Management of Gall Stone Disease

Gallstone disease occurs when hard fatty or mineral deposits (gallstones) form in the gallbladder. Approximately 15% of the adult population is thought to have gallstone disease, ^{(1 & 2).}

Gallstones or cholelithiasis are a major public health problem and affect up to 20% of the population. Gallstone disease is the most common gastrointestinal disorder for which patients are admitted to hospitals in the majority of people with gallbladder stones remain asymptomatic ^{(3 &4)}. For a small proportion of people with gallstone disease, the stones irritate the gallbladder or block part of the biliary system, and this can cause symptoms. If these symptoms are left untreated, gallstones can cause more serious and, in some cases, life-threatening conditions such as cholecystitis, cholangitis, pancreatitis and jaundice ⁽⁴⁾.

Cholecystitis is defined as an inflammation of the gallbladder.  Ninety percent of cases are due to stones in the gallbladder (i.e., calculus cholecystitis), with the other 10% of cases representing acalculus cholecystitis ⁽⁵⁾.

Calculus cholecystitis is related to the presence of stones in the gallbladder or an obstruction of the cystic duct from cholelithiasis, while acalculous cholecystitis is related to conditions associated with biliary stasis, such as debilitation, major surgery, severe trauma, sepsis, long-term total parenteral nutrition (TPN), and prolonged fasting. Other causes of acalculous cholecystitis include cardiac events; sickle cell disease; Salmonella infections; diabetes mellitus; and cytomegalovirus, cryptosporidiosis, or microsporidiosis infections in patients with acquired immunodeficiency syndrome (AIDS) ^{(5 &6).}

Uncomplicated cholecystitis has an excellent prognosis, with a very low mortality rate. Once complications such as perforation/gangrene develop, the prognosis becomes less favorable ^(6).

Delays in making the diagnosis of acute cholecystitis result in a higher incidence of morbidity and mortality. This is especially true for intensive care unit (ICU) patients who develop calculus cholecystitis ^(6).