Cholelithiasis is the formation of gallstones, which are composed of cholesterol, calcium salts, and bile pigments. Gallstones are concretions that form in the biliary system, usually the gallbladder. Gallstones occurs when the bile in the gallbladder becomes over concentrated (they precipitate out like the salt crystal lab experiments done by children in grade school) and form "stones" or crystals in the gallbladder or bile ducts. The spectrum of gallbladder disease ranges from asymptomatic cholelithiasis to gallbladder (or biliary) colic, cholecystitis, choledocholithiasis, and cholangitis Bile is made up of water, salts, lecithin, cholesterol, and other substances.

Causes

People who are overweight or have illnesses like diabetes have a higher risk of developing stones. Native Americans, Hispanics, or people who have a family history of gallstones are also a higher risk. Gallstones occur 1 ? to 2 times more commonly among Scandinavians and Mexican-Americans. Most gallstones in North America are composed primarily of cholesterol (75%). 25% of gallstones are composed of pigment (60% in Japan). These differences probably are accounted for by genetic (hereditary) factors.

Symptoms

Eighty percent of gallstones are asymptomatic; in the remainder, symptoms range from biliary colic to cholecystitis to life-threatening cholangitis. Diabetics are predisposed to severe manifestations.

These conditions are likely to cause some of the following symptoms:

* Abdominal pain

* Nausea and vomiting

* Jaundice

* Made worse by fatty or greasy foods

* occurs within minutes following meals

* Fever

* Heartburn

* Excess gas or flatus

* Clay-colored stools

Treatment

The most common medical treatment for gallstones is surgical removal of the gallbladder (cholecystectomy). Mechanical shock waves (lithotripsy) may also be applied to break up the stones. Unfortunately, gallstones commonly recur following non-surgical forms of treatment.

Electrohydraulic shock wave lithotripsy (ESWL) has also been employed to treat cholelithiasis. The principal of this method is electromagnetically produced high-energy shock waves focused on a specific point in a liquid medium, producing fragmentation.

Aparoscopic cholecystectomy is the gold standard for care of symptomatic cholelithiasis and is one of the most common operations performed in hospitals today. Using this approach, a patient with symptomatic cholelithiasis may have their gallbladder removed in the morning and be discharged from the hospital on the same evening or the next morning.