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Cholelithiasis (Gallstones)

Last reviewed: 12 Oct 2024
Last updated: 28 Oct 2024

Summary

Definition

History and exam

Key diagnostic factors

  • right upper quadrant (RUQ) or epigastric pain (lasting >30 minutes)
Full details

Other diagnostic factors

  • postprandial pain
  • RUQ or epigastric tenderness
  • nausea
  • jaundice
Full details

Risk factors

  • increasing age
  • female sex
  • Hispanic and American Indian ethnicity
  • family history of gallstones
  • gene mutations
  • estrogen and progesterone
  • obesity, diabetes, and metabolic syndrome
  • nonalcoholic liver disease
  • prolonged fasting/rapid weight loss
  • total parenteral nutrition (TPN)
  • octreotide
  • glucagon-like peptide 1 (GLP-1) analogs
  • ceftriaxone
  • terminal ileum disease or resection
  • hemoglobinopathy
  • cirrhosis
  • cystic fibrosis
  • diet and lifestyle
  • helicobacter pylori gallbladder infection
Full details

Diagnostic tests

1st tests to order

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

Tests to consider

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

Treatment algorithm

ACUTE

symptomatic cholelithiasis

choledocholithiasis with or without symptoms

ONGOING

asymptomatic cholelithiasis

Contributors

Authors

Eldon Shaffer, MD, FRCPC

Emeritus Professor of Medicine

Division of Gastroenterology

University of Calgary

Calgary

Canada

Disclosures

ES is an author of several references cited in this topic.

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

Timothy B. Gardner, MD

Assistant Professor

Director of Pancreatic Disorders

Section of Gastroenterology

Dartmouth-Hitchcock Medical Center

Lebanon

NH

Disclosures

TBG declares that he has no competing interests.

Ajith Siriwardena, MD, FRCS

Professor of Hepatobiliary Surgery

Manchester Royal Infirmary

Manchester

UK

Disclosures

AS declares that he has no competing interests.

Kurinchi Gurusamy, MBBS, MS, MRCS, MSc

Clinical Research Fellow

Hepatopancreatobiliary and Liver Transplant Surgery

University Department of Surgery

Royal Free Campus

UCL Medical School

London

UK

Disclosures

KG declares that he has no competing interests.

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