Gallstone disease

Gallstones are commonly found in the middle to the elderly aged population.  They are found in the gallbladder as a result of a variety of risk factors.

Gallstones are of primary of 3 types

Yellow cholesterol stones (70%-80%)- Due to supersaturation of bile with cholesterol

Black pigment stones (20%-25%)- Due to the precipitation of calcium with unconjugated bilirubin.  

Brown pigment stones- are commonly associated with bacterial infection due to the release of beta-glucuronidase to hydrolyze glucuronic acid from bilirubin. 




  • Modifiable risk factors

  1. Obesity
  2. Low fiber high calorie foods
  3. Low physical activity
  4. Hypertriglyceridemia
  5. Low HDL and high LDL
  6. Metabolic syndrome

  • Non-modifiable risk factors

  1. Age
  2. More common in females 
  3. Inherited lipid metabolism disorders

Signs and Symptoms

  • Right upper quadrant pain predominantly post-meals, especially if the high-fat meal
  • Nausea and vomiting
  • Fever (Acute cholecystitis, cholangitis)
  • Leukocytosis
  • Altered mental status (cholangitis)

Complications

Management

  • Transabdominal ultrasound for diagnosis
  • Endoscopic ultrasound (EUS)
  • Hepatobiliary iminodiacetic acid (HIDA) scan
  • Endoscopic retrograde cholangiopancreatography (ERCP)

Treatment

  1. Lifestyle modifications
  2. Cholecystectomy

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