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  • • Divided into symptomatic and asymptomatic

    • Caused by cholesterol (most common), black pigment, or brown pigment stones

    • Cholesterol stones form in 20% of women and 10% of men by age 60

    • Cholesterol stone risk factors include:

    • -Female gender

      -Age

      -Obesity

      -Estrogen exposure

      -Fatty diet

      -Rapid weight loss

    • Black pigment stone risk factors include:

    • -Hemolytic disorders

      -Living in Asia

    • Brown pigment stone risk factors include:

    • -Biliary stasis

      -Biliary infections

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Epidemiology

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  • • 20 million affected in United States

    • Symptoms develop in about 3% of asymptomatic patients each year (20-30% over 20 years)

    • Each year, complicated gallstone disease affects 3-5% of patients who are symptomatic

    • Each year, complicated gallstone disease affects < .5% of patients who are asymptomatic

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Symptoms and Signs

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  • • Asymptomatic

    • Biliary colic

    • -Right upper quadrant or epigastric

      -Episodic, often after meals or at night, lasting as long as 2-4 hours

    • Nausea

    • Vomiting

    • Diarrhea

    • Mild right upper quadrant tenderness to palpation

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Laboratory Findings

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  • • Normal liver function tests, normal amylase and lipase, normal WBC count

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Imaging Findings

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  • • Right upper quadrant US showing acoustically dense stones in gallbladder with acoustic shadowing without evidence of gallbladder wall thickening or pericholecystic fluid (> 90% sensitive for gallstones)

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  • • Other causes of abdominal pain

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Rule Out

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  • • Cholecystitis

    • Choledocholithiasis

    • Pancreatitis

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  • • History and physical exam

    • CBC

    • Liver function tests

    • Amylase and lipase

    • Right upper quadrant US

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Surgery

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  • • Laparoscopic cholecystectomy

    • Open cholecystectomy

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Indications

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  • • Symptomatic cholelithiasis

    • Porcelain gallbladder (25% risk of carcinoma)

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Contraindications

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  • • First or third trimester of pregnancy (relative)

    • Previous upper abdominal surgeries (laparoscopic)

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Complications

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  • • Bile duct injury or leak

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References

Beckingham IJ: ABC of diseases of liver, pancreas, and biliary system. Gallstone disease. BMJ 2001;322:91.  [PubMed: 11154626]
Glasgow RE et al: The spectrum and cost of complicated gallstone disease in California. Arch Surg 2000;135:1021.  [PubMed: 10982504]

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