Gallstones

Refers to the formation of hard stones in the gallbladder

Aetiology

Risk factors

  • 'Fair, fat, fertile, female and forty'
  • Other risk factors include:
    • Increasing age
    • Positive family history
    • Loss of bile salts e.g. Crohn's
    • Diabetes
    • Dysmotility of gall bladder
    • Prolonged fasting
    • TPN

Pathophysiology

  • Cholesterol gallstones (10%) develop when bile contains too much cholesterol and not enough bile salts - bile stasis, excess cholesterol
  • Pigment stones (10%) are caused by excess bilirubin
  • 80% of gallstones are mixed - pigment and cholesterol

Clinical presentation

  • Vast majority of people with gallstones are asymptomatic
  • Some may experience nausea, early satiety and bloating
  • Each year 1-4% of people with gallstones will have an acute presentation - 60% biliary colic, 40% acute cholecystitis

Management

  • Depends on nature of presentation