Impact of biliary calculi on the liver

Abstract

Introduction: Gallstone is implicated for hepatocellular injury due to chronic extra hepatic large bile duct obstruction with or without repeated episodes of cholangitis. Aim: To study the liver changes in patients undergoing operative procedure for gallstone disease and to determine the relationship between severity of these changes with position of biliary calculus in biliary tree. Materials and Methods: Sixty patients who underwent operative procedure for gallstone disease between October 2013 and September 2015 were evaluated. The Liver Function Test (LFT) was done preoperatively and postoperatively. Intraoperative liver biopsy was taken. The histopathological changes of liver and their severity were noted. Results: The most commonly observed liver function abnormality both in cholelithiasis (12.8%) and choledocholithiasis patients (50%) was increased alkaline phosphatase. Most commonly observed liver histology changes in patients with cholelithiasis was nonspecific reactive hepatitis (46.9%) and in choledocholithiasis was chronic cholestasis (50%). Patient with choledocholithiasis showed significant changes (p<0.001) in liver histopathology and LFT as compared to cholelithiasis. Conclusion: Patients with gallstone diseases developed significant functional as well as structural hepatic changes. Though the change was more significant in patient with choledo-cholithisis compared to cholelithiasis, early operative procedure is recommended in all gallstone disease patients to prevent potential liver damage, irrespective of position of biliary calculi in biliary tree to prevent morbidities associated with it.