A study of gallstone disease

INTRODUCTION: Calculus disease of biliary system is one of the most common disorders affecting the gastrointestinal tract constituting a major cause of morbidity. There has been a marked rise in the incidence of gall stone disease in the west during the past century. In the UK, USA and Australia, the prevalence rates varies from 15- 25%. In India, it is more common in North India than in South India. Similarly the incidence in Eastern India is higher than in the West. Incidence of gallstones increases with age. It is more common in females than males (M:F = 1:4) . About 50% of patients with gall stones are asymptomatic. 1 to 2% of asymptomatic patients will develop symptoms requiring cholecystectomy per year, making cholecystectomy one of the most common operations performed by surgeons. The etiopathogenesis of gallstones is multifactorial. It varies according to the type of gallstones. Primarily gallstones can be divided into two major groups. First is pure gallstones contributing to 10% of gallstones. Second is mixed and combined gallstones which accounts for 90% of gallstones. Mixed gallstones have increased preponderance for cholecystitis. Infection seems to be a major cause of gallstones formation. Moynihan’s aphorism that “gall stone is a tomb stone erected in the memory of the organism with in it” is true today. Evidence in favour of infection includes isolation of E. coli, klebsiella, bacterium typhosum, streptococcus from the bile within the gallbladder. Slow growing actinomyces also have been recovered from the bile. These organisms reach the gallbladder via blood stream from an infective focus elsewhere in the body and also by lymphatics. Brown pigment gallstones occur as a result of infection. Bacteria are found with in the calcium bilirubinate and protein matrix of brown pigment gallstones. Predisposing factors are obesity, dietary factors, liver disease, gallblader disease, haemolytic anaemia, gastric surgery and terminal ileal resection. Treatment varies from medical management to surgical management. Recently minimally invasive surgery improves the patient’s compliance and reduces the morbidity. Sequalae of gallstone disease contributes to most of the surgical problems in patients with the disease. OBJECTIVES: To study the age, sex incidence and various modalities of clinical presentation. Bacteriological analysis of the bile collected from all cases subjected to cholecystectomy in our study so as to identify the commonest type of organism associated with gall stones. METHODOLOY: Source of data : Patients admitted to Tirunelveli Medical College Hospital with the diagnosis of Gallstone disease were taken for this observational study from March 2011 to October 2012. Type of study: It is a prospective study. Inclusion Criteria: Patients of age >12 years and < 65 years. All proven cases of gallstone disease wh o got admitted to the hospitalfor cholecystectomy both open and laparoscopic cholecystectomy. Exclusion Criteria: Acute chole cystitis, Acute acalculus cholecystitis Emphyema gall bladder Mucocele of the gall bladder, Jaundice patients, Gallstones with multiple common bile duct stones (multiple CBD and intrahepatic stones), Patients who refused surgery. CONCLUSION: From observation of our prospective study of 50 cases, the following conclusions were derived: • Gallstone disease is common in females than in the males and the age group was 51 to 65 years. • All the cases presented with right hypochondriac pain. Nausea and vomiting were present in 18 cases and fever was present in 11 cases. • Ultrasound abdomen was the main investigation to detect gall stones and MRCP to know the anatomy of common bile duct. • In our study, 28 patients underwent open cholecystectomy, 17 patients underwent laparoscopic cholecystectomy and 5 patients underwent laparoscopy which was converted to open cholecystectomy for practical difficulties. • 21 cases showed organisms in bile culture –of which 17 were females and 4 were males. • The most common microorganism isolated from bile culture was Klebsiella in our study although E. Coli is the commonest organism as per standard text books.Our study revealed E.Coli growth only in 4 patients. • 34 cases in our study showed pigment stones and 16 cases were cholesterol stones. • Histopathological examination of gallbladder wall showed features of chronic calculus cholecystitis in all the cases