ABC of diseases of liver, pancreas, and biliary system: Gallstone disease
Gall stones are the most common abdominal reason for admission to hospital in developed countries and account for an important part of healthcare expenditure. Around 5.5 million people have gall stones in the United Kingdom, and over 50 000 cholecystectomies are performed each year.
Non-specific abdominal pain, early satiety, fat intolerance, nausea, and bowel symptoms occur with comparable frequency in patients with and without gall stones, and these symptoms respond poorly to inappropriate cholecystectomy. In many of these patients symptoms are due to upper gastrointestinal tract problems or irritable bowel syndrome.
When obstruction of the cystic duct persists, an acute inflammatory response may develop with a leucocytosis and mild fever. Irritation of the adjacent parietal peritoneum causes localised tenderness in the right upper quadrant. As well as gall stones, ultrasonography may show a tender, thick walled, oedematous gall bladder with an abnormal amount of adjacent fluid. Liver enzyme activities are