Plenary Discussion

I.CLARIFYING UNFAMILIAR TERMS

- flatus : gas or air that expelled through the anus
- compos mentis : fully awake
- hepatitis : inflammation of the liver
- hypertension : high arterial blood pressure by persistent
- diabetes : a disorder characterized by excessive excretion of urine
- cholelithiasis : gallstone
- cholecystitis : inflammation of the gallstones
II. PROBLEM DEFINITION
1. What is cholelithiasis/gallstone?
2. What are the symptom of cholealithiasis/gallstone?
3. what are the factors of cholesterol gallstone formation?
4. how to diagnose gallstones?
5. What is the possible complications of cholealithiasis/gallstone?
6. How choelithialisis treated?
III. BRAINSTORMING
1. Gallstones (commonly misspelled gall stones or gall stone) are solid
particles that form from bile in the gallbladder.
2. You may experience cholelithiasis symptoms daily or just once in a
while. At times any of these common symptoms can be severe:
Abdominal pain
Abdominal swelling, distension or bloating
Abdominal symptoms that occur within minutes after a meal
Abdominal tenderness
Clay-colored stools
Fever and chills

Loss of appetite
Nausea with or without vomiting
Pain that radiates from the abdomen to the right shoulder or back
Sweating
Yellowing of the skin and whites of the eyes (jaundice)
3. female gender, being overweight,losing a lot of weight quickly on a
"crash" or starvation diet, ortaking certain medications such as
birth control pills or cholesterol lowering drugs.
4. Blood Examination,USG,X-Ray,CT-Scan
5. Acute cholecystitis,Cholangitis,Cholecystitis- chronic,
Choledocholithiasis, Pancreatitis
6. Surgery and Non-Surgery
IV. ANALYZING THE PROBLEM
1.

The gallbladder is a small saclike organ in the upper right part

of the abdomen. It is located under the liver, just below the front rib
cage on the right side. The gallbladder is part of the biliary system,
which includes the liver and the pancreas. The biliary system,
among other functions, produces bile and digestive enzymes.Bile is
a fluid made by the liver to help in the digestion of fats.It contains
several different substances, includingcholesterol and bilirubin, a
waste product of normal breakdown of blood cells in the liver. Bile is
stored in the gallbladder until needed. When we eat a high-fat, highcholesterol meal, the gallbladder contracts and injects bile into the
small intestine via a small tube called the common bile duct. The
bile then assists in the digestive process.

2. Abdominal pain is any pain or discomfort that occurs between the

lower chest and the groin. Commonly referred to as the belly, the
abdomen consists of many organs, including the stomach,
intestines, liver, gallbladder, pancreas, esophagus, and numerous
blood vessels. Abdominal pain may be generalized, occurring
throughout the abdomen, or it may be present in a small area of the
belly.
Vomiting, also known as emesis and throwing up, is the forceful
ejection of the stomachs contents. Vomiting is a common symptom
of a wide variety of mild to serious diseases, disorders and

conditions. It occurs in all age groups and populations and may or

may not occur with nausea.
Fever is an increase in your bodys temperature to a range that is
above normal (more than 37 degrees Celcius). Normal body
temperature can change throughout the day by a few degrees.
Various factors can increase your body temperature including
eating, physical activity, medications, surrounding (room or outdoor)
temperature, or a strong emotional response.
Obstructive jaundice is a condition in which there is blockage of the
flow of bile out of the liver. This results in an overflow of bile and its
by-products into the blood, and bile excretion from the body is
incomplete. Bile contains many by-products, one of which is
bilirubin, a pigment derived from dead red blood cells. Bilirubin is
yellow, and this gives the characteristic yellow appearance of
jaundice in the skin, eyes, and mucous membranes. Symptoms of
obstructive jaundice include yellow eyes and skin,abdominal pain,
and fever.
3. Clear enough4. There is no blood test that can identify gallstones. Blood will be
taken for tests that can help to determine if the gallbladder is
obstructed, if the liver or pancreas is inflamed or not functioning
properly, or if the patient has an infection. If a woman, the blood
may also be tested to check for a possible pregnancy,
Urine may be tested to rule out kidney infection. Kidney infections
can cause abdominal pain similar to that caused by gallstones.
Ultrasound is the best test to examine the gallbladder for
stones.Ultrasound uses painless sound waves to create images of
organs. Ultrasound examinations are very good at seeing
abnormalities in the biliary system, including stones or signs of
inflammation or infection. This is the same technique used to look at
a fetus in a pregnant woman. Finding gallstones by ultrasound does
not diagnose gallbladder disease. The doctor has to correlate the
ultrasound findings with the patient's symptoms.
An alternative to ultrasound is an oral cholecystogram (OCG).
An X-ray is taken of the gallbladder after the patient swallow pills
containing a safe, temporary dye. The dye helps the gallbladder
and gallstones show up better on the X-ray.

Both ultrasound and OCG can detect gallstones in the gallbladder

about 95% of the time. Ultrasound is usually the first choice
because it is completely noninvasive and involves no exposure to
radiation.
If either test gives an uncertain result, another test usually is
necessary. These tests are the alternatives to ultrasound and OCG.
They are better choices if gallstones have left the gallbladder and
moved into the ducts.

Cholescintigraphy (HIDA scan): This is a test in which a solution

is injected into an IV line in the patient's arm. The liquid is absorbed
by the liver, then passed on to be stored in the gallbladder (much
like bile). The solution contains a harmless radioactive marker,
which is seen by a special camera. If the gallbladder is inflamed or
blocked by gallstones, none of the marker is seen in the
gallbladder.

CT scan: This test is similar to an X-ray, however more detailed. It

shows the gallbladder and the biliary ducts and can detect
gallstones, blockages, and other complications.

Endoscopic retrograde cholangiopancreatography (ERCP): A

thin, flexible endoscope is used to view parts of the patient's biliary
system. The patient is sedated, and the tube is passed through the
mouth and stomach and into the small intestine. The device then
injects a temporary dye into the biliary ducts. The dye makes it
easy to see any stones in the ducts when X-rays are taken.
Sometimes a stone can be removed during this procedure.
A chest X-ray may be performed to make sure there are no other
reasons for the abdominal pain. Sometimes problems in the chest
(such as pneumonia ) can cause pain in the upper abdomen.
Occasionally the chest X-ray can also show stones in the
gallbladder. As most gallstones are asymptomatic, many times
gallstones are diagnosed when the patient undergoes a test for
another reason.

5. Acute cholecystitis is a sudden inflammation of the gallbladder

that causes severe abdominal pain. In 90% of cases, acute
cholecystitis is caused by gallstones in the gallbladder. Other
causes include severe illness and (rarely) tumors of the gallbladder.
Acute cholecystitis occurs when bile becomes trapped in the
gallbladder. The buildup of bile causes irritation and pressure in the
gallbladder. This can lead to infection and a hole (perforation) in the
organ.
Cholangitis is an infection of the common bile duct, the tube that
carries bile from the liver to the gallbladder and intestines. Bile is a

liquid made by the liver that helps digest food.Cholangitis usually

caused by a bacterial infection, which can occur when the duct is
blocked by something, such as a gallstone or tumor. The infection
causing this condition may also spread to the liver.
Chronic cholecystitis is swelling and irritation of the gallbladder
that persists over time.The gallbladder is a sac located under the
liver. It stores bile that is made in the liver. Bile helps the intestines
digest fats. Chronic cholecystitis is usually caused by repeated
attacks of acute (sudden) cholecystitis. Most of these attacks are
caused by gallstones in the gallbladder.These attacks cause the
walls of the gallbladder to thicken. The gallbladder begins to shrink.
Over time, the gallbladder is less able to concentrate, store, and
release bile. The disease occurs more often in women than in men,
especially after age 40.
Choledocholithiasis is the presence of at least one gallstone in
the common bile duct. The stone may be made up of bile pigments
or calcium and cholesterol salts.
About 15% of people with gallstones will develop stones in the
common bile duct, the small tube that carries bile from the
gallbladder to the intestine. Risk factors include a history of
gallstones. However, choledocholithiasis can occur in people who
have had their gallbladder removed.
Pancreatitis is inflammation of the pancreas. The pancreas is a
gland located behind the stomach. It releases the hormones insulin
and glucagon, as well as digestive enzymes that help you digest
and absorb food.
6. SURGERY
Some people have gallstones and have never had any symptoms.
The gallstones may not be found until an ultrasound is done for
another reason. Surgery is usually not needed unless symptoms
begin. One exception is in patients who have weight-loss surgery. In
general, patients who have symptoms will need surgery either right
away, or after a short period of time.
A technique called laparoscopic cholecystectomy is most commonly
used now. This procedure uses smaller surgical cuts, which allow for
a faster recovery. Patients are often sent home from the hospital on
the same day as surgery, or the next morning.
In the past, open cholecystectomy (gallbladder removal) was the
usual procedure for uncomplicated cases. However, this is done less
often now.

Endoscopic retrograde cholangiopancreatography (ERCP) and a

procedure called a sphincterotomy may be done to find or
treat gallstones in the common bile duct.
MEDICATION
Medicines called chenodeoxycholic acids (CDCA) or ursodeoxycholic
acid (UDCA, ursodiol) may be given in pill form to dissolve
cholesterol gallstones. However, they may take 2 years or longer to
work, and the stones may return after treatment ends. Rarely,
chemicals are passed into the gallbladder through a catheter. The
chemical rapidly dissolves cholesterol stones. This treatment is not
used very often, because it is difficult to perform, the chemicals can
be toxic, and the gallstones may return.
LITHOTRIPSY
Electrohydraulic shock wave lithotripsy (ESWL) of the gallbladder
has also been used for certain patients who cannot have surgery.
Because gallstones often come back in many patients, this
treatment is not used very often anymore.
CONCLUSION
-

There are various kind of treatment in order to diagnose cholelithiasis

If the treatment is too late, it will cause complications in cholelithiasis.

This inflammation can cause destruction of the pancreas, resulting

in severe abdominal pain.

Management in this case is open cholecystectomy with consideration the

multiplenumber of gallstones and the complication of cholecystitis.