What are the risk factors for developing gallstones. How are gallstones diagnosed and treated. What complications can arise from untreated gallstones. Why do some people develop symptomatic gallstones while others remain asymptomatic.

Understanding Gallstones: Formation and Composition

Gallstones, also known as cholelithiasis, are solid deposits that form in the gallbladder. They develop when bile, a fluid produced by the liver to aid in digestion, becomes supersaturated with cholesterol or other substances. This supersaturation leads to crystal formation, which can eventually grow into gallstones.

There are several types of gallstones, each with a distinct composition:

• Cholesterol stones: The most common type, accounting for about 80% of gallstones
• Pigment stones: Composed primarily of bilirubin, these can be black or brown
• Mixed stones: A combination of cholesterol and pigment
• Calcium stones: Less common, formed from calcium salts

The formation of gallstones is a complex process influenced by various factors. Can gallbladder emptying affect stone formation? Indeed, sluggish emptying of the gallbladder can lead to bile stasis, promoting the precipitation of bile components and the formation of sludge, which can eventually develop into gallstones.

Risk Factors for Gallstone Development

Understanding the risk factors for gallstone formation is crucial for prevention and early intervention. Several factors increase the likelihood of developing gallstones:

• Age: The risk increases with age, particularly after 40
• Gender: Women are more susceptible, especially during pregnancy and childbearing years
• Obesity: Excess weight increases cholesterol in bile and reduces gallbladder emptying
• Rapid weight loss: Paradoxically, losing weight too quickly can lead to gallstone formation
• Genetics: Family history plays a role in gallstone susceptibility
• Certain medical conditions: Metabolic syndrome, Crohn’s disease, and liver cirrhosis increase risk
• Medications: Some drugs, including estrogen-containing medications, can promote gallstone formation

Are there any controllable risk factors for gallstones? Yes, maintaining a healthy weight through balanced diet and regular exercise can significantly reduce the risk of gallstone formation. Additionally, avoiding rapid weight loss and crash diets can help prevent gallstone development.

Symptoms and Diagnosis of Gallstones

Many individuals with gallstones remain asymptomatic for years. However, when symptoms do occur, they can be quite severe and typically include:

• Sudden, intense pain in the upper right abdomen or center of the abdomen
• Pain that radiates to the right shoulder or between the shoulder blades
• Nausea and vomiting
• Fever and chills (if infection is present)
• Jaundice (yellowing of the skin and eyes) if a stone blocks the bile duct

How are gallstones diagnosed? The primary diagnostic tool for gallstones is abdominal ultrasound. This non-invasive imaging technique can detect stones as small as 2mm with high accuracy. Other diagnostic methods may include:

• CT scans: Useful for detecting complications of gallstones
• HIDA scans: To assess gallbladder function and detect blockages
• Blood tests: To check for signs of infection or obstruction

Early diagnosis is crucial for preventing complications and determining the most appropriate treatment approach.

Treatment Options for Gallstones

The treatment of gallstones depends on the severity of symptoms and the patient’s overall health. Options include:

1. Watchful Waiting

For asymptomatic gallstones, a “watch and wait” approach may be recommended. Many people with gallstones never develop symptoms and don’t require treatment.

2. Surgical Intervention

Laparoscopic cholecystectomy is the gold standard for treating symptomatic gallstones. This minimally invasive procedure involves removing the gallbladder through small incisions in the abdomen.

3. Medication

In some cases, medications like ursodeoxycholic acid may be prescribed to dissolve small cholesterol stones. However, this approach is less common and typically reserved for patients who cannot undergo surgery.

4. Lithotripsy

Shock wave lithotripsy, which uses sound waves to break up stones, may be an option for some patients, although it’s less commonly used than surgery.

Is surgery always necessary for gallstones? No, surgery is typically recommended only for symptomatic gallstones or those causing complications. Asymptomatic gallstones often don’t require treatment, but regular monitoring may be advised.

Complications of Untreated Gallstones

While many gallstones remain asymptomatic, untreated symptomatic gallstones can lead to serious complications:

• Cholecystitis: Inflammation of the gallbladder
• Choledocholithiasis: Blockage of the common bile duct
• Cholangitis: Infection of the bile ducts
• Pancreatitis: Inflammation of the pancreas
• Gallbladder cancer: A rare but serious complication of chronic gallstone disease

Can gallstones resolve on their own? While small gallstones may occasionally pass through the bile duct without intervention, larger stones typically do not resolve spontaneously and may require treatment if they become symptomatic or cause complications.

Prevention Strategies for Gallstones

While not all gallstones can be prevented, certain lifestyle modifications can reduce the risk of their formation:

• Maintain a healthy weight through balanced diet and regular exercise
• Avoid rapid weight loss and crash diets
• Eat a diet rich in fiber and low in saturated fats
• Stay hydrated to help maintain proper bile flow
• Exercise regularly to promote healthy gallbladder function

Can dietary changes prevent gallstone formation? Yes, a diet low in saturated fats and high in fiber can help reduce the risk of gallstone formation. Additionally, maintaining a consistent eating schedule and avoiding prolonged fasting can promote healthy gallbladder function.

The Role of the Interprofessional Team in Gallstone Management

Effective management of gallstones often requires a collaborative approach involving various healthcare professionals:

• Primary care physicians: For initial assessment and ongoing management
• Gastroenterologists: For specialized diagnosis and non-surgical treatments
• Surgeons: For surgical interventions when necessary
• Radiologists: For imaging studies and interpretation
• Nutritionists: To provide dietary guidance for prevention and management
• Nurses: For patient education and post-operative care

How does interprofessional collaboration improve outcomes for gallstone patients? By working together, healthcare professionals can ensure comprehensive care, from accurate diagnosis to appropriate treatment selection and follow-up care. This collaborative approach can lead to better patient outcomes, reduced complications, and improved quality of life for those affected by gallstones.

Future Directions in Gallstone Research and Treatment

As our understanding of gallstone formation and progression continues to evolve, new avenues for prevention and treatment are emerging:

• Genetic research: Identifying genetic markers for gallstone susceptibility
• Novel drug therapies: Developing medications to prevent stone formation or promote dissolution
• Minimally invasive techniques: Refining surgical approaches for even less invasive treatments
• Microbiome studies: Exploring the role of gut bacteria in gallstone formation

What potential breakthroughs are on the horizon for gallstone treatment? Ongoing research into the genetic and molecular basis of gallstone formation may lead to personalized prevention strategies and targeted therapies. Additionally, advancements in imaging technologies could enable earlier detection and intervention, potentially reducing the need for surgical treatments.

In conclusion, gallstones remain a significant health concern affecting millions worldwide. While many cases are asymptomatic, the potential for serious complications underscores the importance of awareness, prevention, and timely intervention. By understanding the risk factors, recognizing symptoms, and seeking appropriate medical care, individuals can effectively manage gallstone-related health issues and maintain optimal digestive health.

Gallstones (Cholelithiasis) – StatPearls – NCBI Bookshelf

Mark W. Jones; Connor B. Weir; Sassan Ghassemzadeh.

Author Information and Affiliations

Last Update: April 24, 2023.

Continuing Education Activity

Gallstones or cholelithiasis are stones that form in the gallbladder composed of cholesterol, bilirubin, and bile. These stones are asymptomatic in most cases, with stones discovered incidentally. Symptomatic patients present with right upper abdominal pain after eating greasy or spicy food, nausea, vomiting, pain in epigastrium that radiates to the right scapula or mid-back. This activity illustrates the evaluation and management of gallstones and reviews the role of the interprofessional team in improving care for patients with this condition.

Objectives:

• Identify the risk factors associated with the development of gallstones.

• Describe the pathophysiology of gallstones.

• Outline the use of a right upper quadrant abdominal ultrasound in the evaluation of gallstones.

• Explain the importance of improving care coordination among the interprofessional team members to improve outcomes for patients affected by gallstones.

Access free multiple choice questions on this topic.

Introduction

Gallstones or cholelithiasis are responsible for one of the most prevalent digestive disorders in the United States. They are considered a disease of developed populations but are present around the world. It is both the result of a chronic disease process and the cause of subsequent acute disorders of the pancreatic, biliary, hepatic, and gastrointestinal tract. Over 6.3 million females and 14.2 million males in the United States between the ages of 20 and 74 have gallstones. Most patients with gallstones are asymptomatic, but 10% of patients will develop symptoms within five years, and 20% of patients will develop symptoms within 20 years of diagnosing gallstones. Gallstone prevalence also increases with age. Over one-quarter of females older than the age of 60 will have gallstones. Gallstones have various compositions and etiologies.[1]

The critical feature of gallstones is that they are not all symptomatic. Sometimes they may migrate near the opening of the cystic duct and block the flow of bile. This can lead to tension in the gallbladder, which results in the classic biliary colicky pain. If the cystic duct is obstructed for more than a few hours, it can lead to inflammation of the gallbladder wall (cholecystitis). Sometimes the gallstone may move into the bile duct and cause obstruction, leading to jaundice and abdominal pain. Patients who have chronic gallstones may develop progressive fibrosis and loss of motor function of the gallbladder. The best test to make a diagnosis of gallstones is ultrasound. The treatment of gallstones depends on symptoms. The standard of care for symptomatic patients is laparoscopic cholecystectomy.

Etiology

Gallstones usually form from sluggishly emptying of bile from the gallbladder. When bile is not fully drained from the gallbladder, it can precipitate as sludge, which in turn can develop into gallstones. Biliary obstruction from various causes such as strictures in the bile duct or neoplasms may also lead to gallstones. The most common cause of cholelithiasis is the precipitation of cholesterol from cholesterol-rich bile. The second most common form of gallstones is pigmented gallstones. These form from the breakdown of red blood cells and are black. The third type of gallstones is mixed pigmented stones, a combination of calcium substrates such as calcium carbonate or calcium phosphate, cholesterol, and bile. The fourth type of stone is calcium stones. These may be due to the precipitation of serum calcium in patients with hypercalcemia. Often these patients will have concurrent kidney stones.[2]

Risk factors for gallstones include:

• In pregnancy, progesterone decreases the contractility of the gallbladder leading to stasis.

• Obesity

• Genes

• Certain medications (estrogens, fibrates, somatostatin analogs)

• Stasis of the gallbladder

• Female gender

• Metabolic syndrome

• Rapid weight loss

• Prolonged fasting

• Bariatric surgery

• Crohn disease, ileal resection

Epidemiology

Most gallstones are asymptomatic. In the United States, approximately 14 million women and 6 million men with an age range of 20 to 74 have gallstones. The prevalence increases as a person ages. Obesity increases the likelihood of gallstones, especially in women, due to increases in the biliary secretion of cholesterol. On the other hand, patients with drastic weight loss or fasting have a higher chance of gallstones secondary to biliary stasis. Furthermore, there is also a hormonal association with gallstones. Estrogen has been shown to result in an increase in bile cholesterol as well as a decrease in gallbladder contractility. Women of reproductive age or on estrogen-containing birth control medication have a two-fold increase in gallstone formation compared to males. People with chronic illnesses such as diabetes also have an increase in gallstone formation and reduced gallbladder wall contractility due to neuropathy.[3]

Pathophysiology

Gallstones occur when substances in the bile reach their limits of solubility. As bile becomes concentrated in the gallbladder, it becomes supersaturated with these substances, which in time precipitate into small crystals. These crystals, in turn, become stuck in the gallbladder mucus, resulting in gallbladder sludge. Over time, these crystals grow and form large stones. Complications caused by gallstones are a direct consequence of occlusion of the hepatic and biliary tree by sludge and stones.[3]

There are two types of gallstones, cholesterol and calcium bilirubinate.

Cholesterol gallstones form the majority of gallstones. The major component of these stones is cholesterol. The bilirubinate stones contain bilirubin. In patients with a high turnover of heme, such as cirrhosis or chronic hemolysis, the unconjugated bilirubin will crystallize and eventually form stones. These stones are usually dark black or blue and account for about 15% of gallstones in the United States.

Sometimes, the cholesterol gallstones will become colonized with microorganisms, which leads to inflammation of the mucosa. The resulting leucocyte infiltration and presence of bilirubin leads to mixed stones.

Histopathology

Pathologists can analyze the composition of gallstones and bile, which may help to determine the cause of the stones, especially in cases of primary common bile duct stones, after gallbladder removal and the exact cause of the stones is unknown.[4][5]

History and Physical

Usually, patients with symptoms from gallstones present with right upper abdominal pain after eating greasy or spicy foods. There is often nausea and vomiting. Pain can also be present in the epigastric area that radiates to the right scapula or mid-back. The classic physical exam finding is a positive Murphy’s sign, where the pain is elicited on deep palpation to the right upper quadrant underneath the rib cage upon deep inspiration. Patients may be asymptomatic for months to years until the discovery of gallstones. Acute cholecystitis presents similarly. However, it is more severe. Jaundice can be a sign of a common bile duct obstruction from an entrapped gallstone.  In the presence of jaundice and abdominal pain, often, a procedure is an indication to go and retrieve the stone to prevent further sequelae. One such sequela is ascending cholangitis, with symptoms of right upper abdominal pain, fever, and jaundice (Charcot’s triad). Progression of this condition is indicated by neurologic changes and hypotension (Reynold’s pentad). Other sequelae are acute pancreatitis with symptoms of mid-epigastric pain and intractable vomiting.[6]

Evaluation

The best diagnostic test for diagnosing gallstones and subsequent acute cholecystitis is a right upper quadrant abdominal ultrasound. It is associated with a 90% specificity rate and, depending on the ultrasound operator, can detect stones as small as 2 mm as well as sludge and gallbladder polyps. Ultrasound findings that point towards acute cholecystitis versus cholelithiasis include gallbladder wall thickening greater than 3 mm, pericholecystic fluid, and a positive sonographic Murphy’s sign. Gallstones can also often be present on CT scans and MRIs. However, these tests are not as sensitive for diagnosing acute cholecystitis. Approximately 10% of gallstones may be found on routine plain films due to their high calcium content. If there is a suspected stone in the common bile duct based on ultrasound results, magnetic resonance cholangiopancreatography (MRCP) is the next step. If a common duct stone is identified on the MRCP, then the gold-standard test of an endoscopic retrograde cholangiopancreatogram (ERCP) should be performed by a gastroenterologist. A percutaneous transhepatic cholangiogram (PTHC) is also useful in diagnosing common bile duct stones if an ERCP is not possible.[7]

Treatment / Management

Cholecystectomy treats symptomatic gallstones. The laparoscopic approach is the standard of care. Open cholecystectomies are the option when it is not practical or advisable to do a laparoscopic procedure. It is not wise to only remove the gallstones as studies have shown that they recur after about one year. In cases of acute cholecystitis in critically ill patients or patients who are poor surgical candidates, a decompression cholecystostomy tube can be placed to temporize the patient until stable enough for definitive surgery. Common bile duct stones can be removed with a preoperative or postoperative ERCP, PTHC, or operatively with a common bile duct exploration. Ascending cholangitis needs to be addressed urgently by removing the blockage either with ERCP, PTHC, or surgery, as well as early antibiotic administration. In cases of nonacute cholecystitis and very poor surgical candidates, gallstones can be treated medically. Ursodiol is administered daily with the hope of dissolving the gallstones and has shown mixed success with some studies at best, showing less than a 50% response rate.[8]

Differential Diagnosis

Prognosis

Less than 50% of patients who have gallstones will develop symptoms. Today, the mortality rate following laparoscopic cholecystectomy is less than 1%; however, emergency cholecystectomy rates are 10% or greater. Other complications include retained stones in the bile duct, incisional hernia, and chronic right upper quadrant pain. Despite the fact that laparoscopic cholecystectomy is now the standard of care for symptomatic gallstones, the rates of injury to the bile duct during surgery continue to increase.

Complications

Complications from gallstones may include [9][10]:

• Gallbladder inflammation leading to cholecystitis

• Common bile duct blockage resulting in bile duct infection and jaundice

• Pancreatic duct blockage which can cause pancreatitis

• Cancer of the gallbladder

Deterrence and Patient Education

Patient education centers around maintaining a low-fat diet, medication adherence, explaining the pathophysiology of the condition, follow-up appointments to track progress, and explaining potential surgical interventions if they become necessary.

Enhancing Healthcare Team Outcomes

Gallbladder disease can be a difficult diagnosis. Early suspicion with proper testing will make the diagnosis. The condition is best managed by an interprofessional team. Having a skilled radiologist and emergency physician will often be the critical first step in properly diagnosing gallstones. Early intervention by an experienced surgeon is also vital. Practitioners should remember that not all gallstones will require surgery. The correct clinical decision must be made as a group recommendation between the primary care physician, nurse practitioner, radiologist, gastroenterologist, the patient, and the surgeon. The primary care clinicians should encourage patients to eat a healthy diet, maintain healthy body weight, eat a low-fat diet, and abstain from prolonged fasting. Nurses monitor patients perioperatively, educate patients and their families, and inform the team of changes in patient status. Close communication between the team members if vital to lower the morbidity of gallstones.[11][12][13]

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

Figure

Gallstone on point-of-care ultrasound. Contributed by Emory EM Ultrasound Section

Figure

CT Acute Cholecystitis Wall Thickening Pericholecystic Fluid Gallstone. Contributed by Scott Dulebohn, MD

Figure

Gallstones in a female. Image courtesy S Bhimji

Figure

Figure 1. 37-year old female diagnosed as gallstones with acute cholecystitis. The incidental findings ; a: US image show multiple hypoechoic lesions, some of them with comet-tail artifacts, raises the possibility of multiple biliary hamartoma; b: T2-weighted (more…)

Figure

Gallbladder Gallstones (Calculi), Common
bile duct, Pancreas, Intestine, Gallbladder, Gallstones, Liver. Illustration by Emma Gregory

References

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Tsai TJ, Chan HH, Lai KH, Shih CA, Kao SS, Sun WC, Wang EM, Tsai WL, Lin KH, Yu HC, Chen WC, Wang HM, Tsay FW, Lin HS, Cheng JS, Hsu PI. Gallbladder function predicts subsequent biliary complications in patients with common bile duct stones after endoscopic treatment? BMC Gastroenterol. 2018 Feb 27;18(1):32. [PMC free article: PMC6389262] [PubMed: 29486713]

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Rebholz C, Krawczyk M, Lammert F. Genetics of gallstone disease. Eur J Clin Invest. 2018 Jul;48(7):e12935. [PubMed: 29635711]

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Shabanzadeh DM. New determinants for gallstone disease?
. Dan Med J. 2018 Feb;65(2) [PubMed: 29393043]

4.

Del Pozo R, Mardones L, Villagrán M, Muñoz K, Roa S, Rozas F, Ormazábal V, Muñoz M. [Effect of a high-fat diet on cholesterol gallstone formation]. Rev Med Chil. 2017 Sep;145(9):1099-1105. [PubMed: 29424395]

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Charfi S, Gouiaa N, Mnif H, Chtourou L, Tahri N, Abid B, Mzali R, Boudawara TS. Histopathological findings in cholecystectomies specimens: A single institution study of 20 584 cases. Hepatobiliary Pancreat Dis Int. 2018 Aug;17(4):345-348. [PubMed: 30173787]

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Wilkins T, Agabin E, Varghese J, Talukder A. Gallbladder Dysfunction: Cholecystitis, Choledocholithiasis, Cholangitis, and Biliary Dyskinesia. Prim Care. 2017 Dec;44(4):575-597. [PubMed: 29132521]

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Hiwatashi K, Okumura H, Setoyama T, Ando K, Ogura Y, Aridome K, Maenohara S, Natsugoe S. Evaluation of laparoscopic cholecystectomy using indocyanine green cholangiography including cholecystitis: A retrospective study. Medicine (Baltimore). 2018 Jul;97(30):e11654. [PMC free article: PMC6078678] [PubMed: 30045318]

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Hirajima S, Koh T, Sakai T, Imamura T, Kato S, Nishimura Y, Soga K, Nishio M, Oguro A, Nakagawa N. Utility of Laparoscopic Subtotal Cholecystectomy with or without Cystic Duct Ligation for Severe Cholecystitis. Am Surg. 2017 Nov 01;83(11):1209-1213. [PubMed: 29183521]

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Del Vecchio Blanco G, Gesuale C, Varanese M, Monteleone G, Paoluzi OA. Idiopathic acute pancreatitis: a review on etiology and diagnostic work-up. Clin J Gastroenterol. 2019 Dec;12(6):511-524. [PubMed: 31041651]

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Brägelmann J, Barahona Ponce C, Marcelain K, Roessler S, Goeppert B, Gallegos I, Colombo A, Sanhueza V, Morales E, Rivera MT, de Toro G, Ortega A, Müller B, Gabler F, Scherer D, Waldenberger M, Reischl E, Boekstegers F, Garate-Calderon V, Umu SU, Rounge TB, Popanda O, Lorenzo Bermejo J. Epigenome-Wide Analysis of Methylation Changes in the Sequence of Gallstone Disease, Dysplasia, and Gallbladder Cancer. Hepatology. 2021 Jun;73(6):2293-2310. [PubMed: 33020926]

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Patel SS, Kohli DR, Savas J, Mutha PR, Zfass A, Shah TU. Surgery Reduces Risk of Complications Even in High-Risk Veterans After Endoscopic Therapy for Biliary Stone Disease. Dig Dis Sci. 2018 Mar;63(3):781-786. [PubMed: 29380173]

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Genser L, Vons C. Can abdominal surgical emergencies be treated in an ambulatory setting? J Visc Surg. 2015 Dec;152(6 Suppl):S81-9. [PubMed: 26522504]

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Coleman J. Bile duct injuries in laparoscopic cholecystectomy: nursing perspective. AACN Clin Issues. 1999 Nov;10(4):442-54. [PubMed: 10865529]

Disclosure: Mark Jones declares no relevant financial relationships with ineligible companies.

Disclosure: Connor Weir declares no relevant financial relationships with ineligible companies.

Disclosure: Sassan Ghassemzadeh declares no relevant financial relationships with ineligible companies.

Calculus of Gallbladder with Acute Cholecystitis: Symptoms & More

What is calculus of gallbladder with acute cholecystitis?

The gallbladder is an expandable pear-shaped organ located beneath your liver. The gallbladder stores bile — a dark green fluid that helps your body digest and absorb food.

After you eat, your gallbladder releases bile into your cystic duct. From there, bile moves down the common bile duct and enters your small intestine.

Sometimes this process is inhibited and bile builds up inside your gallbladder, causing it to become larger and inflamed. This buildup can lead to the creation of gallstones, or gallbladder calculi. Gallstones can also form from other substances in the body, such as calcium, bilirubin, or cholesterol.

These gallstones are not an issue as long as they are small in number and remain in the gallbladder space. However, if a stone blocks the cystic duct, inflammation and infection may occur.

Acute cholecystitis is an inflammation of the gallbladder. Most cases of acute cholecystitis are caused by gallstones.

If you have calculus of gallbladder with acute cholecystitis, you may experience some of the following symptoms:

• pain
• abdominal tenderness
• nausea
• vomiting
• dark urine
• pale stools
• fever
• chills
• sweating

On their own, gallstones don’t always lead to symptoms. Eighty percent of people have “silent gallstones” with no symptoms. However, pain is one of the most distinct symptoms of acute cholecystitis. People with calculus of gallbladder with acute cholecystitis will also have pain.

You will usually feel it in the upper right area of your abdomen. Pain may also occur between your shoulder blades or radiate from the abdominal area to your right shoulder.

The onset of the pain is often sudden and may be intense. Often the pain is constant. It can last for a few minutes or hours, and may become worse after you eat.

The exact cause of gallstones hasn’t been pinpointed. They may form as a result of too much cholesterol or bilirubin in your bile. Another possible cause is a malfunctioning gallbladder that doesn’t empty bile properly, leading to bile that’s overly concentrated.

In about 90 percent of cases, acute cholecystitis is caused by gallstones blocking your cystic duct. It may also be caused by tumors or other problems with your bile duct, which may include:

• inflammation
• strictures
• cysts
• trauma
• surgery
• parasites
• infection

However, in most cases the infection that causes acute cholecystitis is a result of gallstones, not the cause.

Gallstones and acute cholecystitis share many of the same risk factors, such as:

• high-fat diet
• high-cholesterol diet
• low-fiber diet
• advanced age
• being a woman
• being overweight or obese
• rapid weight loss
• certain drugs
• pregnancy
• diabetes

Any of the above can increase your chances of developing calculus of gallbladder with acute cholecystitis.

On their own, gallstones are also considered a risk factor for acute cholecystitis.

The following tests may be helpful in diagnosing calculus of gallbladder with acute cholecystitis:

Blood tests

Blood tests provide your doctor with a complete blood count (CBC), and a liver function panel helps them assess your liver function. The results can help your doctor learn if your bile flow is blocked.

Ultrasonography

An ultrasonography is usually the first step to reaching a diagnosis of gallstone disease or acute cholecystitis. It uses sound waves to create an image of your gallbladder and bile ducts.

X-ray

X-rays are often done to rule out other conditions.

Oral cholecystogram (OCG)

An oral cholecystogram (OCG) involves swallowing pills containing a dye before your X-ray is taken. The dye will help your doctor detect any problems with your gallbladder.

Hepatobiliary iminodiacetic acid (HIDA) scan

A HIDA scan can help your doctor track and identify an obstruction in your bile flow. Your doctor will give you an intravenous (IV) injection of a solution containing radioactive tracers. Then they will use a special camera to view the solution move through your body.

Computed tomography (CT)

CT scans can create cross-sectional images of your abdomen. These images allow your doctor to detect gallstones.

Magnetic resonance imaging (MRI)

MRI scans use a magnetic field and radio waves to create an image of your abdomen.

The first step in treating calculus of gallbladder with acute cholecystitis is to control inflammation caused by the acute cholecystitis. Your doctor may prescribe:

• antibiotics to prevent or treat infection
• medications to temporarily control your pain
• fasting to relieve the gallbladder from stress

After your condition is stabilized, your doctor may recommend surgery to remove your gallbladder. This is the only guaranteed way to prevent cholecystitis from happening again.

This procedure is known as a cholecystectomy. A cholecystectomy may be performed laparoscopically or through open surgery.

Laparoscopic surgery is performed by making small incisions in your abdomen.

A small camera and some surgical instruments are then inserted through the incision. The camera displays the inside of your abdomen on a monitor. Your surgeon can then guide the instruments to remove the gallbladder.

Laparoscopic surgery is preferred over classic open surgery because it’s done with small incisions. You’ll recover faster from small incisions. People also prefer this option because it leaves small scars, rather than a large one across the abdomen.

You don’t need your gallbladder for your body to function properly. However, it’s possible to reduce your chances of developing gallstones and acute cholecystitis by:

• losing weight slowly if you are overweight or obese
• maintaining a healthy diet that is rich in fiber and low in fat
• eating more fruits and vegetables

how to detect stones in the gallbladder using ultrasound

Gallstone disease (GSD) is a pathology associated with the formation of stones (calculi) in the lumen of the gallbladder or ducts. For a long time, stone formation may not manifest itself clinically in any way, symptoms appear only when the stone blocks the lumen of the duct and jaundice develops. In other cases, gallstones may be accompanied by subjective discomfort in the right hypochondrium, and sometimes cause an acute attack of cholecystitis.

Most stones become an incidental diagnostic finding during examination for other diseases, only a quarter of patients complain of periodic or acute abdominal pain. The simplest, but informative method for detecting calculi in the biliary tract is an ultrasound examination of the abdominal organs, which allows you to determine the condition of the gallbladder and ducts, as well as determine the size and location of stones.

Gallbladder and ducts: norm and pathology on ultrasound

On ultrasound, the gallbladder looks like an elongated pear-shaped pouch. Its position, shape and size are variable. In the structure of the organ, the bottom, body and neck are distinguished.

The thickness of the wall of the gallbladder is normally no more than 3 mm when examined on an empty stomach, and with tight filling with bile (after eating, especially fatty) – 1 mm. Its thickening may indicate the presence of an inflammatory process, the cause of which can be both diseases of the organ itself (acute or chronic cholecystitis) and other pathologies (heart failure, liver disease, decreased protein levels in the blood, etc.). An acute inflammatory process in the gallbladder is said to be in cases where a small amount of fluid is visualized around it, and the organ wall itself becomes heterogeneous, “loose”.

The neck of the bladder smoothly passes into the cystic duct, it later merges with the common hepatic duct and forms the common bile duct (choledochus, ductus choledochus). In turn, the choledochus opens into the lumen of the duodenum in the region of the major duodenal papilla, where bile enters. The normal diameter of the common bile duct in the initial sections is no more than 6 mm.

Gallstones form in the gallbladder due to changes in the composition of bile secreted. During ultrasound scanning, they are defined as bright structures, from which an acoustic shadow departs, while the bubble itself often increases in size, becomes stretched. The number, size and location of stones in the bladder can vary widely. In cases where the organ is 100% filled with calculi, they speak of a “disabled” gallbladder, i.e. he is no longer able to perform his functions.

Stones change their position in the bladder depending on the position of the patient’s body. To determine the displacement of the stone and conduct a differential diagnosis with a parietal polyp, the ultrasound doctor performs a study in several positions of the patient: lying on his back, on his left side. However, some stones can be tightly fixed to the wall of the gallbladder due to a pronounced inflammatory process around.

Especially dangerous are stones that are wedged into the neck or localized in the lumen of the common bile duct, this can cause obstructive jaundice – a condition in which the natural outflow of bile into the duodenum is disturbed and intoxication of the body with bilirubin occurs.

Preparation

Preparing for abdominal ultrasound.

3 days before the study, gas-forming foods should be excluded from the diet: brown bread, fresh vegetables and fruits, juices, legumes, dairy products, alcohol, carbonated drinks, sweet bakery products.

The last meal before the study should be light and no later than 8-12 hours before the procedure.

Do not drink liquids 3 hours before the examination.

If there is a problem with increased gas formation or constipation: 2 days before the ultrasound, we recommend taking the drug “Espumizan” (2 times a day, one capsule) or activated charcoal (2 times a day, 4 tablets). In case of constipation, 1 day before the examination, cleanse the intestines: put an enema or take a mild laxative, or put a glycerin suppository, or use the Microlax microclyster.

In case of an acute pain attack, the examination is carried out without any preparation.

Further tactics

If stones are found in the lumen of the gallbladder, you should consult a gastroenterologist. Treatment tactics are of two types: conservative and surgical. In the first case, the patient should constantly adhere to a special diet (fatty, smoked, fried, coffee, cocoa, chocolate and some other products are excluded from the diet) and special drugs can be prescribed to dissolve stones. With the ineffectiveness of conservative therapy, surgical intervention is performed.

Operations are of several types and depend on the location of the stones. In cases where the stones are in the gallbladder, laparoscopic or open cholecystectomy is performed – removal of the gallbladder. If the stone is located in the bile duct, one of the varieties of papillosphincterotomy (dissection of the major duodenal papilla) or choledochotomy (dissection of the common bile duct and removal of the calculus) is performed.

The material was prepared by
specialist of the medical center “URO-PRO”
Murashova Oksana Viktorovna,
ultrasound doctor, neurologist, experience 11 years

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Surgery for cholelithiasis (gall bladder stones)

HomeServicesGeneral surgeryCholelithiasis surgery (gall bladder stones)

Who needs gallbladder removal?

We perform removal of the gallbladder in the presence of stones (calculi) in it and with polyps of the gallbladder. The operation is indicated in all patients with stones that have clinical manifestations (attacks of pain, dull pain and discomfort in the hypochondrium, nausea and intolerance to fatty foods) and a complicated course of cholelithiasis (attacks of acute cholecystitis, pancreatitis, mechanical jaundice, stones in the bile ducts and others).
In asymptomatic gallstone disease, prophylactic cholecystectomy can currently be performed to prevent its complications of stone carrying, especially in the presence of small stones in the gallbladder and in people of certain professions and lifestyles (long business trips, expeditions, etc.). Prophylactic removal of the gallbladder is possible in the absence of a high risk of surgery through the use of laparoscopy.

Why is it better to perform the operation in the Medica Medical Clinical Center?

In the medical clinical center, classical laparoscopic cholecystectomy is more often used, it is also possible to perform minilaparoscopic cholecystectomy.
Operations are performed at an expert level on the equipment of the German company Karl Storz. The technique of laparoscopic cholecystectomy in the clinic “Medica” is performed in accordance with the clinical guidelines of the European Society of Endoscopic Surgeons for the prevention of bile duct injuries.

Regardless of the method of removal of the gallbladder during surgery, all patients, without exception, undergo an examination of the bile ducts by C-arm cholangiography, which allows, if necessary, to perform one-stage elimination under anesthesia of pathological changes in the bile ducts (stones, narrowings) detected during cholangiography. ) by applying the technique of antegrade endoscopic papillosphincterotomy. Cholangiography is an obligatory method of intraoperative examination of the bile ducts in case of previous jaundice due to an attack, dilatation of the ducts, and previous attacks of pancreatitis – especially in patients with small stones in the gallbladder.

A highly informative, painless and safe method of examining the bile ducts before surgery is magnetic resonance imaging (MRI cholangiography), which is performed in our center and can be performed in most patients. This method allows the surgeon to obtain information about possible anomalies in the structure of the bile ducts and the presence of pathological changes in them (stones, narrowing, neoplasms) before the operation.

The duration of a comfortable stay in the hospital after a low-traumatic method of gallbladder removal, as a rule, is 2-3 days.

Classical laparoscopic cholecystectomy is a generally accepted technique in the world, performed under general anesthesia through four accesses, from 6 mm to 10 mm long, with the expansion of one of the accesses up to 20-40 mm to remove the gallbladder.

Figure – diagram of the location of accesses for classical laparoscopic cholecystectomy

Minilaparoscopic cholecystectomy is performed with instruments with an outer diameter of 3 to 5 millimeters, the removal of the gallbladder is performed through the umbilical access.