Cholelithiasis

Two-thirds of patients with gallstones are asymptomatic. Biliary pain often radiates into the shoulders or back. An attack is often accompanied by nausea and vomiting. Biliary pain lasting more than 12 hours with accompanying fever or jaundice is indicative of acute cholecystitis or cholangitis. Ultrasonography is the investigation of choice for the diagnosis of both uncomplicated and complicated cases. Asymptomatic gallstones need not be treated. Patients with repeated episodes of biliary pain should be operated on within a few months. Acute cholecystitis should be treated surgically within 2-7 days from the onset of the symptoms. Patients with acute biliary pancreatitis must be immediately referred to hospital.MRCP (magnetic resonance cholangiopancreatography) (or ERCP) is carried out to verify the presence of common bile duct stones. If an impacted stone or cholangitis is detected during the urgent (within 48 hours) ERCP, a sphincterotomy and removal of the stone is carried out. Cholecystectomy is carried out within a month to prevent the recurrence of pancreatitis.

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