Pregnancy and Cholelithiasis
Pregnancy predisposes women to cholelithiasis due to the hormonal effects of estrogen and progesterone on cholesterol, soluble bile acid secretion, and gallbladder emptying. Gallstones cause biliary colic, acute cholecystitis, gallstone pancreatitis, choledocholithiasis, gallstone ileus, and cholangitis. Signs and symptoms include intermittent right upper quadrant pain, nausea, vomiting, epigastric pain, anorexia, intolerance of fatty foods, fever, elevated white blood cell count, elevated amylase and lipase, elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT), jaundice, and positive Murphy’s sign. Findings of cholecystitis on ultrasound are thickened gallbladder wall (>3–5 mm) or edema, presence of gallstones, pericholecystic fluid, and a sonographic Murphy’s sign. Cholecystectomy is clearly indicated for obstructive jaundice, acute cholecystitis failing medical therapy, gallstone pancreatitis, or suspected peritonitis. Conservative management has a 38% chance of suboptimal outcome, with a 34% risk of relapse, and increased severity of disease at relapse. The consideration for definitive surgical management of gallstone disease during pregnancy, especially in the first and second trimesters, is supported.
KeywordsGallstones Pregnancy Cholelithiasis Cholecystitis Gallstone pancreatitis Choledocholithiasis Gallstone ileus Cholangitis Murphy’s sign Cholecystectomy ERCP MRCP
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