Cholelithiasis

Basics

Symptoms arise due to transient gallstone obstruction of cystic duct
Biliary dyskinesia can produce symptoms similar to biliary colic in the absence of stones
Choledocholithiasis (common bile duct stones), may lead to prolonged pain, elevated LFTs and bilirubin, and to more complications like cholangitis or pancreatitis

Cholesterol stones:
- Most common type of gallstone (>90% in the U.S. and Europe)
- Form due to disturbance of cholesterol disposal
Pigment stones:
- Much less common
- Composed of calcium bilirubinate
- Associated with clinical conditions such as hemolytic diseases, cirrhosis, cystic fibrosis that lead to increased concentration of unconjugated bilirubin
Incidence increases with age and favors females to males 2:1 (4:1 during reproductive years). Other risk factors include Hispanic ethnicity, obesity, pregnancy, rapid weight loss, and drugs that induce biliary stasis (e.g., ceftriaxone and oral contraceptives), family history of gallstones
Gallstones are exceedingly rare in childhood and are most commonly associated with sickle cell disease, hereditary spherocytosis, or other hemolytic diseases that result in pigment stone formation
Biliary sludge:
- Nonstone, crystalline, granular matrix
- Associated with rapid weight loss, pregnancy, ceftriaxone or octreotide therapy, and organ transplantation
- May develop symptoms identical to cholelithiasis and its complications
“Porcelain gallbladder” from mucosal precipitation of calcium salts owing to recurrent obstruction of cystic duct

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