What is Cholelithiasis?

From the Guidelines

Cholelithiasis is a common disease characterized by the presence of gallstones, which can be asymptomatic or symptomatic, with symptoms including severe, steady biliary pain, and potential complications such as acute cholecystitis, acute pancreatitis, and gallbladder cancer. The diagnosis of cholelithiasis can be made using ultrasonography, oral cholecystography, or plain roentgenography, with ultrasonography being the most accurate method for detecting gallstones, with a reported accuracy of 96% 1.

Key Characteristics of Cholelithiasis

• Most cases are asymptomatic, with the patient remaining unaware of its presence 1
• Symptomatic disease generally occurs as uncomplicated, infrequent biliary pain, with episodes appearing suddenly as severe, steady pain that is unaffected by household remedies, position change, or gas passage 1
• Complications of cholelithiasis include acute cholecystitis, acute pancreatitis, common duct obstruction, ascending cholangitis, gallbladder cancer, and gallstone ileus 1

Diagnosis and Management

• Ultrasonography is the first choice of investigation for biliary symptoms or right upper quadrant abdominal pain, due to its high accuracy and ability to diagnose or exclude gallstones, as well as differentiate cholelithiasis from gallbladder sludge, polyps, or masses 1
• The diagnosis of chronic cholecystitis is difficult on anatomic imaging, but ultrasonography can help identify gallbladder wall thickening, pericholecystic fluid, and other signs of inflammation 1
• Management of cholelithiasis depends on the presence and severity of symptoms, as well as the risk of complications, with options including watchful waiting, medications to manage symptoms, and surgical removal of the gallbladder (cholecystectomy) for symptomatic cases or those with a high risk of complications 1

From the Research

Definition of Cholelithiasis

• Cholelithiasis refers to the formation of gallstones in the gallbladder 2, 3, 4, 5, 6
• Gallstones are relatively common in the general population and can be asymptomatic or cause symptoms such as biliary colic or vague gastrointestinal symptoms 2

Types of Gallstones

• Gallstones can be composed of calcium bilirubinate and cholesterol monohydrate crystals 3
• Biliary sludge, also known as microlithiasis, biliary sand or sediment, pseudolithiasis, and microcrystalline disease, can also occur in the gallbladder 3

Diagnosis of Cholelithiasis

• Abdominal ultrasonography is the most useful diagnostic tool for gallstones, showing high sensitivity and specificity 2
• Endoscopic ultrasonography, abdominal CT, MRCP, or ERCP can also be used to identify complications or other accompanying diseases caused by gallstones 2

Treatment of Cholelithiasis

• Asymptomatic gallstones do not require specific treatment, but a cholecystectomy may be necessary if the patient has a high risk of complications or gallbladder cancer 2
• Oral bile acid dissolution therapy using ursodeoxycholic acid can be attempted for patients with mild or atypical symptoms who are unable or unwilling to undergo a cholecystectomy 2, 4, 5
• Cholecystectomy is the treatment of choice for patients who develop biliary-type pain, cholecystitis, cholangitis, or pancreatitis 3, 4, 6