Prevalence of Gall Stones in Liver Cirrhosis

  • Sudhamshu K.C. Liver Unit, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal, Norvic International Hospital, Kathmandu, Nepal
  • Dilip Sharma Liver Unit, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal.
  • Sandip Khadka Liver Unit, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal.
  • Niyanta Karki Liver Unit, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal.
  • Bikash Jaishi Liver Unit, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal.
  • Kiran Regmi Liver Unit, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal.
  • Dipendra Khadka Liver Unit, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal.
Keywords: gallstones; liver cirrhosis; ultrasonography.

Abstract

Introduction: Increased incidence and prevalence of gallstones in liver cirrhosis has already been reported by many studies. This study aimed to investigate the prevalence of gallstone disease in Nepali patients with liver cirrhosis and to identify risk factors for gallstone formation.

Methods: Consecutive patients of liver cirrhosis presenting to liver clinic from January, 2010 to December, 2012 were evaluated for GS by ultrasonography at their first visit. Liver cirrhosis was diagnosed on the basis of clinical features, laboratory parameters, ultrasonography, and/or histopathology.

Results: Two hundred and twenty four LC patients were studied. Male to female ratio was 2.3:1. Alcohol was the major etiological factor for LC followed by hepatitis B, alone or in conjunction with alcohol. Seventy-four patients (33%) were found to have GS. Incidence of GS was more in advance stage of cirrhosis. There was no significant correlation between formation of GS and etiology of LC, except for the HCV related liver cirrhosis, in which it was present in 39% of the patients. More the advance disease,more was the incidence as 57% of Child-C patients had GS. Portal vein diameter was also associated with GS formation. When portal vein diameter was more than 13 mm, there was more GS formation.

Conclusions: One third of the patients of LC showed GS at the presentation. Patients with HCV related cirrhosis are more prone to develop GS than other. Severity of the disease and portal vein diameter was found to be associated with GS formation.

Keywords: gallstones; liver cirrhosis; ultrasonography.

References

Bouchier IAD. Postmortem study of the frequency of
gallstones in patients with cirrhosis of the liver. Gut
1969;10:705–710.
2. Acalovschi M, Badea R, Dumitrascu D, Varga C. Prevalence
of gallstones in liver cirrhosis: A sonographic survey. Am J
Gastroenterol 1988; 83:954 –956.
3. Fornari F, Civardi G, Buscarini E, Cavanna L, Imberti D, Rossi
S et al. Cirrhosis of the liver. A risk factor for development of
cholelithiasis in males. Dig Dis Sci 1990;35:1403–1408.
4. Iber FL, Caruso G, Polepalle C, Kuchipudi V, Chinoy M.
Increasing prevalence of gallstones in male veterans with
alcoholic cirrhosis. Am J Gastroenterol 1990;85:1593–1596.
Fornari F, Imberti D, Squillante MM, Squassante L, Civardi
G, Buscarini E et al. Incidence of gallstones in a population of
patients with cirrhosis. J Hepatol 1994;20:797– 801,
6. Conte D, Barisani D, Mandelli C, Bodini P, Borzio M, Pistoso
S et al. Cholelithiasis in cirrhosis: analysis of 500 cases. Am J
Gastroenterol 1991;86:1629–1632,
7. Benvegnu L, Noventa F, Chemello L, Fattovich G, Alberti A.
Prevalence and incidence of cholecystolithiasis in cirrhosis
and relation to the etiology of liver disease. Digestion
1997;58:293–8.
8. Del Olmo JA, Garcia F, Serra MA, Maldonado L, Rodrigo
JM. Prevalence and incidence of gallstones in liver cirrhosis.
Scand J Gastroenterol 1997; 32:1061–1065
9. Shea JA, Berlin JA, Escarce JJ. Revised estimates of diagnostic
test sensitivity and specificity in suspected biliary tract
disease. Arch Intern Med. 1994;154: 2573.
10. Matsutani S, Kimura K, Ohto M, Okuda K. Ultrasongraphy
in the diagnosis of portal hypertension. In: Okuda K,
Benhamou JP eds. Portal Hypertension: Clinical and
physiological aspects. Tokyo: Sprnger, 1987: 197-206.
11. Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC,
Williams R. Transection of the oesophagus for bleeding
oesophageal varices. Br J Surg 1973; 60: 646-649.
12. Bini EJ, McGready J. Prevalence of gallbladder disease
among persons with hepatitis C virus infection in the United
States. Hepatology 2005; 41: 1029–1036.
13. Stroffolini T, Sagnelli E, Mele A, Cottone C, Almasio PL;
Italian Hospitals' Collaborating Group. HCV infection is a
risk factor for gallstone disease in liver cirrhosis: an Italian
epidemiological survey.J Viral Hepat. 2007 Sep;14(9):618-23.
14. Alvaro D, Angelico M, Gandin C, Ginanni Corradini S,
Capocaccia L. Physico-chemical factors predisposing to
pigment gallstone formation in liver cirrhosis. J Hepatol
1990; 10: 228–234.
15. Li CP, Hwang SJ, Lee FY, Chang FY, Lin HC, Lu RH et al.
Evaluation of gallbladder motility in patients with liver
cirrhosis: relationship to gallstone formation. Dig Dis Sci
2000; 45:1109–1114.
16. Acalovschi M, Dumitrascu DL, Nicoara CD. Gallbladder
contractility in liver cirrhosis: comparative study in patients
with and without gallbladder stones. Dig Dis Sci. 2004 Jan;
49(1):17-24.
17. Castellano L, De Sio I, Silvestrino F, Marmo R, Del Vecchio
Blanco C. Cholelithiasis in patients with chronic active
liver disease: evaluation of risk factors. Ital J Gastroenterol.
1995;27:425-429.
18. Zhang Y, Liu D, Ma Q, Dang C, Wei W, Chen W. Factors
influencing the prevalence of gall stone formation in liver
cirrhosis. J Gastroenterol and Hepatol 2006: 21(9) 1455–1458.
19. Kurihara N, Ide H, Omata T, Yonamine S, Mashima Y, Tanno
M et al. Evaluation of gallbladder emptying in patients
with chronic liver disease by 99mTc-EHIDA hepatobiliary
scintigraphy. Radioisotopes 1989; 38:269–274.
20. Acalovschi M, Dumitrascu DL, Csakany I. Gastric and
gallbladder emptying of a mixed meal are not coordinated in
liver cirrhosis—a simultaneous sonographic study. Gut 1997:
40:412–417.
21. Li CP, Hwang SJ, Lee FY, Chang FY, Lin HC, Lu RH, Chu CJ,
Lee SD. Evaluation of gallbladder motility in patients with
liver cirrhosis: relationship to gallstone formation. Dig Dis
Sci 2000; 45:1109–1114.
22. Chawla A, Puthumana L, Thuluvath PJ. Autonomic
dysfunction and cholelithisis in patients with cirrhosis. Dig
Dis and Sci 46:3; 495–498, 2001.
23. Finucci G, Tirelli M, Bellon S, Zambon M, Toffolo L, Merkel
C et al. Clinical significance of cholelithiasis in patients with
decompensated cirrhosis. J Clin Gastroenterol 1990;12:538
–541.
Published
2015-12-31
How to Cite
K.C., S., Sharma, D., Khadka, S., Karki, N., Jaishi, B., Regmi, K., & Khadka, D. (2015). Prevalence of Gall Stones in Liver Cirrhosis. Journal of Nepal Medical Association, 53(200), 275-279. https://doi.org/10.31729/jnma.2745
Section
Original Article