What is the spectrum of biliary tract disease?

Updated: Jan 18, 2017
  • Author: Peter A D Steel, MBBS, MA; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

Answer

Biliary colic and cholecystitis are in the spectrum of biliary tract disease. This spectrum ranges from asymptomatic gallstones to biliary colic, cholecystitis, choledocholithiasis, and cholangitis. [1]

Gallstones can be divided into 2 categories: Cholesterol stones (80%) and pigment stones (20%). Most patients with gallstones are asymptomatic. Stones may temporarily obstruct the cystic duct or pass through into the common bile duct, leading to symptomatic biliary colic, which develops in 1-4% of patients with gallstones annually.

Cholecystitis occurs when obstruction at the cystic duct is prolonged (usually several hours) resulting in inflammation of the gallbladder wall. Acute cholecystitis develops in approximately 20% of patients with biliary colic if they are left untreated. [2] However, the incidence of acute cholecystitis is falling, likely due to increased acceptance by patients of laparoscopic cholecystectomy as a treatment of symptomatic gallstones. [3]

Choledocholithiasis occurs when the stone becomes lodged in the common bile duct, with the potential sequelae of cholangitis and ascending infections.

Biliary sludge is a reversible suspension of precipitated particulate matter in bile in a viscous mucous liquid phase. The most common precipitates are cholesterol monohydrate crystals and various calcium-based crystals, granules, and salts. [4] A portion of biliary sludge contains comparatively large particles (1-3 mm) called microliths, the formation of which is an intermediate step in the formation of gallstones (about 12.5%). [5]

For patient education information, see the Digestive Disorders Center and Gallstones.

Go to Cholecystitis for more information on this topic.


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