Cholelithiasis (gallstones)

Gallstone disease (cholelithiasis) is highly prevalent, but most cases are asymptomatic.

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 the most common gastrointestinal disease that requires hospitalisation in developed countries.

Cholelithiasis is the presence of solid concretions in the gallbladder. Gallstones form in the gallbladder but may exit into the bile ducts (choledocholithiasis). Symptoms ensue if a stone obstructs the cystic, bile, or pancreatic duct.

Most gallstones in developed countries (>90%) consist of cholesterol. 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.

This topic covers only the diagnosis and management of symptomatic uncomplicated cholelithiasis and asymptomatic or symptomatic choledocholithiasis. For detailed information on the diagnosis and management of patients with acute cholecystitis, acute cholangitis, or acute pancreatitis, see our topics Acute cholecystitis, Acute cholangitis, and Acute pancreatitis.