Diagnosis of the etiological factor impact on recurrences

A causal factor should be sought (Table.1). Because of the immediate therapeutic implication of calculus impaction and total prevention of further attacks after removal of stones from the biliary tree, early detection is mandatory. Up to 20 per cent of apparently alcohol-related attacks occur in patients who also have gallstones. Female gender, age (>50 years), and early increases (within 48 h of the onset of symptoms) in serum alanine aminotransferase above 100 IU/l, alkaline phosphatase above 300 IU/l, and bilirubin above 40 mmol/l (2.3 mg/dl) predict the presence of stones in 70 to 90 per cent of patients with gallstone-associated pancreatitis. Plain abdominal radiography reveals stones in up to 15 per cent of cases; however, when the gallbladder is outlined, stones are accurately detected by ultrasonography in over 90 per cent of cases. As overlying bowel gas precludes satisfactory evaluation in 20 to 30 per cent, the overall sensitivity for early ultrasound examination detecting gallstones is decreased to 70 per cent. Sandy stones without acoustic shadows and microlithiasis also produce false negatives. Common bile duct dilatation does not necessarily equate with stone impaction, since swelling of the pancreatic head may be responsible. Although specific, the CT scan has a sensitivity of only 30 to 50 per cent in identifying gallstones.

Common bile duct stones and impaction are best diagnosed by endoscopic retrograde cholangiopancreatography (ERCP), although this risks exacerbating pancreatitis and introducing infection into devitalized pancreatic areas. In 10 to 20 per cent technical failure occurs due to duodenal stenosis by pancreatic swelling, papillary edema, and previous gastrectomy. Because of these technical difficulties and the potential morbidity, ERCP should only be carried out in patients whose clinical course fails to improve despite full intensive care unit (ICU) support and in whom ampullary or common bile duct stone impaction is suspected by ultrasound and/or clinical/biochemical signs of acute cholangitis. Percutaneous transhepatic cholangiography avoids the risk of exacerbation of pancreatitis but, for calculus obstruction of the ampulla, does not allow the immediate therapeutic option of endoscopic papillotomy and stone retrieval.

Biliary sludge and microlithiasis can be diagnosed by ultrasonography, ERCP, and, with more accuracy, biliary drainage and subsequent microscopic analysis. There is a substantial initial false-negative rate. Recurrence of hypertriglyceridemia-related pancreatitis can be prevented with diet and lipid-lowering agents.

Accurate identification of the causal factor of the attack in the later phase is important, since recurrent episodes may be prevented in selected cases by appropriate endoscopic sphincterotomy or stenting, surgical sphincteroplasty, and other operative interventions.

Get Rid of Gallstones Naturally

Get Rid of Gallstones Naturally

One of the main home remedies that you need to follow to prevent gallstones is a healthy lifestyle. You need to maintain a healthy body weight to prevent gallstones. The following are the best home remedies that will help you to treat and prevent gallstones.

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