What are the differences between cholelithiasis cholecystitis choledocholithiasis and cholangitis? How are patients with these disorders managed?
• Cholelithiasis is the term used to describe gallbladder stones. Patients with symptomatic cholelithiasis often note episodic abdominal pain, which is due to a gallstone obstructing the cystic duct. Patients with asymptomatic cholelithiasis require no intervention. Those with symptoms may undergo elective cholecystectomy.
• Cholecystitis implies inflammation of the gallbladder wall. This syndrome is associated with abdominal pain, fever, and an elevated white blood cell count. Ninety percent of cases are due to gallbladder outlet obstruction by a gallstone, although a subset of cases can occur without gallstones (“ acalculous cholecystitis ”). Patients are treated with antibiotics and surgical removal of the gallbladder.
• Choledocholithiasis is the term that describes stones in the bile ducts. This can be painful or asymptomatic. Complications of choledocholithiasis, such as pancreatitis and cholangitis (discussed later), can have significant morbidity and mortality. Therefore, patients with choledocholithiasis often require intervention such as ERCP (to dislodge a stone) and cholecystectomy (to minimize the formation and passage of additional stones).
• Cholangitis describes an infection due to obstruction of the bile ducts. The infection can be mild or life threatening. Treatment of cholangitis includes urgent stone removal (often by ERCP) and antibiotics. Patients with cholangitis from an obstructed gallstone also require cholecystectomy to prevent recurrence.