Cholelithiasis

　　Gallstone cholecystitis is the most common lesion in the biliary tract system, and the specific causes of onset are as follows:

　　1. Age of onset

　　Epidemiological studies show that the incidence rate increases with age. This disease is rare in childhood, and its occurrence may be related to hemolytic diseases or congenital biliary tract diseases. The 5-year incidence rate in individuals aged 40 to 69 is four times higher than that in younger age groups, and the boundary between high and low incidence is 40 years old. Although there are certain differences in reports from different countries, the peak age of incidence is generally between 40 and 50 years old.

　　2. Gender differences in incidence

　　The results of ultrasonic diagnosis show that the ratio of male to female incidence is about 1:2, and the difference in gender ratio is mainly reflected in the incidence of cholesterol stones, while there is no significant gender difference in the incidence rate of gallbladder pigment stones. The high incidence of cholesterol stones in women may be related to the reduction of estrogen, which decreases bile flow, increases the secretion of cholesterol in bile, decreases the total bile acid content and activity, and the influence of progesterone on gallbladder motility, leading to bile stasis.

　　3. Relationship between incidence and obesity

　　Clinical and epidemiological studies show that obesity is an important risk factor for the occurrence of gallstone cholecystitis, with an incidence rate of three times higher than that of normal weight individuals. The reason why obese people are more prone to the disease is that the absolute amount of cholesterol synthesis in their bodies increases, or the relative increase in bile acids and phospholipids makes cholesterol oversaturated.

　　4. Relationship between incidence and childbirth

　　Pregnancy can promote the formation of gallstones, and the number of pregnancies is positively correlated with the incidence rate, which has been proven by clinical and epidemiological research.

　　5. Regional differences in incidence

　　There are certain differences in the incidence rates of gallstones between different countries and regions. In Western Europe, North America, and Australia, the incidence rate of gallstone cholecystitis is high, while gallstones are rare in many places in Africa. The types of gallstones also differ between countries and regions; in countries like Sweden and Germany, cholesterol stones are predominant, while in the UK, the incidence rate of calcium carbonate stones is higher than in other countries.

　　6. Onset and dietary factors

　　Dietary habits are the main factors affecting the formation of gallstones. The incidence rate of those who eat refined foods and high cholesterol foods is significantly increased. Because refined carbohydrates increase the saturation of cholesterol in bile.

　　7. Onset and genetic factors

　　The difference in the incidence of cholelithiasis cholecystitis among races also suggests that genetic factors are one of the pathogenic mechanisms. For any population with Indian genetic background, the incidence of gallstones is high. Research with monozygotic twins as the object proves that the risk of gallstones in the relatives of patients is also high, and the incidence rate of cholelithiasis cholecystitis in the family is also high, and the onset age is also early, so there is a genetic predisposition.

　　7. Other factors

　　The onset of cholelithiasis cholecystitis is also related to liver cirrhosis, diabetes, hyperlipidemia, parenteral nutrition, surgical trauma, and the use of certain drugs. For example, the incidence rate of liver cirrhosis patients is 3 times higher than that of non-liver cirrhosis patients, and the incidence rate of diabetes patients is twice that of non-diabetes patients. The formation of cholelithiasis cholecystitis is considered to be closely related to various factors such as lipid metabolism, nucleation time, gallbladder motility function, and bacterial gene fragments.

　　The most serious complication of cholelithiasis cholecystitis is acute cholecystitis of varying degrees of severity, including gangrenous, emphysematous cholecystitis, pericholecystic abscess and perforation, etc. Chronic cholelithiasis cholecystitis is also a common complication of gallstones. In addition, complications of gallstones include pancreatitis, liver abscess, cholangitis, ascending hepatitis, portal vein inflammation, Mirizzi syndrome, and gallbladder cancer, etc.

　　Gallstones inside the gallbladder usually do not cause symptoms of biliary colic, known as static stones, and may have symptoms of indigestion such as upper right abdominal dull pain, acid regurgitation, belching, bloating, etc., which are more obvious after consuming fatty foods. If accompanied by infection, symptoms of acute cholecystitis may occur. Gallstones in the cystic duct may cause symptoms of biliary colic, with sudden onset of persistent pain in the upper right abdomen, exacerbating intermittently, radiating to the shoulder and back, accompanied by nausea and vomiting, etc. Key points for inquiry are detailed in acute and chronic cholecystitis.

　　The purpose of prevention is to prevent the formation of stones. Diet changes and stone formation, the type of stone that induces stones (cholesterol stones or bile pigment stones), and stone dissolution are related. The occurrence of stones has both genetic and environmental factors, the former is more difficult to change, while the latter can be adjusted. The research on risk factors of cholesterol gallstone disease also confirms this: high calorie and fat intake increases the incidence of gallstone disease; intake less reduces the incidence of stone disease.

　　Cholelithiasis cholecystitis is a condition characterized by upper right abdominal discomfort and pain, primarily due to gallstones. The necessary examinations include:

　　1. Total white blood cell count > 10×10^9/L with left shift.

　　2. Abdominal X-ray film shows positive gallstones in the gallbladder area.

　　3. Ultrasound examination shows gallbladder enlargement, wall thickness > 3.5mm, with a bright spot accompanied by acoustic shadow inside.

　　4. Intrahepatic biliary ductography does not show gallbladder imaging.

　　5. CT or MR shows gallstones in the gallbladder.

　　For patients with cholelithiasis, in terms of dietary routine, it is advisable to eat at regular intervals, eat less and more meals, and not overeat. In terms of dietary structure, it is necessary to strictly control the intake of fat and cholesterol-containing foods, such as fatty meat, fried foods, animal viscera, etc., because the formation of gallstones is related to excessively high cholesterol levels and metabolic disorders in the body. It is not advisable to drink alcohol or eat spicy foods, and it is advisable to eat more radishes, green vegetables, beans, soy milk, and other side dishes. Radishes have a choleretic effect and can help in the digestion and absorption of fats; green vegetables contain a large amount of vitamins and fiber; beans contain abundant plant protein. In addition, some fruits and juices should also be supplemented to compensate for the loss of body fluids and vitamins caused by inflammation.

　　Cholelithiasis is a gallstone disease characterized by right upper quadrant discomfort and pain as the main symptom, and it is a common disease in middle-aged and elderly people. With the increase of age, the incidence rate also increases. Due to the different locations of stone formation, it is often divided into gallbladder stones, bile duct stones, and choledochal stones in clinical practice. These stones coexist with biliary infection and cause each other, and how to choose the best treatment plan is important. It is necessary to fully understand the condition through clinical diagnosis and physical examination, make an accurate diagnosis, determine the location, size, and quantity of gallstones, and then choose different treatment plans according to different situations.

　　There are two methods for the clinical treatment of gallstones: one is surgical treatment, which involves removing the diseased gallbladder and removing the stones, and the other is non-surgical treatment, which is to adopt symptomatic treatment with traditional Chinese and Western medicine, extracorporeal shock wave lithotripsy, dissolution of stones, and other therapies. Both methods have their respective advantages and disadvantages.

　　Surgical treatment is an important method for the treatment of gallstones, but it must be strictly controlled for surgical indications. When gallstone patients clinically present with severe obstruction, infection, and jaundice, toxic shock and liver complications occur, or biliary obstruction, infection recurs frequently, and non-surgical treatment is ineffective, surgical treatment can be considered. In addition, some patients have large gallstones, frequent symptoms, or recurrent infection of the bile duct due to gallstones, and suspected liver damage, the treatment principle is to remove the gallstones as soon as possible and excise the diseased gallbladder.