DEPARTMENT OF

SURGERY

MADE BY: GUIDED BY:

SNEHAL GANGARDE DR.RIZWAN SHAIKH
 CHOLELITHIASIS
DEFINITION: Cholelithiasis is the medical
term for gallstone disease. Gallstones are concretions that
form in the biliary tract, usually in the gallbladder :
PATHOGENESIS OF GALLSTONES:
1.METABOLIC FACTOR : The solubility of the cholesterol
depends on the concentration of conjugated bile salts and
phospholipids. Prolonged administration of progesteron and
oestradiol to rabits resulted in the formation of gallstones .

2.REFLUX FACTOR: Reflux of pancreatic enzymes into the

gallbladder is also considered to be the cause of cholesterol
precipitation.

3. STASIS FACTOR: Temporary cessation of bile flow into the

intestine and stagnation of the bile in the gallbladder has also
been incriminated as major factor in producing gallstones.

4.INFECTIVE FACTOR: Evidence in favour of infection include

isolation of such organism
As E.coli ,bacterium typhosum streptococcus from the
gallbladder wall as well as from the centre of the stones in
majority of gallstones.

TYPES OF GALLSTONES:
1.PURE STONES
A.CHOLESTEROL STONES: 70% Stones are of cholesterol .it is oval
And round in shape .they are solitary.
B. PIGMENT STONES: Pigments stones may be pure or consist of
calcium bilirubinate.
These stones are usually small soft putty like masses.

C.CALCIUM CARBONATE STONES: These are rare .greyish white in

colour.

2.MIXED AND COMBINED STONES: Mixed gallstones referred

to those having varying propotions of all three of the stones
forming constituents of the bile eg.cholesterol,bile pigment and
calcium.
Combined gallstones those in which either the centre core or
external layer are pure and remainder of the stones is mixture of
constituents.
COMPLICATIONS OF GALLSTONES:
1.IN THE GALLBLADDER:
A.Asymptomatic gallstones
B.Hydrops of gallbladder
C.Flatulence dyspepsia
D.Gallstones colic
E.Acute obstructive cholecystitis –a.mucocele ,b.empyema
c.gangrene,d.perforation and fistula formation.
F.Chronic cholecystitis
G.Carcinoma
2.IN THE COMMON BILE DUCT:
A.Obstructive jaundice
B.Liver failure
C.Cholangitis
D.Acute or recurrent pancreatitis.

3.IN THE PANCREAS:

A.Acute pancreatitis
B.Acute relapsing pancreatitis
C.Chronic pancreatitis

4.IN THE INTESTINE:

A.Gallstone ileus
TREATMENT OF GALLSTONES:
1.Treatment of gallstones is cholecystectomy but in acute cases
treatment is same as that of acute cholecystitis.

2. If gallstones has migrated into the common bile duct –

treatment is cholecystectomy with choledolithotomy.
gallbladder has to be removed as the main source of stone
is the gallbladder.

3. Extra corporeal shockwave lithotripsy (ESWL): Fragment the

stones by using focused sound waves. Fragments are subsquently
dissolved by bile acid therapy.
HOMEOPATHIC TREATMENT OF CHOLELITHIASIS:

• The treatment of gallstones depends upon the

stage of disease.
• Asymptomatic gallstones may be managed
expectantly.
• Once gallstones become symptomatic, definitive
surgical intervention with cholecystectomy is
usually indicated, although, in some cases, medical
dissolution may be considered.
Podophyllum peltatum - sweat profuse- dropped off the
prover’s fingers.

Calcarea carbonica– family history of gallstones and kidney

stones; overweight; high cholesterol and 3-glycerides;
chronic constipation. Sluggish and anxious.

Chelidonium– pain in the right upper abdomen that radiates

to the back, pain under the right shoulder blade.

Lycopodium– family history of gallstones and kidney stones;

other chronic digestive issues – gastritis, peptic ulcer,
constipation, high cholesterol. Bloating after meals. Biliary
colics occur mostly in the late afternoon. Irritable, hates
contradiction but suppresses his anger.
Natrum sulphuricum – multiple health disorders-
gallstones, chronic diarrhea, asthma, COPD (chronic
obstructive pulmonary disease), obesity, joint disorders,
depression. Overly sensitive to weather changes and
humidity.

Nux vomica– heartburn, nausea, bloating; biliary colic

with constrictive, spasmodic pain; overindulgence in rich
food and drinks; sedentary lifestyle; irritable and
impatient.

Dioscorea villosa -Hard, dull pain, gall bladder, at 7 p.m. -

Better hard pressure.