Cholelithiasis
Cholelithiasis is the medical term for gallstones – solid deposits that form in the gallbladder, a small organ beneath the liver that stores and releases bile (a digestive fluid).
---
🔹 Causes & Risk Factors
Gallstones form when the balance of substances in bile is disrupted (cholesterol, bile salts, and bilirubin).
Common risk factors are remembered by the "5 F’s":
Female
Forty (middle-aged)
Fertile (pregnancy, high estrogen)
Fat (obesity, high-fat diet)
Fair (more common in Caucasians)
Other risk factors:
Rapid weight loss or fasting
Family history
Certain medical conditions (hemolytic anemia, cirrhosis, Crohn’s disease)
---
🔹 Types of Gallstones
1. Cholesterol stones (most common) – usually yellow-green
2. Pigment stones – made of bilirubin, more common in liver disease or hemolysis
3. Mixed stones
---
🔹 Symptoms
Many patients are asymptomatic (“silent stones”)
Symptomatic (biliary colic):
Sudden, severe right upper abdominal pain (often after fatty meals)
Pain may radiate to the right shoulder or back
Nausea, vomiting, bloating
---
🔹 Complications
Cholecystitis – inflammation of the gallbladder
Choledocholithiasis – stones in the common bile duct
Cholangitis – infection of bile ducts (fever, jaundice, pain – Charcot’s triad)
Gallstone pancreatitis
---
🔹 Diagnosis
Ultrasound → first-line investigation
CT/MRI if complications suspected
LFTs (liver function tests) may show abnormalities if bile duct is blocked
---
🔹 Treatment
Asymptomatic: usually no treatment, just monitoring
Symptomatic:
Cholecystectomy (surgical removal of gallbladder, laparoscopic preferred) – definitive treatment
Pain relief (NSAIDs, opioids if severe)
In high-risk patients unfit for surgery: medications like ursodeoxycholic acid (for small cholesterol stones)
---
