Clinical Review ABC of the upper gastrointestinal tract

Upper abdominal pain: Gall bladder

BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7322.1170 (Published 17 November 2001) Cite this as: BMJ 2001;323:1170
  1. C D Johnson

    Gall stones are common but often do not give rise to symptoms. Pain arising from the gall bladder may be typical of biliary colic, but a wide variety of atypical presentations can make the diagnosis challenging. After a period of uncertainty in the 1980s, when operative techniques were challenged by drug treatment and lithotripsy, it is now widely accepted that symptomatic gallbladder stones should be treated by laparoscopic cholecystectomy. Clinical judgment and local expertise will greatly influence the management of bile duct stones, particularly if cholecystectomy is also required.

    Asymptomatic gall stones are common and require no treatment Typical symptoms include biliary colic—right upper quadrant pain, radiating to the back, and lasting less than 12 hours Symptomatic gall stones are usually treated by laparoscopic cholecystectomy

    Epidemiology of gall stones

    In the United Kingdom about 8% of the population aged over 40 years have gall stones, which rises to over 20% in those aged over 60. Fortunately, 90% of these stones remain asymptomatic, but cholecystectomy is the most commonly performed abdominal procedure.

    Risk factors for gall stones

    Cholesterol stones
    • Obesity

    • High fat diet

    • Oestrogens (female, pregnancy, oral contraception)

    • Hereditary

    • Loss of bile salts (Crohn's disease, terminal ileal resection)

    • Impaired gall bladder emptying (such as truncal vagotomy, type 1 diabetes, octreotide, parenteral nutrition, and starvation or rapid voluntary weight loss)

    Pigment stones
    • Haemolytic disease

    • Biliary stasis

    • Biliary infection

    Mixed gall stone with bilirubin nucleus and attached clear cholesterol crystals

    The incidence of gall stones varies widely, being greatly influenced by dietary intake, particularly of fat. For example, in Saudi Arabia gallstone disease was virtually unheard of 50 years ago, but, with increasing affluence and a Western type diet, gall stones are now as common there as in many Western countries. Genetic factors also contribute. The native Indian populations of Chile and Peru are highly susceptible, with a close to 100% lifetime risk of gall stones …

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