Gallstone

C O M P L I C AT I O N S

D R . R O Y S P A N G A Y O M A N , S P. B , F I N A C S
Anatomy
PHYSIOLOGY

Bile produced by
Liver ;
500-1000 cc/ day

Bile salts stored in

gallbladder (in empty
stomach), and
pumped out through
CBD when triggered
by fatty chyme in the
food
PHYSIOLOGY
FACTORS CAUSING GALLSTONE FORMATION

• High cholesterol intake

• Fe m a l e

• Fa t
5F
• Obesity • Fo r t y o r a bo ve

• Fa m i l y h i s t o r y
• Unhealthy diets/ sedentary lifestyle
• Fa u l t y di et
• Infection

• Hereditary IMPAIRED
GALLBLADDER
FUNCTION
GALLSTONES

• Bile contains bile acids and salts, phospholipids,  cholesterol,

pigments, water, and electrolyte chemicals.

• Imbalance in the gallbladder contents due to impaired function

may cause crystallization, causing bile sludge and stone
formation
SIGNS & SYMPTOMS

Mostly
misdiagnosed
as Gastritis
SIGNS & SYMPTOMS

• Epigastric pain (similar to gastritis)

• Nausea (esp. after high-fat meals)
• Upper right abdominal pain WARNING
• Pain radiating to right scapula
• Fever, shivering
60-80%
• Jaundice, icteric patient with
• Dark brown urine gallstones
• Pale stools DO NOT REVEAL
• Itching ANY SYMPTOMS
• Confusion, loss of consciousness
(silent stone)
• Death
IMAGING

• USG • CT SCAN
IMAGING

• MRCP • ERCP

CBD

GB
IMAGING

• HIDA scan (cholescintigraphy)

• Ejection fraction (normal : > 35%)

• Gallbladder dyskinesia / hyperkinesia

LABORATORY

• CBC (Leucocyte)
• Bilirubin (total, direct, indirect)
• Alkali-fosfatase
• Gamma GT
• SGOT (AST)
• SGPT (ALT)
• Amylase
• Lipase
THERAPY

• CHOLECYSTECTOMY

GOLD
S TA N D A R D
MEDICATION?

• ursodeoxycholic acid

• Effectiveness < 40%

• Long term (years)

• Stone(s) will stay exist and highly recur

• Only given to patients with sludge, asymptomatic stones, or in

very high-risk patients

• May increase complications of gallstones

COMPLICATIONS OF GALLSTONES

• Cholecystitis

• Jaundice

• Cholangitis

• Pancreatitis

• Cancer (gallbladder cancer)

• Gallstone ileus
CHOLECYSTITIS
JAUNDICE
GALLSTONE JAUNDICE

• THERAPY:

• ERCP + laparoscopic cholecystectomy

• Open Cholecystectomy + explore CBD

• Laparoscopic cholecystectomy + cholangioscopic CBD stone

removal
CHOLANGITIS

• Infection of bile ducts

(biliary tracts)

• May lead to SEPSIS

(Reynolds Pentad)  shock
 death

• Treatment:
• Biliary drainage
• Stone removal
• Cholecystectomy
PANCREATITIS

• ERCP+ ES (endoscopic sphincterotomy)

• Cholecystectomy
GALLBLADDER CANCER

• Porcellain gallbladder

• Mainly adenocarcinoma
GALLBLADDER CANCER
GALLSTONE ILEUS

• Cholecystitis berat
(AAST 3-4)

• Menimbulkan fistula ke
usus (umumnya
duodenum atau colon
transversum

• Batu besar dapat

menyebabkan
obstructive ileus
GALLSTONE ILEUS
 Roys Pangayoman
dr. SpB, FInaCS

General Surgeon
Laparoscopic Surgeon

Thank you Siloam Hospital

TB Simatupang ; MRCCC
South Jakarta