Cholelithiasis (Gallstones)

Last reviewed: 3 May 2023
Last updated: 28 Oct 2020

Summary

Definition

History and exam

Key diagnostic factors

  • right upper quadrant or epigastric pain (lasting >30 minutes)
More key diagnostic factors

Other diagnostic factors

  • postprandial pain
  • right upper quadrant or epigastric tenderness
  • nausea
  • jaundice
Other diagnostic factors

Risk factors

  • increasing age
  • female sex
  • Hispanic and Native American ethnicity
  • family history of gallstones
  • gene mutations
  • pregnancy/exogenous estrogen
  • obesity, diabetes, and metabolic syndrome
  • nonalcoholic liver disease
  • prolonged fasting/rapid weight loss
  • total parenteral nutrition (TPN)
  • octreotide
  • incretin-based drugs
  • ceftriaxone
  • terminal ileum disease or resection
  • hemoglobinopathy
  • low-fiber diet
  • helicobacter pylori gallbladder infection
More risk factors

Diagnostic investigations

1st investigations to order

  • CBC
  • serum LFTs
  • serum lipase or amylase
  • abdominal ultrasound
More 1st investigations to order

Investigations to consider

  • abdominal CT scan
  • magnetic resonance cholangiopancreatography (MRCP)
  • endoscopic ultrasound scan (EUS)
  • endoscopic retrograde cholangiopancreatography (ERCP)
More investigations to consider

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 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

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 (Healthcare informatics)

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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