Cholecystitis And Biliary Colic

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Tom P. Aufderheide William J. Brady Judith E. Tintinalli

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Biliary tract emergencies result primarily from obstruction by biliary calculi in the gallbladder and bile ducts. The four major biliary tract emergencies related to gallstones include biliary colic, cholecystitis, gallstone pancreatitis, and ascending cholangitis. While gallstones are common, most are asymptomatic. The incidence of new-onset biliary pain among patients with previously asymptomatic gallstones is about 2 percent per year for the first 5 years and 15 percent at 10 years. 1 Although the classic patient with symptomatic biliary tract disease is an obese female aged 20 to 40 years, the disease occurs in all age groups and must be especially considered in diabetics and the elderly. 2 In both men and women, age over 60, right upper quadrant (RUQ) pain has the highest positive predictive value (11 to 16 percent) for gallstones.3

A number of risk factors are associated with cholecystitis and calculi, including increased age, female sex, parity, obesity, diabetes, profound weight loss, prolonged fasting, cystic fibrosis, intestinal malabsorption syndromes, various medications (particularly oral contraceptive agents and clofibrate), and a familial tendency. Clinical characteristics associated with an increased risk of the development of pigment stones are Asian descent, chronic biliary tract infection, parasitic infection (e.g., Ascaris lumbricoides), chronic liver disease (particularly related to alcohol), and chronic intravascular hemolysis (sickle cell anemia and hereditary spherocytosis). Hepatitis A, B, C, and E; HIV; and the herpesviruses are associated with viral cholangitis and hepatitis. 4

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