Gallstones (Cholelithiasis) Causes, Risks and Diagnosis

What is Cholelithiasis

Cholelithiasis refers to the presence of gallstones within the gallbladder. Gallstones form when components of bile, most commonly cholesterol or bilirubin, precipitate and crystallize. It is one of the most common disorders of the biliary system.

In many cases, cholelithiasis may remain asymptomatic for long periods and is often diagnosed incidentally.

Causes and Risk Factors

The exact mechanism of gallstone formation is not always fully understood. However, several factors are known to increase the risk, including:

• increased cholesterol concentration in bile,

• impaired gallbladder emptying,

• female sex,

• age over 40 years,

• obesity or rapid weight loss,

• pregnancy,

• family history of gallstone disease.

Symptoms

Gallstones may cause no symptoms. When symptomatic, patients most commonly experience:

• episodic pain in the right upper quadrant of the abdomen (biliary colic),

• pain radiating to the back or right shoulder,

• nausea and vomiting,

• indigestion, particularly after fatty meals.

Possible Complications

Cholelithiasis may lead to serious complications, including:

• acute cholecystitis,

• choledocholithiasis (migration of stones into the common bile duct),

• acute biliary pancreatitis,

• cholangitis, a potentially life-threatening infection of the biliary tree.

These conditions require prompt medical evaluation and treatment.

Diagnosis

The diagnosis of cholelithiasis is primarily made with abdominal ultrasound, which is the imaging modality of choice. In selected cases, further imaging studies such as CT scan or magnetic resonance imaging may be required.

Treatment of Cholelithiasis

The definitive treatment of cholelithiasis is the surgical removal of the gallbladder (cholecystectomy). This approach eliminates the source of gallstone formation and prevents future complications.

In modern surgical practice, cholecystectomy is most commonly performed using a laparoscopic approach. In selected cases, an open surgical approach may be necessary, depending on the clinical findings.