Galstones

Gallstones: Summary

• Gallstones are common, with a prevalence of approximately 10–15% of adults in Europe.
• Risk factors for developing gallstones include:
  • Crohn's disease.
  • Diabetes mellitus.
  • Diet — diets higher in triglycerides and refined carbohydrates, and low in fibre, are associated with gallstones.
  • Female sex. 
  • Genetic and ethnic factors.
  • Increasing age.
  • Medication (for example somatostatin analogues, glucagon-like peptide-1 analogues, and ceftriaxone).
  • Non-alcoholic fatty liver disease.
  • Obesity.
  • Prolonged fasting/weight loss.
  • Use of hormone replacement therapy (HRT).
    
    
• Most people with gallstone disease are asymptomatic and remain asymptomatic. However, each year about 2-4% of people with previously asymptomatic gallstones develop symptoms or complications.
• Biliary colic is the most common complication and acute cholecystitis is the second most common complication of gallstone disease. Other complications are uncommon or rare, but some are life-threatening such as cholangitis and pancreatitis.
• An abdominal ultrasound examination and liver function tests (LFTs) should be arranged for people suspected of having gallstone disease.
  • If gallstones are not detected by ultrasound but suspicion of symptomatic gallstone disease remains high, further tests may be arranged in secondary care. 
• No treatment is required for people with asymptomatic gallstones in a normal gallbladder with a normal biliary tree.
  • However, referral should be offered to people with asymptomatic gallstones found in the common bile duct for consideration for bile duct clearance and laparoscopic cholecystectomy.
• Emergency admission should be arranged for people who are systemically unwell with a suspected complication of gallstone disease, such as acute cholecystitis, cholangitis, or pancreatitis. 
• Urgent referral should be arranged for people with known gallstones and jaundice, or if there is a clinical suspicion of biliary obstruction (for example, significantly abnormal liver function tests). 
• All other people with symptomatic gallstone disease should be referred to a surgeon for consideration of laparoscopic cholecystectomy, with the referral urgency dependent on clinical judgement.
• Appropriate pain relief should be offered to people awaiting secondary care assessment. 
  • For severe pain, diclofenac or an opioid should be administered intramuscularly. 
  • For intermittent mild to moderate pain, paracetamol or a nonsteroidal anti-inflammatory drug (NSAID), should be offered. 
• If pain cannot be managed in primary care the person should be referred to hospital