Curriculum · Gastroenterology
Gallstones: cholelithiasis and choledocholithiasis
What it is
Cholelithiasis involves the presence of gallstones in the gallbladder. Choledocholithiasis refers to the presence of gallstones in the common bile duct (CBD). The types of stone are cholesterol, pigmented from chronic hemolysis, and mixed.
Causes and risk
Gallstones carry the F risk factor features: female, fat, forty, fertile.
How it presents
Gallstones are often asymptomatic and found incidentally on imaging. When they become symptomatic the pain is usually in the right upper quadrant or epigastrium. Most patients with symptomatic gallstones present with chronic cholecystitis, which causes recurrent attacks of pain: the pain is constant, increases in severity at the beginning, and lasts from 1 to 5 hours. It often starts during the night after a fatty meal and may be associated with nausea and vomiting. Where the stone sits decides the picture. A stone that reaches the neck or cystic duct obstructs and causes pain, then either goes back or passes, and that is biliary colic. If it stays longer, about 6 hours, it causes inflammation, and that is acute cholecystitis.