(3)
Signs and symptoms. Included are the following:
(a) Intolerance of fatty foods or heavy meals. The patient may
experience belching, nausea, and right upper abdominal discomfort with pain and
cramps after a meal containing fried, greasy, spicy, or fatty foods.
(b) A low-grade fever, chills, and a light increase in the white blood
count when inflammation of the gallbladder is severe.
(c) Pain in the right upper quadrant of the abdomen or pain radiating to
the scapula and right shoulder. (Pain felt in the shoulder region is caused by a
connection with the phrenic nerve; such pain is called "referred pain.")
(d) Rigid abdominal muscles, shallow respirations, and increased pulse
rate when pain is severe.
(e) Prolonged gallbladder attack may cause liver damage with these
symptoms: jaundice, pruritus, dark urine, and clay-colored stools.
(4) Treatment. Examine the urine and stool to make a diagnosis. Surgery
to remove the stones from the gallbladder may be indicated. Eventually, the gallbladder
may have to be removed.
b. Cholelithiasis.
(1) Definition. Cholelithiasis is the presence or formation of gallstones.
Gallstones can be classified according to chemical composition. Some stones are
primarily composed of cholesterol while other stones contain calcium bilirubinate. Thirty
to forty percent of the gallstones found in Japan are of the calcium bilirubinate type
while less than five percent of the stones found in the United States and Europe are of
this variety.
(2) Etiology. The exact reason gallstones form is not know. The method of
formation is known. In the case of stones with a cholesterol center, a disturbance
between the amount of cholesterol in the bile and its ability to be dissolved in the bile
causes the cholesterol to separate and fuse into a single crystal. This is the beginning
of ninety-five percent of all gallstones. These stones can move into positions in which
they obstruct the outflow of bile from the gallbladder and irritate the gallbladder mucosal
surface. The obstruction and irritation combined with bacteria cause other substances
to adhere to the crystals; substances such as calcium, inorganic salts, and bilirubin.
Additional causes of gallstones include the following:
(a) Inflammation of the mucous membrane of the cystic duct with a free
discharge, a condition which might cause an obstruction of the cystic duct.
MD0581
3-36
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