Gallstones


Gallstones are a common problem. The incidence of gallstones increases with age, and estimated to be 10% of people over the age of 50.


The majority of people with gallstones do not get any symptoms. In about 20% of cases, gallstones become symptomatic (causing severe pain), which may lead to complications and/or surgery. The complications of gallstones include acute and chronic cholecystitis (inflammation of gallbladder) which may lead to empyema (abscess formation), gangrene or perforation of the gallbladder. Gallstone(s) jammed in the bile duct can cause cholangitis (infection), jaundice and acute pancreatitis (inflammation of pancreas).

Patients who have pain or other symptoms from gallstones need urgent specialist assessment. Most patients are relatively straightforward and progress from an ultrasound scan to surgery and its over! Others may require more complex investigations and treatment depending on details and it’s important to get this right.


Management Pathway

A patient typically presents with abdominal pain, is referred to a clinic, and undergoes an abdominal ultrasound. If the findings suggest uncomplicated gallstones, the doctor will discuss surgery with the patient. The surgery to remove gallbladder and gallstones is called a cholecystectomy. This is almost always possible using laparoscopic (keyhole) surgery.

If there are unusual features or uncertainty about any findings, he/she needs a medical assessment and further imaging with CT or MRI. It may be necessary to carry out an ERCP before a cholecystectomy.

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OGD = oesophago-gastro-duodenoscopy or gastroscopy, ERCP = endoscopic retrograde cholangio-pancreatography, EUS = endoscopic ultrasound
US = ultrasound, CT = computed tomography, MRI = magnetic resonance imaging, MRCP = magnetic resonance cholangio-pancreatography