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There are two major types of gallstones: cholesterol and pigment stones. Cholesterol gallstones contain >50% cholesterol monohydrate. Pigment stones have <20% cholesterol and are composed primarily of calcium bilirubinate. In Western industrialized countries, >90% are cholesterol stones.


In the United States, the prevalence of gallstones is 7.9% in men and 16.6% in women. Predisposing factors include demographic/genetics, obesity, weight loss, female sex hormones, age, gallbladder hypomotility, pregnancy, ileal disease, chronic hemolysis, and cirrhosis.


Many gallstones are “silent,” i.e., present in asymptomatic pts. Symptoms occur when stones trigger inflammation or cause obstruction of the cystic or common bile ducts (CBDs). Major symptoms: (1) biliary colic—a severe steady ache in the RUQ or epigastrium that begins suddenly; often occurs 30–90 min after meals, lasts for several hours, and occasionally radiates to the right scapula or back; (2) nausea, vomiting. Physical examination may be normal or show epigastric or RUQ tenderness.


Occasionally, mild and transient elevations in bilirubin (<85 µmol/L [<5 mg/dL]) accompany biliary colic.


Only 10−15% of cholesterol gallstones are radiopaque. Ultrasonography is best diagnostic test. The oral cholecystogram has been largely replaced by ultrasound, but may be used to assess the patency of the cystic duct and gallbladder emptying function (Table 153-1).

TABLE 153-1Diagnostic Evaluation of the Bile Ducts

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