Stones in gallbladder; may be asymptomatic, cause biliary colic, cholecystitis, or complications.
History taking
- • Postprandial RUQ pain radiating to right shoulder, after fatty meals
- • Nausea, vomiting, fever (cholecystitis), jaundice (CBD stone)
- • Risk factors: female, fat, fertile, forty, family history
Examination
- • RUQ tenderness, Murphy's sign positive in cholecystitis
- • Look for jaundice, palpable mass, signs of sepsis
Red flags
- • Fever + jaundice + RUQ pain (Charcot's triad) — cholangitis
- • Signs of peritonitis, sepsis
- • Gallstone pancreatitis
Differential diagnosis
- • Peptic ulcer, GERD, MI, hepatitis, hepatic abscess, renal colic
Recommended investigations
- • USG abdomen — first-line (sensitivity 95%)
- • LFT, lipase if pancreatitis suspected; CBC, CRP
- • MRCP if CBD stone suspected; ERCP therapeutic
Diagnosis
- • USG: stones, GB wall thickness, CBD diameter
Initial treatment / management
- • Symptomatic: elective laparoscopic cholecystectomy
- • Acute cholecystitis: admit, IV antibiotics, early lap chole (within 7 d)
- • CBD stone: ERCP + sphincterotomy then cholecystectomy
Prescription examples
- • Acute: Inj Piperacillin-Tazobactam 4.5 g IV TDS
- • Pain: Inj Diclofenac 75 mg IM, Tab Paracetamol 1 g QID
- • NPO, IV fluids in acute
Follow-up advice
- • Post-op review at 1 week; reduce dietary fat initially
- • Asymptomatic incidental stones — usually no intervention unless porcelain GB, large stones >3 cm
Patient counselling
- • Low-fat diet, weight management
- • Recurrent attacks → surgery
Referral criteria
- • All symptomatic gallstones — surgery
- • Cholangitis, pancreatitis — urgent admission
Clinical pearls
- • Porcelain gallbladder has cancer risk — prophylactic cholecystectomy
- • Mirizzi syndrome (impacted cystic duct stone with jaundice) — surgical challenge
References
- • Tokyo Guidelines 18 (TG18) for acute cholangitis and cholecystitis
- • SAGES Safe Cholecystectomy Programme
Educational outpatient guide — verify against local guidelines before clinical use.
