Refers to the formation of hard stones in the gallbladder

Aetiology

Risk factors

• 'Fair, fat, fertile, female and forty'
• Other risk factors include:
  • Increasing age
  • Positive family history
  • Loss of bile salts e.g. Crohn's
  • Diabetes
  • Dysmotility of gall bladder
  • Prolonged fasting
  • TPN

Pathophysiology

• Cholesterol gallstones (10%) develop when bile contains too much cholesterol and not enough bile salts - bile stasis, excess cholesterol
• Pigment stones (10%) are caused by excess bilirubin
• 80% of gallstones are mixed - pigment and cholesterol

Clinical features

• Vast majority of people with gallstones are asymptomatic
• Some may experience nausea, early satiety and bloating
• Each year 1-4% of people with gallstones will have an acute presentation - 60% biliary colic, 40% acute cholecystitis

Management

• Depends on nature of presentation