Gallstones

Disease Description (Causes and Symptoms)

• Definition: A condition in which an imbalance of bile components (such as cholesterol, bile acids, and bilirubin) and reduced gallbladder contractility lead to the formation of crystals in the gallbladder or bile ducts, forming stones (cholelithiasis, gallstones).
• Main causes and pathophysiology:
  • Cholesterol stones: Excess cholesterol in bile and reduced gallbladder emptying (gallbladder contraction) → cholesterol crystallization. Risk factors include being female, multiple childbirths, obesity, rapid weight loss, prolonged fasting or parenteral nutrition, certain medications (such as oral contraceptives), and metabolic diseases.
  • Pigment stones: Infection (such as clonorchiasis), bacterial infection of the bile ducts (brown stones), sterile bile, hemolytic conditions (black stones), and others.
• Main symptoms:
  • Most cases are asymptomatic (60–80%).
  • Characteristic symptoms when present: persistent, severe pain in the epigastrium or right upper abdomen (biliary colic), with pain radiating to the subscapular region or right shoulder; pain lasting 1–6 hours; nausea and vomiting are common.
  • If fever, chills, and jaundice occur together, complications such as cholecystitis or cholangitis should be suspected.

Treatment Methods

• Principles:
  • Asymptomatic gallstones: Observation is appropriate unless there are separate indications (e.g., a large gallbladder polyp or an immunosuppressed state).
  • Treatment is recommended when symptoms or complications are present.
• Surgical treatment:
  • Laparoscopic cholecystectomy (preferred standard): Reduced pain and hospital stay, with faster recovery.
  • Open cholecystectomy: Used when adhesions from previous upper-abdominal surgery or other factors make conversion from laparoscopy necessary.
  • When choledocholithiasis is suspected or confirmed, the bile duct stones are often removed by endoscopic retrograde cholangiopancreatography (ERCP), followed by cholecystectomy.
• Medical and nonsurgical treatment:
  • Oral dissolution therapy (such as ursodeoxycholic acid [UDCA]): Some effectiveness for cholesterol stones with a diameter of ≤10 mm (the probability of complete dissolution is limited, and recurrence is possible).
  • Extracorporeal shock wave lithotripsy and percutaneous gallbladder access procedures may be considered for limited indications.
• Treatment when complications occur:
  • Acute cholecystitis or cholangitis: Antibiotics and urgent medical or surgical treatment (such as surgery or percutaneous drainage).
  • Biliary acute pancreatitis: Intensive treatment according to severity, with endoscopic treatment (ERCP) if necessary.
• Lifestyle management and precautions:
  • Exercise regularly, maintain a normal body weight (avoid rapid weight loss), and eat a balanced diet (limit excessive intake of saturated fat).
  • Seek medical attention immediately if symptoms such as severe abdominal pain, high fever, jaundice, or persistent vomiting occur.

Checklist Before an Outpatient Visit (Including Example Questions)

• Items to prepare / bring:
  • A list of currently used medications (including prescription drugs, over-the-counter drugs, and supplements).
  • Previous surgical history and significant medical history (including liver disease, hemolytic disease, and pregnancy history).
  • Results of recent tests and imaging (such as abdominal ultrasound, CT, and blood tests), including image files if possible.
  • Symptom records: the location, severity, duration, radiation, accompanying symptoms (fever, jaundice, and vomiting), and frequency of pain episodes.
• Information to tell the healthcare professionals first during the outpatient visit:
  • Whether acute pain, fever, or jaundice is present (to determine whether emergency treatment is needed).
  • Whether pregnancy is possible or whether you are currently pregnant.
• Example questions (to ask healthcare professionals during the outpatient visit):
  • "Are my current symptoms an indication for surgery? Is it okay to postpone surgery?"
  • "If the tests suggest a common bile duct stone, what additional tests will be performed?"
  • "What are the indications for drug treatment (such as UDCA), and what level of benefit can be expected?"

Examples of General Questions to Ask the Doctor

• What are the side effects and precautions associated with this medication (or treatment)?
• What are the advantages, disadvantages, and prognosis of the treatment you recommend for me (surgery vs. conservative treatment)?
• Are there any foods or activities I should avoid in daily life?
• What weight-management methods are recommended to reduce the risk of recurrence?

Examples of Condition-Specific Questions

• When laparoscopic cholecystectomy is recommended, how high is the risk of conversion to open surgery based on my individual risk factors (age, underlying diseases, and surgical history)?
• When microlithiasis (or a common bile duct stone) is suspected on ultrasound, which test do you recommend first, endoscopic ultrasound (EUS) or ERCP? What are the risks and benefits of each test?

(Note: The primary imaging test for diagnosis is abdominal ultrasound, and endoscopic ultrasound is useful for evaluating microlithiasis or accompanying common bile duct stones. Complications such as acute cholecystitis, cholangitis, and pancreatitis require immediate treatment.)