15/10/2024
A gallstone (cholelithiasis) is a solid deposit that forms within the gallbladder. Gallstone disease describes the presence of one or more stones in the gallbladder or biliary tree. Gallstones occur when there is a problem relating to the chemical composition of bile.
Causes: cholesterol supersaturation, accelerated cholesterol crystal nucleation, and impaired gallbladder motility.
Risk factors:
Crohn's disease
Diabetes mellitus
Diets high in triglycerides, carbs and low in fibre
Female, genetic and ethnic factors, increasing age
Medication
Non-alcoholic fatty liver disease
Obesity
HRT
Biliary colic is the most common complication and acute cholecystitis is the second most common complication of gallstone disease. Other rare complications are cholangitis and pancreatitis.
Mgmt:
An abdominal ultrasound examination and a blood test to measure liver function tests (LFTs) should be arranged for people suspected of having gallstone disease. Sometimes magnetic resonance cholangiopancreatography (MRCP) or endoscopic ultrasound (EUS) are required. No treatment is required for people with asymptomatic gallstones found in a normal gallbladder, and with a normal biliary tree. However, referral should be offered to people with asymptomatic gallstones found in the common bile duct for consideration for bile duct clearance and laparoscopic cholecystectomy.
Emergency admission should be arranged for people who are systemically unwell with a suspected complication of gallstone disease, such as acute cholecystitis, cholangitis, or pancreatitis. Urgent referral should be arranged for people with known gallstones and jaundice, or if there is a clinical suspicion of biliary obstruction (for example, significantly abnormal liver function tests).
All other people with symptomatic gallstone disease should be referred to a surgeon for consideration of laparoscopic cholecystectomy, with the referral urgency dependent on clinical judgment.
Appropriate pain relief should be offered to people awaiting secondary care assessment.
For severe pain, diclofenac or an opioid should be administered intramuscularly.
For intermittent mild to moderate pain, paracetamol or a nonsteroidal anti-inflammatory drug (NSAID), should be offered.
If pain cannot be managed in primary care the person should be referred to hospital.
REF: Nice Guidelines 2024