Overview
What is cholelithiasis (gallstone disease)?
What are the stages of gallstone disease (cholelithiasis)?
What causes gallstone disease (cholelithiasis) complications?
What are the characteristics of biliary colic?
Do asymptomatic patients with gallstones (cholelithiasis) present with abnormal physical findings?
How is uncomplicated biliary colic distinguished from acute cholecystitis?
What symptoms of gallstone disease (cholelithiasis) should be examined for further complications?
What imaging studies are useful in the diagnosis of gallstones (cholelithiasis)?
Are treatment options for gallstones (cholelithiasis) based on disease stage?
Which medical treatments are used for gallstones (cholelithiasis)?
When is cholecystectomy indicated in the treatment of gallstones (cholelithiasis)?
What are the surgical interventions for gallstones (cholelithiasis)?
What are gallstones (cholelithiasis)?
How do gallstones (cholelithiasis) develop?
What are initial and chronic complications of gallstones (cholelithiasis)?
What is the initial procedure used to diagnosis gallstone disease (cholelithiasis)?
When is surgical intervention indicated in the treatment of gallstones (cholelithiasis)?
How are cholesterol gallstones formed?
Which factors determine whether cholesterol gallstones will form?
What is the role of bilirubin in the formation of gallstones?
What is the role of bacteria in the formation of gallstones?
How are mixed gallstones formed?
Do all types of gallstones have identical risk factors?
What are the risk factors for development of cholesterol gallstones?
Is pregnancy a risk factor for the development of cholesterol gallstones?
Which causes of gallbladder stasis increase the risk for development of gallstones?
What medications increase the risk for the formation of gallstones?
Is there a genetic predisposition for gallstone (cholelithiasis) formation?
Which disorders predispose to black and brown pigment gallstones?
What comorbidities are associated with gallstones (cholelithiasis)?
What factors affect the prevalence of cholelithiasis (gallstones)?
What is the incidence of gallstones (cholelithiasis) in the US?
What is the mortality rate of gallstone disease (cholelithiasis) in the US?
What is the worldwide incidence of cholelithiasis (gallstones)?
Why is choledocholithiasis more prevalent outside the US?
Are there racial differences in the prevalence of gallstones (cholelithiasis)?
Are gallstones (cholelithiasis) more common in women or men?
Does the risk for development of gallstones (cholelithiasis) vary with age?
What is the prognosis of gallstones (cholelithiasis)?
What education should be provided to asymptomatic patients with gallstones (cholelithiasis)?
Presentation
What are the different stages of gallstone disease (cholelithiasis)?
Do asymptomatic gallstones (cholelithiasis) require treatment?
What are the symptoms and complications of biliary colic?
What are the physical findings of stage 1 (lithogenic state) gallstone disease (cholelithiasis)?
How is uncomplicated biliary colic differentiated from acute cholecystitis?
What are the physical findings associated with choledocholithiasis?
What are the physical finding associated with ascending cholangitis?
What are the physical findings associated with acute gallstone pancreatitis?
What are the complications of gallstones (cholelithiasis)?
What are the complications of gallstones (cholelithiasis) in the common bile duct?
What are the complications of inflammation due to chronic cholelithiasis (gallstones)?
DDX
What should be included in the differential diagnoses of gallstones (cholelithiasis)?
What are the differential diagnoses for Gallstones (Cholelithiasis)?
Workup
Is lab testing required to diagnosis gallstones (cholelithiasis)?
How are asymptomatic gallstones (cholelithiasis) diagnosed?
What blood tests are helpful in the workup of suspected gallstone (cholelithiasis) complications?
Which blood tests are helpful in the diagnosis of choledocholithiasis?
How often should blood tests be repeated in suspected gallstone (cholelithiasis) complications?
What is the role of radiography in the evaluation of suspected gallstones (cholelithiasis)?
What are the ultrasonographic findings in gallstones (cholelithiasis)?
Why are common bile duct (CBD) stones frequently missed on ultrasonography?
Is laparoscopic ultrasound useful for bile duct imaging?
What is the role of CT scanning in the workup of suspected gallstones (cholelithiasis)?
When is CT scanning useful in the workup of suspected gallstones (cholelithiasis)?
What is the role of MRI in the diagnosis of gallstones (cholelithiasis)?
Treatment
When is surgical intervention indicated in the treatment of gallstones (cholelithiasis)?
What is the role of medical therapy in the management of gallstones (cholelithiasis)?
Which medications are used for the management of gallstones (cholelithiasis)?
When is medical treatment of gallstones the most effective?
Is surgical intervention recommended for asymptomatic gallstones (cholelithiasis)?
When should cholecystectomy be considered for asymptomatic gallstones (cholelithiasis)?
When should elective cholecystectomy be considered for gallstones (cholelithiasis)?
What is the role of dissolution agents in the treatment of gallstones (cholelithiasis)?
When is cholecystectomy indicated for symptomatic gallstones (cholelithiasis)?
What are the SAGES guidelines for laparoscopic surgery in symptomatic gallstones (cholelithiasis)?
When is cholecystostomy indicated for gallstones (cholelithiasis)?
What is the role of sphincterotomy in the treatment of gallstones (cholelithiasis)?
Are dietary changes effective in reducing the risk of development of gallstones (cholelithiasis)?
Does regular exercise reduce the risk of development of gallstones (cholelithiasis)?
Which specialists should be consulted for gallstones (cholelithiasis)?
What are possible complications following cholecystectomy for gallstones (cholelithiasis)?
Medications
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Excised gall bladder opened to show 3 gallstones. Image from Science Source (http://www.sciencesource.com/).
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Magnetic resonance cholangiopancreatography (MRCP) showing 5 gallstones in the common bile duct (arrows). In this image, bile in the duct appears white; stones appear as dark-filling defects. Similar images can be obtained by taking plain radiographs after injection of radiocontrast material in the common bile duct, either endoscopically (endoscopic retrograde cholangiography) or percutaneously under fluoroscopic guidance (percutaneous transhepatic cholangiography), but these approaches are more invasive.
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Intraoperative cholangiogram demonstrating a distal common bile duct stone with dilatation.
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Intraoperative cholangiogram demonstrating a distal common bile duct stone without dilatation.
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Cholecystitis with small stones in the gallbladder neck. Classic acoustic shadowing is seen beneath the gallstones. The gallbladder wall is greater than 4 mm. Image courtesy of DT Schwartz.
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The WES (wall echogenic shadow) sign, long axis of the gallbladder. The arrow head points to the gallbladder wall. The second hyperechoic line represents the edge of the congregated gallstones. Acoustic shadowing (AS) is readily seen. The common bile duct can be seen just above the portal vein (PV). Image courtesy of Stephen Menlove.
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Wall echogenic shadow (WES sign), short axis view of the gallbladder. Image courtesy of Stephen Menlove.
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Sludge in the gallbladder. Note the lack of shadowing. Image courtesy of DT Schwartz.
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Common bile duct stone (choledocholithiasis). The sensitivity of transabdominal ultrasonography for choledocholithiasis is approximately 75% in the presence of dilated ducts and 50% for nondilated ducts. Image courtesy of DT Schwartz.
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What are gallstones? Gallstones are solid stones that are produced in the gallbladder when there’s an imbalance in the composition of bile. The main types of gallstones are cholesterol stones, bilirubin stones, and brown stones.