Written by Dr. Vardhan S Bhobe, MS General Surgery, FIAGES, FAIS, General and Laparoscopic Surgeon
Gallbladder stone disease, or cholelithiasis, refers to the formation of gallstones—solid stones formed mainly from cholesterol or bilirubin—within the gallbladder. It is a common condition affecting up to 10–15% of the adult population, with higher prevalence in women, multiparity, individuals over 40, obese individuals, and those with a sedentary lifestyle or certain ethnic backgrounds (e.g., Native Americans).
Gallstones are broadly classified into cholesterol stones (most common in Western countries) and pigment stones (more common in Asia and in patients with hemolytic disorders or chronic infections). Cholesterol stones form due to bile supersaturation with cholesterol, gallbladder hypomotility, and mucus hypersecretion, which facilitates stone nucleation and growth.
Most gallstones are asymptomatic, discovered incidentally on imaging. However, symptomatic cholelithiasis can lead to biliary colic, characterized by sudden, intense, right upper quadrant or epigastric pain that may radiate to the right shoulder or back. This pain typically follows 2 hours after a fatty meal and may last from 30 minutes to several hours.
Complications of gallstone disease include:
- Acute cholecystitis (gallbladder inflammation)
- Choledocholithiasis (stones in the common bile duct)
- Cholangitis (bile duct infection)
- Gallstone pancreatitis
- Gallbladder empyema or perforation
Diagnosis is usually made via ultrasonography, which is highly sensitive and specific for detecting gallstones. Additional imaging like MRCP (Magnetic Resonance Cholangiopancreatography) or ERCP (Endoscopic Retrograde Cholangiopancreatography) may be necessary for suspected ductal stones or complications.
Management depends on symptoms and complications:
- Asymptomatic gallstones typically do not require treatment.
- Symptomatic gallstones or complicated cases warrant laparoscopic cholecystectomy, the gold standard treatment. Laparoscopic Surgery is painless, cosmetic due to minimal cuts, bloodless, without stitches, often daycare with a quick recovery and fast return to work.
- Non-surgical options, like oral bile acid dissolution therapy (ursodeoxycholic acid) or extracorporeal shock wave lithotripsy, are mostly ineffective.
- In high-risk surgical patients, percutaneous drainage or endoscopic interventions may be considered, to tide over an emergency.
Prevention includes weight control, dietary modifications (low-fat, high-fiber diets), and physical activity. Rapid weight loss should be avoided, as it increases the risk of stone formation. Top of Form
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