Cholelithiasis vs Cholecystitis vs Choledocholithiasis vs Cholangitis
Cholelithiasis vs cholecystitis vs choledocholithiasis vs cholangitis made easy! Gallbladder and gallstone diseases, definitions, symptoms, diagnosis, and treatment!
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Gallbladder and Biliary Diseases
Are you looking to better understand the different types of gallbladder and biliary diseases?
Then you have come to the right spot!
We’re going to walk through the different gallbladder and biliary diseases below!
You will be given simple explanations and visuals for the following:
Cholelithiasis (Gallstones)
Biliary Colic (Gallbladder Attack)
Cholecystitis (Gallbladder Inflammation)
Choledocholithiasis (Common Bile Duct Gallstones)
Cholangitis (Bile Duct Inflammation)
You may have noticed the above terms share similarities in their name.
Many begin with “chole” and end in “lithiasis” or “itis”.
This can create confusion and make them challenging to learn.
No worries…...you’ll be given easy tricks to help remember each disease!
So let’s get right into it!
Cholelithiasis vs Cholecystitis vs Choledocholithiasis vs Cholangitis: Comparing gallbladder definitions and diseases
Breaking it Down…
To help us better understand the different gallbladder terms, let’s first break them into 2 groups based on the ending of the word.
-Lithiasis
-Itis
You will quickly learn that one of the tricks to remembering and understanding the different gallbladder diseases is to simply break down the word.
We can see 2 of the terms end in “-lithiasis”:
Cholelithiasis
Choledocholithiasis
The other 2 words end in “-itis”:
Cholecystitis
Cholangitis
Lithiasis = Stone
We know from our medical terminology lecture that the suffix “-lithaisis” refers to the presence or formation of stones.
So for “-lithiasis”, simply remember stone.
Lithiasis = Stone
Repeat that over and over in your head until it sticks.
Itis = Inflammation
We also know form our medical terminology lecture that the suffix “-itis” means inflammation.
So for “-itis”, simply remember inflammation.
Itis = Inflammation
Repeat that in your head until sticks.
But Where?
So now we know the terms cholelithiasis and choledocholithiasis will have to do with stones, and the terms cholecystitis and cholangitis will have to do with inflammation.
Now we have to figure out where the stones are located and where the inflammation is taking place.
For that let’s look at each term starting with cholelithiasis.
Cholelithiasis vs Cholecystitis vs Choledocholithiasis vs Cholangitis: Definitions and meanings using medical terminology suffixes
Cholelithiasis (Gallstones)
What is cholelithiasis?
Let’s first break down the word….
Chole = Gall or Bile
Lithiasis = Stone
Cholelithiasis = Gallstone
Breaking it Down…
We already mentioned “-lithiasis” refers to stone.
But what does “chole-” mean?
“Chole-” refers to gall or bile.
So if we put it together, then we have gallstones.
And that’s exactly what cholelithiasis is.
Cholelithiasis = The presence or formation of gallstones, usually located in the gallbladder.
Simply put, cholelithiasis is the fancy medical term for gallstones.
Cholelithiasis Definition: Cholelithiasis means gallstones; The formation or presence of gallstones, usually in the gallbladder.
Biliary Anatomy
Let’s turn our attention to the simple visual below, which will help us better visualize what cholelithiasis is.
We can see in the diagram below that we have the liver, gallbladder, and pancreas.
The right and left hepatic ducts (yellow stars) exit the liver and join to form the common hepatic duct.
The gallbladder connects to the common hepatic duct through the cystic duct.
Together the cystic duct and common hepatic duct form the common bile duct.
What Are Gallstones?
We now know cholelithiasis is the medical term for gallstones.
But what are gallstones?
Gallstones are hardened deposits that can form in the biliary tract, usually in the gallbladder as shown in the image below (yellow circles).
The liver releases cholesterol, bile salts, and bilirubin in the form of bile to assist with digestion of fats.
Formation of gallstones may occur when any of the substances that make up the bile are present in large concentrations.
As the bile becomes more concentrated in the gallbladder, sludge may form.
The continued aggregation of sludge can lead to the formation of gallstones, or cholelithiasis.
Many people live with gallstones and don’t even know they have them.
Gallstones do not necessarily cause symptoms.
However, problems can occur when the gallstones move or become obstructed which we will see coming up.
Diagnosis & Treatment
Ultrasound can be used to diagnose gallstones.
The treatment will depend on the presentation but may include conservative management or gallbladder removal, called cholecystectomy.
Summary
Let’s recap.
Chole = Gall or Bile
Lithiasis = Stone
Cholelithiasis = Gallstones
More specifically, cholelithiasis is the presence or formation of gallstones in the biliary system, usually in the gallbladder.
Cholelithiasis (Gallstones): Gallstones are usually located in the gallbladder (yellow circles) and diagnosed with ultrasound. Treatment includes surgery vs conservative management.
Cholecystitis
What is cholecystitis?
Let’s break down the word again…
Chole = Gall or Bile
Cyst = Bladder
Cholecyst = Gallbladder
Itis = Inflammation
Cholecystitis = Inflammation of the Gallbladder
Breaking it Down…
We already mentioned “-itis” means inflammation.
But where is the inflammation taking place?
We can break down the rest of the word to find out!
We already know “chole-” means gall or bile.
The last part of the word is “cyst-” which means bladder.
So if we put “chole-” and “cyst-” together to make “cholecyst-”, then we have gallbladder.
If we put the entire word together, then we have inflammation of the gallbladder.
And that’s exactly what cholecystitis is.
Cholecystitis = Inflammation of the gallbladder, usually caused by a gallstone obstructing the cystic duct.
Cholecystitis Definition: Cholecystitis means inflammation of the gallbladder.
Biliary Colic (Gallbladder Pain or Attack)
Let’s go back to our diagram we used for cholelithiasis to help us visualize cholecystitis (see below).
We have our yellow gallstones in the gallbladder again.
As previously mentioned, gallstones do not necessarily cause problems.
However, symptoms may develop if the gallstones move….especially if they move through the bile ducts.
Occasionally a gallstone located in the gallbladder can move into the cystic duct (yellow circle - see below).
We now have a stone obstructing or moving through a tiny passageway called the cystic duct.
This can cause right upper quadrant abdominal pain, known as biliary colic.
Biliary Colic = Abdominal pain that occurs when a gallstone either obstructs or tries to move through the biliary ducts, in this case the cystic duct.
The pain may be relieved if the gallstone moves back into the gallbladder and out of the cystic duct.
This is why biliary colic can be intermittent, or in other words the pain comes and goes.
It just depends on what the stone is doing, where the stone is located, and how the stone is traveling.
Treatment is the same as cholelithiasis, which may include conservative management or cholecystectomy (gallbladder removal).
It depends on the severity of the symptoms, the frequency of biliary colic, the impact on the quality life the gallstones are having, among other factors.
What is Cholecystitis?
Sometimes a gallstone moves into the cystic duct and stays there (yellow circle - see below).
This creates an obstruction and blocks the gallbladder outflow tract.
The content in the gallbladder is stuck and is unable to flow out of the gallbladder through the cystic duct.
The persistent obstruction from the gallstone may eventually lead to inflammation to everything behind the blockage.
This would include the gallbladder (see below - inflammation in red)
This is known as cholecystitis, which is inflammation of the gallbladder.
Infection may also develop because the stagnant content in the gallbladder that is just sitting there becomes a breeding ground for bacteria.
Symptoms
Symptoms may include right upper quadrant (RUQ) abdominal pain, fever, and nausea or vomiting.
Diagnosis & Treatment
Similar to cholelithiasis, ultrasound can be used to diagnose cholecystitis as well.
Treatment typically includes antibiotics and cholecystectomy (gallbladder removal).
Summary
Let’s recap.
Chole = Gall or Bile
Cyst = Bladder
Cholecyst = Gallbladder
Itis = Inflammation
Cholecystitis = Inflammation of the gallbladder
Cholecystitis is typically caused by an obstructing gallstone in the cystic duct.
Cholecystitis: Inflammation of the gallbladder (red), usually caused by an obstructing gallstone in the cystic duct (yellow circle). Diagnosis is typically with ultrasound and treatment includes cholecystectomy (gallbladder removal) and antibiotics
Choledocholithiasis
What is choledocholithiasis?
Let’s break down the word again…
Choledocho = Common Bile Duct
Lithiasis = Stone
Choledocholithiasis = Gallstone in the Common Bile Duct
Breaking it Down…
We already mentioned “-lithiasis” means stone.
But where is the stone located?
We can use the rest of the word to find out!
“Choledocho-” refers to the common bile duct.
So if we put it together, then choledocholithiasis is a gallstone in the common bile duct.
And that’s exactly what choledocholithiasis is!
Choledocholithiasis = The presence of a gallstone in the common bile duct
Choledocholithiasis Definition: Choledocholithiasis means gallstones in the common bile duct (CBD)
What is Choledocholithiasis?
You know the drill, let’s go back to our diagram below and visualize this!
We can see we have our gallstones in the gallbladder again.
We already mentioned how gallstones in the gallbladder can sometimes move into the cystic duct, and this can lead to biliary colic or cholecystitis (see above).
Well, sometimes gallstones can form or move even further down the tract into the common bile duct (yellow circle - see below).
This is known as choledocholithiasis, which is the presence of gallstones in the common bile duct.
Symptoms
Remember we mentioned above how gallstones can cause pain when they obstruct or move through the bile ducts.
This is why choledocholithiasis can cause abdominal pain as well, usually in the right upper quadrant (RUQ) or epigastric region.
Choledocholithiasis can also cause jaundice, along with nausea and vomiting.
Question for you!
Why do we see jaundice (yellowing of the skin or eyes) with choledocholithiasis, but not the other diseases we discussed so far?
To answer, we have to remember where the stone is now located!
The gallstone is in the common bile duct.
Now the gallstone is not only potentially obstructing the outflow of the gallbladder (like we saw with biliary colic and cholecystitis), but the gallstone is affecting the outflow of the liver as well.
This can lead to jaundice.
Look at the diagram below to help you visualize!
Diagnosis & Treatment
While ultrasound can show signs of choledocholithiasis, an ERCP or MRCP is sometimes necessary to diagnose it.
ERCP = Endoscopic Retrograde Cholangiopancreatography
MRCP = Magnetic Resonance Cholangiopancreatogarphy
ERCPs and MRCPs help diagnose problems in the bile and pancreatic ducts.
Treatment typically includes removing the stone and gallbladder, along with antibiotics if there is concern for infection which we’ll talk about next!
Summary
Let’s recap.
Choledocho = Common Bile Duct
Lithiasis = Stone
Choledocholithiasis = Gallstone in the Common Bile duct
Choledocholithiasis is the presence of a gallstone in the common bile duct.
Choledocholithiasis: Gallstones in the common bile duct (yellow circle). Diagnosis includes ultrasound, ERCP, or MRCP. Treatment includes stone and gallbladder removal (cholecystectomy)
Cholangitis
What is cholangitis?
Let’s break down the word again…
Chole = Bile of Gall
Angio = Vessel or Duct
Cholangio = Bile Duct
Itis = Inflammation
Cholangitis = Inflammation of the Bile Ducts
Breaking it Down…
We already know “-itis” means inflammation.
We also know “chole-” means bile or gall.
The root word “angio-” refers to vessel or duct.
So together “cholangio-” refers to bile duct.
If we put the entire word together, then cholangitis is inflammation of the bile ducts.
And that’s exactly what cholangitis is!
Cholangitis = Inflammation of the bile ducts, usually caused by a gallstone obstructing the common bile duct.
Cholangitis Definitions: Inflammation of the bile ducts, usually caused by an obstructing gallstone in the common bile duct
What is Cholangitis?
Let’s go back to our diagram and visualize it!
We have our gallstones in the gallbladder again.
We mentioned above that sometimes gallstones can form or move into the common bile duct (see below - yellow circle)
This is known as choledocholithiasis (see choledocholithiasis above).
However, if the gallstone obstructs the common bile duct long enough, then this can lead to inflammation to everything behind the blockage.
Therefore, the inflammation may involve the gallbladder, liver, and bile ducts (see below - inflammation in red).
This is known as cholangitis, which is inflammation of the bile ducts.
This is different than cholecystitis, where an obstructing gallstone in the cystic duct leads to gallbladder inflammation only.
Look at the diagram below to visualize it!
Cholangitis is typically caused by a gallstone obstructing the common bile duct.
However, any pathology that obstructs the bile ducts can lead to cholangitis (i.e. pancreatic mass).
Symptoms
Symptoms will be similar to choledocholithiasis because the stone is in the same location….in the common bile duct.
However, fever, altered mental status, and other signs of infection may be present with cholangitis!
We know from our discussion on cholecystitis above, an obstructed gallstone will block content from passing through.
This not only causes inflammation, but it may also cause infection due to the stagnant content unable to pass by the stone.
As a result, symptoms of cholangitis may include fever, abdominal pain, jaundice, altered mental status, and nausea or vomiting.
Diagnosis & Treatment
An ultrasound, ERCP, or MRCP can be used to diagnose cholangitis, similar to what we saw with choledocholithiasis.
There are other imaging modalities, such as CT, that can diagnose everything we have discussed so far.
However, the options we discussed tend to be more first line.
Blood work is typically ordered as well for all the diseases discussed so far.
Treatment usually includes stone and gallbladder removal, along with antibiotics.
Summary
Let’s recap.
Chole = Bile or Gall
Angio = Duct or Vessel
Cholangio = Bile Duct
Itis = Inflammation
Cholangitis = Inflammation of the Bile Duct
Cholangitis is inflammation of the bile ducts, usually caused by an obstructing gallstone in the common bile duct (but can be caused by any biliary obstruction)
Cholangitis: Inflammation of the bile ducts (red), usually caused by an obstructing gallstone in the common bile duct (yellow circle). Diagnosis includes ultrasound, ERCP, or MRCP. Treatment includes stone and gallbladder removal (cholecystectomy) and antibiotics.
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