Cholelithiasis (Gallstones): Symptoms, Complications, and Management

Cholelithiasis is the presence of gallstones (calculi) in the gallbladder. Most are asymptomatic ("silent stones"); 10–20% develop symptoms or complications over 10–20 years.

Typical Symptomatic Presentation (Biliary Colic)

• Pain: RUQ or epigastric, severe, steady (not colicky), 30 min–6 hrs; often postprandial (fatty meal); may radiate to right scapula, shoulder, or back.
• Associated: Nausea, vomiting, diaphoresis.
• Relief: Spontaneous as stone falls back; no fever, no peritoneal signs.

Complications & Their Presentations

Diagnosis

• Ultrasound (1st line): Sensitivity 95% for GB stones; assesses wall, fluid, CBD diameter.
• MRCP / ERCP: For suspected CBD stones.
• HIDA scan: If US equivocal for acute cholecystitis (GBEF <35–40%).
• Labs: CBC, LFTs, lipase, amylase, coagulation.

Management

• Asymptomatic: Observation (no prophylactic cholecystectomy except porcelain GB, large stones >3 cm, transplant candidates, sickle cell).
• Symptomatic (biliary colic): Laparoscopic cholecystectomy (gold standard, <1% bile duct injury).
• Acute cholecystitis: Early laparoscopic cholecystectomy (within 72 hrs) or percutaneous cholecystostomy (high surgical risk).
• Choledocholithiasis: ERCP ± sphincterotomy → cholecystectomy (same admission or interval).
• Cholangitis: Antibiotics + biliary drainage (ERCP) within 24 hrs.
• Gallstone pancreatitis: Supportive → cholecystectomy during same admission (mild) or after necrosis resolves (severe).

Neurological Disorders - Related Articles

• Carpal Tunnel Syndrome: Understanding Symptoms, Causes & Surgical Options
• Bobath Exercises: Improving Mobility for Neurological Conditions
• Understanding Cerebral Palsy: Definition, Causes & Diagnosis | NINDS
• Understanding Lou Gehrig's Disease (ALS): Symptoms & Causes
• Psoriasis and Disability: Understanding Eligibility and Benefits
• Infant Neurological Disorders: Symptoms, Diagnosis & Treatment
• Savant Syndrome: Cognitive Profile and Exceptional Skills

Neurological Disorders

• Foot Neuropathy: Causes, Symptoms & Treatment Options
• Electro Homeopathy: Constitution, Temperament, and Individualized Treatment Approach
• Sensory Processing Disorder Tools & Strategies
• Conditions Mimicking Cerebral Palsy: Meningitis, Encephalitis, and Other Neurologic Disorders
• Peripheral Nerve Damage: Symptoms, Causes & Treatment
• Alcoholic Neuropathy: Causes, Symptoms & Treatment
• Stellate Ganglion Injection Recovery: What to Expect & Manage Pain
• Understanding Dyscalculia: Causes, Effects & Support
• Understanding Parkinson's Disease: Symptoms, Causes & Management
• Epilepsy and Circulation: No Direct Link, But Indirect Connections Exist
• Cervical Nerve Damage: Causes, Symptoms & Treatment Options
• Syringomyelia Treatment Options: Conservative, Surgical, and Adjunctive Approaches

Health Sciences © https://www.222health.com

Complication	Mechanism	Key Features
Acute Cholecystitis	Cystic duct obstruction → inflammation	RUQ pain >6 hrs + fever + Murphy's sign + leukocytosis; US: wall thickening, pericholecystic fluid, sonographic Murphy's
Choledocholithiasis	Stone migrates to CBD	Obstructive jaundice, clay stools, dark urine, cholangitis risk; ↑ ALP, GGT, bilirubin; US: dilated CBD (>6–7 mm)
Acute Cholangitis	CBD obstruction + infection	Charcot's triad: RUQ pain, fever, jaundice; Reynolds' pentad: + hypotension, AMS
Gallstone Pancreatitis	Stone impacts ampulla of Vater	Epigastric pain radiating to back; ↑ lipase >3× ULN; US: gallstones + pancreatic edema
Gallstone Ileus	Fistula (cholecystoduodenal) → large stone obstructs ileum	SBO in elderly; Rigler's triad on CT: pneumobilia, ectopic stone, SBO
Mirizzi Syndrome	Stone impacted in cystic duct compresses CHD	Jaundice + cholecystitis; ERCP/MRCP for diagnosis
Porcelain Gallbladder	Wall calcification	↑ Cancer risk (10–25%); prophylactic cholecystectomy