Advertisement

What Are Biliary Symptoms?

  • Daniel J. Kilburn
  • Nicholas A. O’Rourke
Chapter

Abstract

In this chapter we shall discuss all symptoms caused by the gallbladder (GB) and gallstones (GS), relying on evidence of symptom resolution following cholecystectomy. Gallstones are very common. An autopsy study from Melbourne, demonstrated a prevalence of ‘asymptomatic GS’ of over 20% [1]. In patients with truly asymptomatic GS, the chance of progression to symptoms ranges from 2% to 5% per year (Chap.  5) [2, 3]. As GS are so common, and most never cause any problems, it is essential for clinicians to understand and identify the patients most likely to benefit from cholecystectomy. Even 300 years ago, Coe described classic biliary pain and, in many ways, his description still holds true [4]. In Victorian times, surgeons realised that the patients who benefited the most from surgery are those who suffered from severe episodes of pain, rather than vague symptoms of gastrointestinal upset [4].

References

  1. 1.
    Vitetta L, Sali A, Chou ST, Fleming H, Little P, Elzarka A. Gallstones at autopsy and cholecystectomy: a comparative study. Aust N Z J Surg. 1988;58(7):561–8.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Sakorafas GH, Milingos D, Peros G. Asymptomatic cholelithiasis: is cholecystectomy really needed? A critical reappraisal 15 years after the introduction of laparoscopic cholecystectomy. Dig Dis Sci. 2007;52(5):1313–25.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Shabanzadeh DM, Sorensen LT, Jorgensen T. A prediction rule for risk stratification of incidentally discovered gallstones: results from a large cohort study. Gastroenterology. 2016;150(1):156–67e1.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Bielefeldt K. Black bile of melancholy or gallstones of biliary colics: historical perspectives on cholelithiasis. Dig Dis Sci. 2014;59(11):2623–34.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Berger MY, Olde Hartman TC, Bohnen AM. Abdominal symptoms: do they disappear after cholecystectomy? Surg Endosc. 2003;17(11):1723–8.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Parmar AD, Sheffield KM, Adhikari D, Davee RA, Vargas GM, Tamirisa NP, Kuo YF, Goodwin JS, Riall TS. PREOP-gallstones: a prognostic nomogram for the management of symptomatic cholelithiasis in older patients. Ann Surg. 2015;261(6):1184–90.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Jagannath SB, Singh VK, Cruz-Correa M, Canto MI, Kalloo AN. A long-term cohort study of outcome after cholecystectomy for chronic acalculous cholecystitis. Am J Surg. 2003;185(2):91–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Festi D, Reggiani ML, Attili AF, Loria P, Pazzi P, Scaioli E, Capodicasa S, Romano F, Roda E, Colecchia A. Natural history of gallstone disease: Expectant management or active treatment? Results from a population-based cohort study. J Gastroenterol Hepatol. 2010;25(4):719–24.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Cafasso DE, Smith RR. Symptomatic cholelithiasis and functional disorders of the biliary tract. Surg Clin North Am. 2014;94(2):233–56.CrossRefPubMedGoogle Scholar
  10. 10.
    Festi D, Sottili S, Colecchia A, Attili A, Mazzella G, Roda E, Romano F. Clinical manifestations of gallstone disease: evidence from the multicenter Italian study on cholelithiasis (MICOL). Hepatology. 1999;30(4):839–46.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Bailey H, Love RJM. A short practice of surgery. London: Lewis; 1959.Google Scholar
  12. 12.
    Patel N, Ariyarathenam A, Davies W, Harris A. Acute cholecystits leading to ischemic ECG changes in a patient with no underlying cardiac disease. JSLS. 2011;15(1):105–8.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Demarchi MS, Regusci L, Fasolini F. Electrocardiographic changes and false-positive troponin I in a patient with acute cholecystitis. Case Rep Gastroenterol. 2012;6(2):410–4.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Babic Z, Bogdanovic Z, Dorosulic Z, Basha M, Krznaric Z, Sjekavica I, Kujundzic M, Tadic M, Banic M, Jagic V, Marusic M. Quantitative analysis of troponin I serum values in patients with acute cholecystitis. Coll Antropol. 2012;36(1):145–50.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Kang JY, Tay HH, Guan R. Chronic upper abdominal pain: site and radiation in various structural and functional disorders and the effect of various foods. Gut. 1992;33(6):743–8.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Lamberts MP, Lugtenberg M, Rovers MM, Roukema AJ, Drenth JP, Westert GP, van Laarhoven CJ. Persistent and de novo symptoms after cholecystectomy: a systematic review of cholecystectomy effectiveness. Surg Endosc. 2013;27(3):709–18.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Finan KR, Leeth RR, Whitley BM, Klapow JC, Hawn MT. Improvement in gastrointestinal symptoms and quality of life after cholecystectomy. Am J Surg. 2006;192(2):196–202.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Vetrhus M, Berhane T, Soreide O, Sondenaa K. Pain persists in many patients five years after removal of the gallbladder: observations from two randomized controlled trials of symptomatic, noncomplicated gallstone disease and acute cholecystitis. J Gastrointest Surg. 2005;9(6):826–31.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Luman W, Adams WH, Nixon SN, McIntyre IM, Hamer-Hodges D, Wilson G, Palmer KR. Incidence of persistent symptoms after laparoscopic cholecystectomy: a prospective study. Gut. 1996;39(6):863–6.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Victorzon M, Lundin M, Haglund C, Roberts PJ, Kellokumpu I. Short and long term outcome after laparoscopic cholecystectomy. Ann Chir Gynaecol. 1999;88(4):259–63.PubMedGoogle Scholar
  21. 21.
    Bates T, Ebbs SR, Harrison M, A’Hern RP. Influence of cholecystectomy on symptoms. Br J Surg. 1991;78(8):964–7.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Burney RE, Jones KR. Ambulatory and admitted laparoscopic cholecystectomy patients have comparable outcomes but different functional health status. Surg Endosc. 2002;16(6):921–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Ure BM, Troidl H, Spangenberger W, Lefering R, Dietrich A, Eypasch EP, Neugebauer E. Long-term results after laparoscopic cholecystectomy. Br J Surg. 1995;82(2):267–70.CrossRefPubMedGoogle Scholar
  24. 24.
    Johnson AG. Gallstones and flatulent dyspepsia: cause or coincidence? Postgrad Med J. 1971;47(554):767–72.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Johnson AG. Cholecystectomy and gallstone dyspepsia. Clinical and physiological study of a symptom complex. Ann R Coll Surg Engl. 1975;56(2):69–80.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Kingston RD, Windsor CW. Flatulent dyspepsia in patients with gallstones undergoing cholecystectomy. Br J Surg. 1975;62(3):231–3.CrossRefPubMedGoogle Scholar
  27. 27.
    Scriven MW, Burgess NA, Edwards EA, Morgan AR, Bundred NJ, Lewis MH. Cholecystectomy: a study of patient satisfaction. J R Coll Surg Edinb. 1993;38(2):79–81.PubMedGoogle Scholar
  28. 28.
    Schmidt M, Sondenaa K, Dumot JA, Rosenblatt S, Hausken T, Ramnefjell M, Njolstad G, Eide GE. Post-cholecystectomy symptoms were caused by persistence of a functional gut disorder. World J Gastroenterol. 2012;18:1365–72.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Kim GH, Lee HD, Kim M, Kim K, Jeong Y, Hong YJ, Kang ES, Han JH, Choi JW, Park SM. Fate of dyspeptic or colonic symptoms after laparoscopic cholecystectomy. J Neurogastroenterol Motil. 2014;20(2):253–60.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Lin OS, Kozarek RA, Arai A, Gan SI, Gluck M, Jiranek GC, Kowdley KV, Triadafilopoulos G. The association between cholecystectomy and gastroesophageal reflux symptoms: a prospective controlled study. Ann Surg. 2010;251(1):40–5.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    McMahon AJ, Ross S, Baxter JN, Russell IT, Anderson JR, Morran CG, Sunderland GT, Galloway DJ, O’Dwyer PJ. Symptomatic outcome 1 year after laparoscopic and minilaparotomy cholecystectomy: a randomized trial. Br J Surg. 1995;82(10):1378–82.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    McNamara DA, O’Donohoe MK, Horgan PG, Tanner WA, Keane FB. Symptoms of oesophageal reflux are more common following laparoscopic cholecystectomy than in a control population. Ir J Med Sci. 1998;167(1):11–3.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Jorgensen T. Abdominal symptoms and gallstone disease: an epidemiological investigation. Hepatology. 1989;9(6):856–60.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Ansaloni L, Pisano M, Coccolini F, Peitzmann AB, Fingerhut A, Catena F, Agresta F, Allegri A, Bailey I, Balogh ZJ, Bendinelli C, Biffl W, Bonavina L, Borzellino G, Brunetti F, Burlew CC, Camapanelli G, Campanile FC, Ceresoli M, Chiara O, Civil I, Coimbra R, De Moya M, Di Saverio S, Fraga GP, Gupta S, Kashuk J, Kelly MD, Koka V, Jeekel H, Latifi R, Leppaniemi A, Maier RV, Marzi I, Moore F, Piazzalunga D, Sakakushev B, Sartelli M, Scalea T, Stahel PF, Taviloglu K, Tugnoli G, Uraneus S, Velmahos GC, Wani I, Weber DG, Viale P, Sugrue M, Ivatury R, Kluger Y, Gurusamy KS, Moore EE. 2016 WSES guidelines on acute calculous cholecystitis. World J Emerg Surg. 2016;11:25.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Kothari SN, Obinwanne KM, Baker MT, Mathiason MA, Kallies KJ. A prospective, blinded comparison of laparoscopic ultrasound with transabdominal ultrasound for the detection of gallbladder pathology in morbidly obese patients. J Am Coll Surg. 2013;216(6):1057–62.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Klingensmith WC 3rd, Eckhout GV. Cholelithiasis in the morbidly obese: diagnosis by US and oral cholecystography. Radiology. 1986;160(1):27–8.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Krishnamurthy GT, Brown PH. Comparison of fatty meal and intravenous cholecystokinin infusion for gallbladder ejection fraction. J Nucl Med. 2002;43(12):1603–10.PubMedPubMedCentralGoogle Scholar
  38. 38.
    Eckenrode AH, Ewing JA, Kotrady J, Hale AL, Smith DE. HIDA scan with ejection fraction is over utilized in the management of biliary dyskinesia. Am Surg. 2015;81(7):669–73.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Carr JA, Walls J, Bryan LJ, Snider DL. The treatment of gallbladder dyskinesia based upon symptoms: results of a 2-year, prospective, nonrandomized, concurrent cohort study. Surg Laparosc Endosc Percutan Tech. 2009;19(3):222–6.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Penacoba LM, de Andres AB, Gandiaga JG, Castillo DG, de Heredia YRJB. Torsion of the Gallbladder. J Gastrointest Surg. 2016;20(10):1784–6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Royal Brisbane HospitalBrisbaneAustralia
  2. 2.School of MedicineThe University of QueenslandBrisbaneAustralia

Personalised recommendations