Cholelithiasis is a topic covered in the 5-Minute Emergency Consult.

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  • Symptoms arise when gallstones pass through the cystic or common bile ducts leading to impedance of normal bile flow and gallbladder spasm.
  • Biliary dyskinesia produces symptoms identical 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
    • Form when solubility exceeded
  • Pigment stones:
    • 20%
    • Composed of calcium bilirubinate
    • Associated with clinical conditions such as hemolytic anemias that lead to increased concentration of unconjugated bilirubin
  • Incidence increases with age and favors females to males 2:1. Other risk factors include Hispanic ethnicity, obesity, pregnancy, rapid weight loss, and drugs that induce biliary stasis (e.g., ceftriaxone and oral contraceptives).
  • Gallstones are exceedingly rare in childhood and are most commonly associated with sickle cell disease, hereditary spherocytosis, or other hemolytic anemias 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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