Gallbladder Stones – Pathogenesis and Treatment

Abstract

Gallstone disease (GSD) refers to all the patients with symptoms due to gallstones (cholelithiasis). The presence of gallstones is a common problem seen in 10–15% of western population; with 1–4% of the population developing symptoms. The most common presentation of patients of GSD is biliary colic. There are several mechanism for cholelithiasis and all these processes are slow. Cholesterol stones are the most common variety of gallstones. Cholesterol stones cannot form if the gallbladder is completely emptied several times a day. Therefore, the total or partial extension of bile storage due to impaired gallbladder movement seems to be an important factor for cholelithiasis. Gallbladder dysmotility is an important risk factor for the development of GSD. Insufficient gallbladder motility may be associated with many risk factors for cholesterol gallstone formation, such as pregnant women, obese patients, and their rapid weight loss, diabetes mellitus, and patients receiving total parenteral nutrition. Transabdominal ultrasound is the mainstay in the evaluation of patients with GSD. The presence of gallbladder dysfunction can be studied using cholecystokinin (CCK)-stimulated cholescintigraphy to evaluate for gallbladder ejection fraction (GBEF); with values <40% after 30 mins of CCK infusion considered diagnostic. The definitive treatment of GSD is cholecystectomy.