Gallsteine

Gallsteine (gallstones) are solid concretions that form within the gallbladder or biliary tree. Most stones are asymptomatic and discovered incidentally. When symptoms occur, they are typically due to temporary obstruction of the cystic duct, producing biliary colic.

Composition and types: The majority are cholesterol stones formed when bile becomes supersaturated with cholesterol. Pigment stones, composed of bilirubin calcium salts, occur in conditions with increased bilirubin turnover or hemolysis, and brown pigment stones are associated with infection and stasis.

Risk factors include female sex, increasing age, obesity, rapid weight loss, pregnancy, certain medications, and family history.

Diagnosis: Ultrasound is the preferred initial test. Findings include echogenic foci with posterior shadowing; gallbladder wall thickening may indicate cholecystitis. If ductal stones are suspected, MRCP or ERCP are used.

Treatment: Asymptomatic stones generally require no treatment. Symptomatic stones or gallstone-related complications are treated by cholecystectomy, commonly laparoscopic. Stones in the common bile duct may require ERCP with sphincterotomy to remove stones, possibly followed by cholecystectomy. Other options include ursodeoxycholic acid for selected cholesterol stones.