Also called
ICD-10
Specialty
Onset
Reviewed
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OverviewOverview
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Etiology & Risk FactorsEtiology & Risk Factors
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PathophysiologyPathophysiology
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Clinical PresentationClinical Presentation
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History TakingHistory Taking
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Physical ExaminationPhysical Examination
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InvestigationsInvestigations
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DiagnosisDiagnosis
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ManagementManagement
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ComplicationsComplications
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PrognosisPrognosis
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Key Points / Clinical PearlsKey Points / Clinical Pearls
Overview
• Gallstones are common and are often found incidentally.
• Most patients are asymptomatic.
• Symptomatic disease presents as biliary colic (typically postprandial right upper quadrant pain).
• Ultrasound is the investigation of choice.
• Definitive treatment for symptomatic gallstones is laparoscopic cholecystectomy.
Etiology & Risk Factors
-Types of stones
• Cholesterol stones (most common)
• Pigment stones
• Mixed stones
-Risk factors
• Conditions associated with cholesterol stone formation
• Hemolysis (pigment stones)
• Infection (pigment stones)
Pathophysiology
• the stones form within the gallbladder due to abnormal bile composition.
• Stones may remain asymptomatic or intermittently obstruct the cystic duct.
• Temporary obstruction causes biliary colic.
• Persistent obstruction may lead to complications such as:
• Acute cholecystitis
• Choledocholithiasis
• Acute cholangitis
• Gallstone pancreatitis
Clinical Presentation
-Asymptomatic:
• Usually discovered incidentally on imaging.
-Symptomatic (Biliary colic):
• Postprandial right upper quadrant pain
• Episodic pain
• Nausea
• Vomiting
History Taking
-Ask about:
• Character of right upper quadrant pain
• Relationship to meals
• Duration of pain
• Nausea and vomiting
• Fever
• Jaundice
• Previous similar episodes
• History of gallstones
• Previous biliary surgery
Physical Examination
-General examination:
• Right upper quadrant tenderness
• Assess for fever
• Evaluate for jaundice
• Assess for signs of complications (e.g., peritonitis or sepsis)
Investigations
-Initial laboratory studies
• Complete blood count (CBC)
• Liver chemistries
• Amylase
• Lipase
Imaging (Investigation of Choice)
Right upper quadrant (RUQ) ultrasound
or Biliary point-of-care ultrasound (POCUS)
-Ultrasound confirms gallstones and helps identify complications.
Ultrasound findings suggesting complications
• Gallbladder wall thickening
• Pericholecystic fluid
• Dilated common bile duct (CBD)
-Additional assessment
Rule out:
• Acute cholecystitis
• Choledocholithiasis
• Acute cholangitis
• Gallstone pancreatitis
Diagnosis
-Asymptomatic Disease:
• Usually diagnosed incidentally.
• No further diagnostic workup is required.
-Symptomatic Disease:
Diagnosis is based on:
• Clinical presentation
• RUQ ultrasound (or biliary POCUS)
• Laboratory investigations to exclude complications
Management
-Asymptomatic cholelithiasis
• Expectant (conservative) management
• No routine treatment required
-Symptomatic cholelithiasis:
Initial supportive treatment
• Nil by mouth (NPO)
• Analgesia
• Intravenous fluids
• Antiemetics
Definitive treatment
• Elective laparoscopic cholecystectomy
• Consult general surgery
-Complicated cholelithiasis
• Admit the patient.
• Manage the specific complication (e.g., acute cholecystitis, cholangitis, choledocholithiasis, or
pancreatitis).
Complications
• Acute cholecystitis
• Choledocholithiasis
• Acute cholangitis
• Gallstone pancreatitis
Prognosis
• Most asymptomatic patients remain symptom-free.
• Symptomatic disease is effectively treated with laparoscopic cholecystectomy.
• Prognosis is excellent when complications are recognized and managed promptly.
Key Points / Clinical Pearls
• Cholelithiasis = gallstones within the gallbladder.
• Most patients are asymptomatic.
• Typical symptom: postprandial right upper quadrant pain (biliary colic).
• RUQ ultrasound is the diagnostic test of choice.
• Initial laboratory tests: CBC, liver chemistries, amylase, and lipase.
• Always exclude acute cholecystitis, choledocholithiasis, cholangitis, and pancreatitis.
• Asymptomatic stones → no treatment (expectant management).
• Symptomatic stones → NPO, analgesia, IV fluids, antiemetics, followed by elective
laparoscopic cholecystectomy.
- National Center for Biotechnology Information (NIH). Gallstones (Cholelithiasis), StatPearls.
- National Center for Biotechnology Information (NIH). Physiology, Gallbladder, StatPearls.
- Sabaratnam A, Sabaratnam R. 4F's - Still Up to Date Risk Factors of Cholelithiasis. Pol Przegl Chir. 2019. PMID: 18540184.
- Su PY, Hsu YC, Cheng YF, et al. Risk Factors Associated With Symptomatic Cholelithiasis in Taiwan: A Population-Based Study. BMC Gastroenterol. 2011;11:64. PMC3215644.
- MedlinePlus, National Library of Medicine (NIH). Gallstones: Health Topic.
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