Gallstones can cause a spectrum of progressive complications, particularly when stones migrate into or obstruct the bile ducts, or when infection supervenes.
Gallbladder-Related Pathologies
1. Biliary Colic (Irritation Only)
- Transient obstruction without inflammation
- Pain is severe but settles within hours
2. Mucocele (Simple Obstruction)
- Cystic duct remains blocked → distended gallbladder filled with mucus
- No infection or systemic signs
3. Empyema (Obstruction + Infection)
- Accumulation of pus inside gallbladder
- Presents with fever, sepsis, tenderness, high WBC count
4. Cholecystitis (Infection)
- Gallbladder wall inflammation
- May follow biliary colic
- Risk of gangrene, perforation, or fistula formation
Common Bile Duct (CBD)-Related Pathologies
1. Biliary (Ductal) Colic
- Stone passes through CBD → transient pain and discomfort
2. Obstructive Jaundice
- Persistent stone obstruction
- Pale stools, dark urine, yellow skin and eyes
3. Cholangitis
- Infected bile due to CBD obstruction
- Charcot’s triad: fever, jaundice, RUQ pain
- Reynold’s pentad adds hypotension and confusion → emergency!
Associated Conditions
| Condition | Description |
|---|---|
| Pancreatitis | Gallstones block ampulla of Vater → back pressure on pancreatic duct |
| Gallstone Ileus | Large stone erodes into intestine → small bowel obstruction (elderly) |
| Gallbladder Cancer | Chronic irritation from stones is a rare but recognized risk factor |
Diagnostic Tests Summary
| Test | Purpose |
|---|---|
| Ultrasound (USG) | First-line for gallstones and gallbladder thickening |
| LFTs | Show obstructive or hepatocellular pattern |
| FBC | Infection or anemia (e.g., hemolysis-related stones) |
| MRCP | Non-invasive CBD evaluation |
| ERCP | Diagnostic and therapeutic for CBD stones |
| CT Scan | Detect complications or unclear anatomy |
| Endoscopic Ultrasound | Best for microlithiasis |
| OGD (Endoscopy) | Rule out peptic ulcers in atypical cases |
Treatment & Surgical Management
General Approach by Condition:
| Condition | Treatment |
|---|---|
| Asymptomatic | No treatment |
| Biliary colic | Pain relief + elective cholecystectomy |
| Cholecystitis | IV fluids, antibiotics + early/interval cholecystectomy |
| Empyema | Emergency cholecystectomy or drainage (cholecystostomy) |
| Cholangitis | ERCP, ductal clearance + antibiotics + early cholecystectomy |
| Pancreatitis | Supportive care, elective surgery once inflammation settles |
| Gallstone Ileus | Laparotomy and removal of obstructing stone |
Laparoscopic Cholecystectomy
Gold standard for symptomatic gallstones:
- Performed under general anesthesia
- 3–4 small incisions
- Same-day or next-day discharge
Complications of Cholecystectomy
- Conversion to open surgery (~5–10%)
- Bile leakage: From cystic duct or liver bed
- Retained CBD stones: May require ERCP post-op
- CBD Injury: Rare, may need reconstructive surgery
- Bleeding or hematoma
- Post-cholecystectomy syndrome: Bloating or pain in a minority
Prognosis and Follow-Up
- Surgery usually curative for gallstones
- Recurrence is rare if gallbladder is removed
- Gallstone ileus and cholangitis carry higher mortality in elderly
- Long-term bile flow is maintained by hepatic secretion directly into duodenum
Patient Tips: Life After Gallbladder Removal
- Most patients resume normal diet
- Limit fatty or greasy meals initially
- Mild bloating/diarrhea in some cases (temporary)
- Stay hydrated and maintain a healthy weight
Summary: Gallstone Disease
| Aspect | Key Information |
|---|---|
| Common symptoms | RUQ pain, nausea, vomiting, fatty food intolerance |
| Diagnosis | Ultrasound, LFTs, MRCP, ERCP |
| Definitive treatment | Laparoscopic cholecystectomy |
| Dangerous complications | Pancreatitis, cholangitis, perforation |
| Preventive tips | Low-fat diet, manage obesity, control diabetes |
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