Complications

The Gallstone Elimination Report

Gallstone Elimination Manual by David Smith

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Fluid and electrolyte deficits due to protracted vomiting and anorexia, and upper gastrointestinal hemorrhage from emesis-related Mallory-Weiss tears can coexist with biliary tract emergencies. Complications associated with cholelithiasis include gallstone pancreatitis, ascending cholangitis, and cholecystitis. Patients with cholecystitis may further develop a number of serious complications, including gallbladder empyema and emphysematous (gangrenous) cholecystitis.

Approximately 70 percent of cases of acute pancreatitis are due to either gallstones or alcohol. Depending on the population studied, gallstones are involved in 30 to 70 percent of patients with acute pancreatitis. Of all patients with gallstones, 15 to 20 percent will develop pancreatitis as a result of biliary calculi. Patients with pancreatitis due to gallstones will present similarly to patients with pancreatic inflammation caused by ethanol, with epigastric or diffuse abdominal pain radiating to the back, associated with nausea and vomiting. Patients may manifest symptoms of both acute cholecystitis and acute pancreatitis. Management includes intravenous fluids, nasogastric decompression, analgesics, and parenteral antibiotics with subsequent surgery. In patients who present in extremis or in those who demonstrate clinical deterioration, urgent biliary decompression (surgical or endoscopic) is mandatory.

Ascending cholangitis is a life-threatening emergency with a mortality rate approaching 100 percent in untreated or improperly treated patients. The process results from complete biliary obstruction in the presence of bacteria (gram-negative organisms as well as enterococcal and various anaerobic species). As the obstruction persists, intraluminal pressure increases, resulting in reflux of bacteria into the lymphatic vessels and hepatic veins, with eventual entrance into the systemic circulation. The obstruction most often is due to choledocholithiasis (gallstone obstruction of the common bile duct) and less often to biliary tract strictures, surgical anastomotic strictures, various postprocedural complications, and extrinsic compression from malignancy. Patients present with jaundice, fever, RUQ pain, mental confusion, and shock. The classic Charcot triad of fever, jaundice, and RUQ pain is noted in only 25 percent of patients. Management includes initial volume resuscitation with vasopressor support in cases unresponsive to crystalloid infusion alone, broad-spectrum parenteral antibiotics, and rapid decompression (surgical or endoscopic) of the biliary tree.

Gallbladder empyema, a life-threatening complication of cholecystitis, results from complete obstruction of the cystic duct with bacterial infection of the stagnant bile and abscess formation within the gallbladder wall. Risk factors include age, diabetes mellitus, trauma, burns, vasculitis, and bacterial or parasitic infections of the biliary tract. The presentation is similar to cholangitis, with fever, RUQ pain, altered mentation, and hypotension. Patients frequently develop gram-negative sepsis and require immediate broad-spectrum antibiotic coverage, fluid resuscitation, and urgent surgical consultation for cholecystectomy. The outcome is poor without prompt definitive care.

Gangrene of the gallbladder wall may be focal or diffuse. Focal gangrene results from segmental ischemia of the gallbladder wall caused by severe distention, acute inflammation, empyema, torsion with arterial compromise, or coexisting vasculitis. Patients with diabetes mellitus are at risk for this complication. Perforation of the wall may occur in a contained fashion (into the omentum) or free (into the peritoneal cavity).

Gangrene of the entire gallbladder, also known as emphysematous cholecystitis, is an uncommon complication, occurring in approximately 1 percent of patients with cholecystitis. Emphysematous cholecystitis is acalculous in 30 percent of patients. The gallbladder wall becomes ischemic, with eventual bacterial infection and gangrene. Patients present in extremis with fever, RUQ pain, and septic shock. Plain-film radiographs may demonstrate air in the gallbladder itself, the gallbladder wall, or the biliary tree because of the frequent presence of gas-forming organisms. An abdominal CT scan is the suggested imaging study. The bacteriology of either focal or diffuse gallbladder gangrene includes gram-negative, gram-positive, and anaerobic organisms. Polymicrobial infection is common. Management is similar to that of gallbladder empyema. Mortality rates for gangrenous cholecystitis are very high because of associated sepsis and attendant comorbidity in the typical elderly diabetic patient.

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Get Rid of Gallstones Naturally

Get Rid of Gallstones Naturally

One of the main home remedies that you need to follow to prevent gallstones is a healthy lifestyle. You need to maintain a healthy body weight to prevent gallstones. The following are the best home remedies that will help you to treat and prevent gallstones.

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