Open main menu

Wikibooks β

Surgical Procedures/Abdominal Surgery/Cholelithiasis

< Surgical Procedures‎ | Abdominal Surgery




  • Approximately 10% of the population have gallstones.
  • The majority of the gallstones are asymptomatic.
  • Only approximately 30% of sufferers have surgery.


  • Cholesterol stones (Approximately 6%, less common).
  • Mixed stones (Approximately 90%, common).
  • Pigment stones (Uncommon).

Incidence of gallstones:Edit

Classically: Fat, fertile flatulent female of  fifty (forty).

Commonest Causal Factors:Edit

  • Cholesterol stones:
    Approximately 75% of all gall stones are Cholesterol stones.
    • Excess of cholesterol relative to bile salts and phospholipids allowing cholesterol crystals to form.
    • Infection can cause cholesterol gallstone.
    • Oestrogens reduces gallbladder contraction and increases chances to gallstone formation.
    • Multiple pregnancies/contraceptive use.
    • Obesity.
    • Rapid weight loss.
    • Infestation with:
      • Clonorchis sinensis, Ascaris Lumbricoides etc.
  • Pigmented stones:
    Approximately 25% of all gall stones are Pigmented Stones.
    • Black color Pigmented Stones:
      • Sufferer with Hemolytic disorders.
      • Sufferer with cirrhosis.
    • Brown color Pigmented stones:
      • Sufferer are mostly Asian population.
      • Bacterial Infection.
  • Mixed stones:
    • mixed of cholesterol and pigmented.


  • USG.
  • CT.

Asymptomatic gallstones diseaseEdit


  • Approximately 50% gallstone sufferer are Asymptomatic.
  • Generally do not require Surgical treatment. (Depending on the indication).
  • Relative Indication:
    • Large stones ( >2-3 cm ) with high risk of cholecystitis.
    • High or increased risk of malignancy (cancer).
    • Sufferer's age above 70.
    • Sufferer with Sugar disease (Diabetes): New evidence suggests that cholecystectomy should be done for the same indications as general population. thaere is no need of prophylactis cholecystectomy in asymptomatic gallstones in diabetics..
    • Sufferer with Immune diseases.
  • Suggestive of gallstone disease.
    • Sufferer with Dyspepsia.
    • Vague abdominal discomfort.
      • Around Epigastric region.
    • Sufferer with increased flatulence.

Symptomatic Gallstone DiseaseEdit

  • Pain:
    • Known as Biliary colic.
    • Usually Right Upper Quadrant (sided) chest/abdominal pain.
      • Usually pain after oily food.
      • Quick pain which lasts few moments to few hours.
      • Pain with discomfort.
      • Pain often radiates (travels) towards  right scapula (back).
  • Nausea and Vomiting may also present with pain.
  • Acute Cholecystitis:
    • Occurs in approximately 10% of symptomatic gallstone disease.
    • Treatment of choice:
      • Laparoscopic cholecystectomy.
      • Open cholecystectomy.
      • Percutaneous transhepatic placement of a cholecystostomy tube.


Effects and Complication of GallStonesEdit

  • In the gall bladder:
    • Asymptomatic gallstone.
    • Hydrops of the gallbladder.
    • Flatulent dyspepsia.
    • Gallstone colic.
    • Acute Obstructive cholecystitis which may lead to:
      • Mucocele.
      • Empyema.
      • Gangrene.
      • Perforation.
      • Fistula.
    • Chronic Cholecystitis.
    • Carcinoma.
  • In the CBD:
    • Obstructive jaundice..
    • Liver failure.
    • Cholangitis.
    • Acute or recurrent pancreatitis.
  • In the pancreas:
    • Acute Pancreatitis.
    • Acute relapsing Pancreatitis.
    • Chronic Pancreatitis.
  • In the Intestine:
    • Gallstone Ileus.

Gallstones with other Diseases:Edit

Gallstone may be associated with other diseases.

  • Saint's Triad:
    • Gallstone + Hiatus Hernia + Diverticulosis of the Colon.
  • Cholecystic Heart:
    • Diseased gallbladder may cause decreased coronary blood flow, arrythmia or heart block in previously heart disorder.
  • Asymptomatic Gallstones:
    • After long follow-ups, approximately 50% asymptomatic turns into symptomatic.

About Gall Bladder and CholelithiasisEdit