From the Guidelines
Cholelithiasis is the medical term for gallstones, which are hardened deposits that form in the gallbladder, and it is crucial to prioritize treatment based on symptom severity to minimize morbidity, mortality, and improve quality of life. These stones develop when substances in bile, primarily cholesterol and bilirubin, crystallize and form solid masses 1. Gallstones can vary in size from tiny grains to larger stones measuring several centimeters. They may cause no symptoms (asymptomatic cholelithiasis) or lead to complications such as biliary colic, cholecystitis (gallbladder inflammation), or blockage of bile ducts.
Key Points
- Risk factors include female gender, obesity, rapid weight loss, certain medications, and genetic predisposition.
- Treatment depends on symptom severity, ranging from watchful waiting for asymptomatic cases to surgical removal of the gallbladder (cholecystectomy) for symptomatic patients, with laparoscopic cholecystectomy being a safe and feasible option for elderly patients with acute cholecystitis 1.
- Medications like ursodeoxycholic acid may help dissolve small cholesterol stones in select cases, but surgery remains the definitive treatment for symptomatic gallstones.
- The gallbladder is not essential for digestion, so its removal typically doesn't cause long-term digestive problems for most people.
Diagnosis and Management
- Abdominal ultrasound is the preferred initial imaging technique for diagnosing gallstones, especially in elderly patients 1.
- Combination of symptoms, signs, and laboratory tests results may have better diagnostic accuracy in confirming the diagnosis of acute cholecystitis.
- Early laparoscopic cholecystectomy should be performed as soon as possible, but can be performed up to 10 days of onset of symptoms, with earlier surgery associated with shorter hospital stay and fewer complications 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Definition of Cholelithiasis
- Cholelithiasis refers to the formation of gallstones in the gallbladder 2, 3, 4.
- It is a common medical problem that can lead to surgical intervention, with approximately 500,000 cholecystectomies performed in the US every year 2.
- The presence of gallstones increases with age, and it is estimated that 20% of adults over 40 years of age and 30% of those over 70 have biliary calculi 2.
Risk Factors and Complications
- Risk factors for gallstone formation include obesity, diabetes mellitus, estrogen and pregnancy, hemolytic diseases, and cirrhosis 2.
- Complications of cholelithiasis can include choledocholithiasis, gallstone ileus, and acute gallstone pancreatitis 2, 4.
- Biliary colic, acute cholecystitis, and cholangitis are also potential complications of gallstones 3, 4.
Diagnosis and Treatment
- Ultrasonography is the diagnostic test of choice for cholelithiasis, with a sensitivity of 90-95% 2.
- Laparoscopic cholecystectomy is the treatment of choice for symptomatic gallstones, and it is also used in the treatment of acute cholecystitis 2, 3, 4.
- Endoscopic retrograde cholangiopancreatography (ERCP) is used to treat symptomatic bile duct stones, and it is also used in the diagnosis of choledocholithiasis 5, 4.