Gallstone disease : pathophysiology and therapeutic approaches


Gallstone disease : pathophysiology and therapeutic approaches

editors, W. Swobodnik, H. Ditschuneit, and R.D. Soloway

Springer-Verlag, c1990

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Includes bibliographical references and index



The nonsurgical management of gallstone disease has drawn widespread clinical interest during the last decade as ultrasound surveys have indicated that cholelithiasis is predom inantly an asymptomatic condition and much more prevalent than previously thought. This book presents an overview of the pathophysiologic and pathobiochemical principles of gallstone formation and the consequences for clinical therapeutic regimens. New information concerning the balance between vesicular and micellar transport of choles terol, early cholesterol nucleation, and the influence of inhibiting and promoting com pounds for cholesterol nucleation as well as information concerning the effects of changes in gallbladder motility and gallbladder mucosal function is reviewed. In order to make further progress in developing treatments which facilitate gallstone dissolution and in preventing disease, it is necessary to integrate this new data into our thinking. Methods of treatment such as systemic litholysis of cholesterol gallbladder stones with bile acid preparations and mechanical fragmentation of stones either by extracorpo ral shock waves or intracorporal laser systems are carefully described and separate discussions of direct contact litholysis of cholesterol stones with ether preparations and the local litholytic treatment of calcified pigment stones are included. New therapeutic applications of HMG-CoA-reductase inhibitors and nonsteroidal anti-inflammatory drugs are also critically reviewed. Finally, for the interested reader an evaluation of prophylactic treatment against stone recurrence after successful conservative treatment and an appraisal of alternative management strategies supplement the information on the conservative treatment of gallstones.


Pathobiochemistry and Pathophysiology of Gallstone Development: Importance for Clinical Decision Processses.- Increased Biliary Lithogenicity Through Cholesterol Supersaturation.- Nucleation and Aggregation of Cholesterol Crystals in the Early Phase of Gallstone Genesis.- Modulation of the Edge Tension of Lipid Membranes by Cholate and Cholesterol and the Micelle-Vesicle Transition in Model Bile Systems.- Pigment Gallstones and Secondary Calcification of Gallstones.- The Influence of the Gallbladder Epithelium on Gallstone Formation.- Biliary Proteins and Their Role as Nucleating Inhibitors/Promotors.- Neurohormonal Aspects of Gallbladder Contractility in Gallstone Disease: The Role of Cholecystokinin.- Environmental Factors and Gallstones.- Different Therapeutic Approaches to Gallstone Disease.- Is Therapeutic Intervention Necessary in Gallstone Disease? The Surgeon's Point of View.- Surgical Therapy for Acute Gallstone Complications.- Therapeutic Interventions in Patients with Gallbladder Stones: The Internist's View.- Acute Biliary Pancreatitis.- Systemic Litholysis with Bile Acids.- Principles of Gallstone Dissolution with Chenodeoxycholic Acid, Ursodeoxycholic Acid, and the Combination of Both Bile Acids.- Systemic Litholysis with Bile Acids: Ursodeoxycholic Acid.- Combination Therapy of Chenodeoxycholic Acid and Ursodeoxycholic Acid.- Results of an Index-Controlled Combination Therapy with Ursodeoxycholic and Chenodeoxycholic Acid.- Extracorporeal Schock-Wave-Lithotripsy.- Physical Basis of Lithotriptors.- Extracorporeal Shock-Wave Lithotripsy of Gallstones.- Administration of Second-Generation Extracorporeal Shock Waves without Waterbath for Fragmentation of Extra- and Intrahepatic Bile Duct Stones.- Piezoelectric Lithotripsy of Gallbladder Stones.- Biliary Shock-Wave Lithotripsy: Experience of the First 3 Years in 612 Patients.- Laser Lithotripsy.- Laser Lithotripsy: Basic Physics.- Laser Lithotripsy: Clinical Applications.- Local Litholysis.- Local Litholytic Agents: Dissolution of Cholesterol Biliary Tract Stones with Methyl tert-Butyl Ether.- Local Litholysis of Calcified Pigment Stones.- Local Litholysis of Intrahepatic Calculi.- New Therapeutic Trends.- Reduction of Biliary Cholesterol Saturation by Inhibition of Cholesterol Synthesis: New Therapeutic Consequences?.- Gallstone Prevention by Alteration of Gallbladder Mucin Secretion via Prostaglandin Synthesis Inhibition.- Gallstone Prevention After Successful Treatment.- Intermittent Bile Acid Therapy as an Alternative Therapeutic Strategy.

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