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Etiology

Several factors determine the formation of gallstones. These factors are: altered composition of hepatic bile, nucleation of cholesterol crystals, and impaired gallbladder function.

Predisposing Factors

1. Obesity
2. Female sex hormone (estrogen)
3. Multiparous women
4. Increasing age( >40 years old)
5. Ileal disease and resection
6. Chronic liver disease
7. Diabetes mellitus
8. Hematologic disease (hemolysis)

Clinical Manifestations

Most stones in the gallbladder are asymptomatic unless they migrate into the neck of gallbladder or into the common bile duct. The most symptom of gallstone disease is epigastric or right upper quadrant pain with frequent radiation to right scapula or shoulder. Acute cholecystitis often begins as an attack of biliary colic that progressively worsens. Fever is characteristically present. Poor appetite, jaundice, nausea, and vomiting may occur.

Diagnosis

1. Image studies:

Ultrasound of abdomen

• CT scan and MRI
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Percutaneous transhepatic cholangiograpgy (PTC)
• Oral cholecystogram

2. Laboratory studies: bilirubin, liver function test

Treatment

Treatment is not needed for asymptomatic patients. Laparoscopic cholecystectomy or open cholecystectomy should be performed for the patients with symptomatic gallstones.

Other measures

In acute stage, general measures include bed rest, intravenous fluids, no oral alimentation or a light diet, relief of pain, and antibiotics treatment.

For patients with asymptomatic gallstones, fat and calorie-lowering diet, avoid overeating, adequate water intake, and regular OPD follow-up are recommended.