الفهرس 
Introduction
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Abstract
This study included 30 patients with chronic calcular cholecytitis
These cases were examined clinically, radiologically, and managed by cholecystectomy
The stones were studied for physical characters
The incidence of gall bladder stone disease was about 8 % from all surgical cases admitted to the hospital
Clinical picture:
Age:
Most common in age group (30-39) then (40-49), together constituting 65% of the cases, this is followed by (50-59), finally above 60 years.
Sex:
The female to male ratio was 3 : 1
The cause of high incidence in male is due to racial causes, bilharziasis affecting the liver function, and could be falacious, as females in upper Egypt don’t consult there doctors except rather late.
Parity:
There were one case nullipara, there were 15 cases less than 5 deliveries and 6 cases more than 5 deliveries
Duration of symptoms:
Before presenting for treatment usually patients had the symptoms for (3 months -8 years). the causes of delay in the presentation of patient for medical treatment explained by the fact that dyspepsia is common among egyptions due to dietary indiscretion, chronic colitis, etc.
Symptoms:
Site of pain:
Most common in rt hypochondrium then the epigastric region
Nature of pain :
Colicy in nature in (65% of cases examined) caused by either spasm of the cystic duct or small stones that had been expelled or dull aching in (73 % of cases examined)
There is association between two types of pain in some cases
Pain is more common with big stones
Dyspepsia:
Present in 93 % of cases. this dyspepsia explained by the disturbed gall bladder function of bile concentration and contraction in responding to fatty meals
Nausia and vomiting :
Usually accompanied the biliary colic and may be continue after its disappearance
Jaundice as a past history:
Some cases noticed to be jaundiced due to: impacted big stone in Hartmann”s pouch , others due to small stones that slip through the common bile duct
Some of these cases missed as infective hepatitis
Acute cholecystitis and pancreatitis:
Some patients had a history of acute attack of cholecystitis or pancreatitis
Other symptoms:
6 cases (20%) have suffering from constipation, diarrhea, distenstion and flatulence
Constipation is due to absence of bile salts that act as astimulant for the intestinal peristalisis
The cause of flatulence is due to the disturbed fat and carbohydrates metabolism
Physical examination:
Murphy’s sign: in 23% of cases
Palpable gall bladder: distended as mucocele or pyocele in 13% of cases
Operative finding :
There were pathological changes that varies with the duration of symptoms and number of stones, these changes include contracted gall bladder, fibrosed and thickening of the wall and adhesions
Some cases revealed normal gall bladder with some sort of mild inflammation and some cases revealed acute changes
Study of the stones:
Number varied from 1 – more than 100
Solitary stone was the most frequent one
Shape: round, disc, globular or angular
Outer surface: smooth, rough, spiky or mammilated
Size: varied from 5mm – 3cm