Calculous Disease

CALCULOUS DISEASE, a general designation for diseases characterized by the presence of stones, calculi (see), in one or another hollow organ or duct. We speak of calculous disease because the formation of stones in organs is usually the result of a complex metabolic disorder in the body, a specific diathesis (see). In view of the fact that special groups of symptoms arise mainly in the case of stones in the biliary apparatus or in the urinary tract, the term calculous disease is applied almost exclusively to these latter cases, whereby the disease caused by gallstones is called cholelithiasis (see), and in the case of stones in the renal pelvis, one speaks of nephrolithiasis (see). Stones formed in one or another cavity may not cause any painful symptoms; there are cases when, at autopsy, as an incidental finding, one, several, or even many stones are encountered in the gallbladder or (more rarely) in the renal pelvis without this having manifested during life. In other cases, stones are the cause of a number of very serious consequences and produce very severe forms of calculous disease. A significant part of the changes caused by stones relates to their action on tissue as dense foreign bodies; damage to the mucous membrane of those parts where they formed, or of the ducts through which they move, is the cause of pain (hepatic colic, renal colic), and bleeding (e.g., hematuria). This same irritation of the mucous membranes can contribute to an inflammatory change of the cavity or duct, which arises under the influence of an infection penetrating into the cavity as a result of the disturbance of the proper outflow of secretion or excretion caused by the stone. The pressure of a stone on the wall of a cavity can cause a protrusion of the wall with the formation of a diverticulum; it often produces necrosis of the tissue, leading to the formation of a pressure sore and even perforation of the wall. Inflammatory changes, especially those accompanied by pressure sores and perforations, spread to adjacent sections (peritonitis in the case of lesions of the gallbladder or ducts, perinephritis in the case of stones in the renal pelvis). Preliminary connective tissue adhesion of the affected cavity to neighboring parts during its perforation sometimes results in the formation of pathological anastomoses, through which stones exit. If a calculus penetrates into a narrow duct or forms in the latter, it hinders the movement of the corresponding secretions and excretions, which leads to subsequent complications; these latter can be general (e.g., jaundice in the case of obstruction of the bile duct, uremia in the case of bilateral obstruction of the ureters) or purely local (dropsy of the gallbladder, hydronephrosis, retention dilation of the ducts). For details, see Cholelithiasis, Nephrolithiasis, etc. A. Abrikosov.