Cholelithiasis (gallstones)

Last reviewed: 8 Jul 2022
Last updated: 04 Jan 2021

Summary

Definition

History and exam

Key diagnostic factors

  • right upper quadrant or epigastric pain (typically lasting >30 minutes)
  • presence of risk factors
Full details

Other diagnostic factors

  • postprandial pain
  • right upper quadrant or epigastric tenderness
  • nausea
  • jaundice
Full details

Risk factors

  • increasing age
  • female sex
  • obesity, diabetes, and metabolic syndrome
  • family history of gallstones
  • gene mutations
  • pregnancy/exogenous oestrogen
  • non-alcoholic liver disease
  • prolonged fasting/rapid weight loss
  • total parenteral nutrition (TPN)
  • medication
  • terminal ileum disease or resection
  • haemoglobinopathy
  • Hispanic and Native-American ethnicity
  • low-fibre diet
  • helicobacter pylori gallbladder infection
Full details

Diagnostic investigations

1st investigations to order

  • abdominal ultrasound
  • serum LFTs
  • FBC
  • serum lipase or amylase
Full details

Investigations to consider

  • magnetic resonance cholangiopancreatography (MRCP)
  • endoscopic ultrasound scan (EUS)
  • abdominal CT scan
Full details

Treatment algorithm

ACUTE

symptomatic cholelithiasis

choledocholithiasis with or without symptoms

ONGOING

asymptomatic cholelithiasis

Contributors

Expert advisers

Eldon Shaffer, MD, FRCPC

Emeritus Professor of Medicine

Division of Gastroenterology

University of Calgary

Calgary

Canada

Disclosures

ES declares that he has no competing interests.

Acknowledgements,

Professor Eldon Shaffer would like to gratefully acknowledge Dr Vikesh K. Singh and Dr Anthony N. Kalloo, previous contributors to this topic.

Disclosures

VKS and ANK declare that they have no competing interests.

Peer reviewers

Christian Macutkiewicz, MD, FHEA, FRCS

Consultant General and Hepato-Pancreato-Biliary Surgeon

Clinical Lead for Emergency General Surgery, Gastrointestinal Medicine, and Surgery CSU

Manchester Royal Infirmary

Manchester

Director of Scientific Programme

Association of Surgeons of Great Britain and Ireland

UK

Disclosures

CM declares that he has no competing interests.

Luke Evans, MBBS, FRCS (GenSurg) MCh, DGM, FEBS (Emerg Surg)

Consultant in Emergency General Surgery

Service Director for Emergency Assessment Unit (Surgical)

Norfolk and Norwich University Hospitals

Norwich

UK

Disclosures

LE declares that he has no competing interests.

Editors

Celia Pincus,

Section Editor, BMJ Best Practice

Disclosures

CP declares that she has no competing interests.

Jo Haynes,

Head of Editorial, BMJ Knowledge Centre

Disclosures

JH declares that she has no competing interests.

Adam Mitchell,

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

Julie Costello,

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

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