of this condition and also possibly the signs and symptoms of its related medical conditions, it may be necessary to examine symptoms that may be caused by: •

Complications of Cholelithiasis

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Hidden causes of Cholelithiasis

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Associated conditions for Cholelithiasis

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Risk factors for Cholelithiasis

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Related symptoms

Medical articles on signs and symptoms: These general reference articles may be related to medical signs and symptoms of disease in general: •

Books on signs and symptoms

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Books on medical diagnosis

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Symptoms of the Silent Killer Diseases

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Symptoms and Medical Malpractice

What are the signs of Cholelithiasis? The phrase "signs of Cholelithiasis" should, strictly speaking, refer only to those signs and symptoms of Cholelithiasis that are not readily apparent to the patient. The word "symptoms of Cholelithiasis" is the more general meaning; see symptoms of Cholelithiasis. The signs and symptom information on this page attempts to provide a list of some possible signs and symptoms of Cholelithiasis. This medical information about signs and symptoms for Cholelithiasis has been gathered from various sources, may not be fully accurate, and may not be the full list of Cholelithiasis signs or Cholelithiasis symptoms. Furthermore, signs and symptoms of Cholelithiasis may vary on an individual basis for each patient. Only your doctor can provide adequate diagnosis of any signs or symptoms and whether they are indeed Cholelithiasis symptoms.

Complications list for Cholelithiasis: The list of complications that have been mentioned in various sources for Cholelithiasis includes: Complications and sequelae of Cholelithiasis from the Diseases Database include: •

Abdominal pain

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Ileus

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Bile duct stricture

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Peritonitis

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Shoulder pain

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Nausea and vomiting

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Alkaline phosphatase liver isoenzyme levels raised (plasma or serum)

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Pancreatitis, acute

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Cholestasis, extrahepatic

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Abdominal mass

Source: Diseases Database See also the symptoms of Cholelithiasis and Cholelithiasis: Introduction.

Cholelithiasis Symptoms: Book Excerpts •

Signs and symptoms - Cholelithiasis and related disorders

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Signs and symptoms - Cholelithiasis, cholecystitis, and related disorders

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Cholelithiasis - signs & symptoms - Cholelithiasis

Cholelithiasis as a symptom: For a more detailed analysis of Cholelithiasis as a symptom, including causes, drug side effect causes, and drug interaction causes, please see our Symptom Center information for Cholelithiasis.

About complications: Complications of Cholelithiasis are secondary conditions, symptoms, or other disorders that are caused by Cholelithiasis. In many cases the distinction between symptoms of Cholelithiasis and complications of Cholelithiasis is unclear or arbitrary.