Summary

• Gallstones are highly prevalent, but most (80%) are asymptomatic.
• Symptoms occur when stones obstruct the cystic or bile ducts.
• Cholesterol gallstone formation begins with the secretion of bile supersaturated with cholesterol from the liver. Initiated by nucleating factors such as mucin, microscopic crystals then precipitate in the gallbladder where hypomotility provides time for stone growth.
• Common risk factors include older age, female sex and pregnancy, obesity, rapid weight loss, drugs, and a family history.
• Abdominal ultrasound provides effective diagnostic imaging.
• Laparoscopic cholecystectomy represents definitive treatment for symptomatic patients.
• Complications such as cholecystitis, cholangitis, and pancreatitis develop in 0.1% to 0.3% of patients annually.
• Gallstones are thus the most common gastrointestinal disease requiring hospitalisation in the US.