gallbladder disease symptoms

Diseases of the biliary tract


2.1. Cholelithiasis

Cholelithiasis heard in the industrialized countries the most common diseases with a prevalence for the total population of 10 - 15%. The incidence increases with age and there is a clear predominance in women. Found in sonographic studies in women under 50 years, a prevalence of 10 - 20%, in women over 50 years, one between 15% and 40%. Women are affected twice as often as men (4, 26, 29, 30). About 80% of gallstones are cholesterol stones and mixed in 10 - 20% are brown, rarely black pigment stones before. In 10-15% of cases at the same time, there is a choledocholithiasis with cholecystolithiasis. The age and sex distribution of bile duct stones corresponding to those gallbladder disease symptoms stones.

As predisposing factors for the formation of cholesterol gallstones a lithogenic bile are due to an excess of cholesterol in relation to bile acids and phospholipids, as well as an accelerated nucleation of Cholesterinmonohydratkristallen a hypomotility of the gall bladder. Pigment stones are often associated with an oversupply of bilirubin in the setting of chronic hemolysis or infection of the biliary tract. 70-80% of all gallstones are asymptomatic. Biliary colic manifest themselves as acute onset of pain in the epigastric or right upper abdomen that may last more than 15 minutes to 5 hours. The most common complications are acute cholecystitis, acute cholangitis and acute biliary pancreatitis.
2.2. Etiology and pathogenesis

During childhood in boys and girls that gallstone symptoms disease is rarely the same (in this case, is mostly due to pigment stones hemolytic disease), disease mostly girls after puberty, and preferably of cholesterol stones. With increasing age, the number of gallstones increases, which remains the preference of the female sex remains recognizable (male to female is 1: 2-3). Only at the age, the difference is like gradually from (4, 9, 18, ​​26, 29, 30). As favorable factors for this higher susceptibility of the female sex that develops with puberty, pregnancy be considered include the steroid hormones, and in connection therewith. Here, the altered lipid and bile acid metabolism such as an impaired Gallenblasenkinetik are causally important.

In previous studies were already in a normal menstrual cycle in the cholesterol saturation of bile behave like cholesterol and triglyceride levels in the serum cycle dependent, premenstrual with increased levels of progesterone, a cholesterol supersaturation of bile and delayed emptying of the gallbladder after gallbladder symptoms . The premenstrual phase may therefore be regarded as "lithogenic".

Also been shown in previous studies that the long-term administration of estrogen and hormonal contraceptives (with high estrogen content) favors the formation of gallstones. Receiving oral contraceptives were gallstones more frequently and earlier than a decade without contraceptives. Similarly, women who were on oral contraceptives to undergo a double risk of gallbladder surgery, and also women who at the age of 45 - were cholecystectomy 69 years had 2.5 times more likely to estrogen for the treatment of menopausal complaints received as a comparison group. Even women who were in a controlled study of the long-term treatment of coronary heart disease among long-term medication of 2.5 mg and 5 mg conjugated estrogens developed, twice as likely to gallstones as a placebo group (literature review in 26).

In contrast to these earlier studies with high doses of estrogen, recent follow-up that the modern hormonal contraceptives with estrogen very low proportion have no or only a small increased risk of gallstone formation (4, 29). In contrast, the risk of gallstone formation is increased unchanged in the postmenopausal estrogen replacement and even in the estrogen treatment for prostate cancer there is an increased incidence of gallstones (24, 47).