A primer on gallbladder/stone disease to clear up some confusion
Cholelithiasis:
Gallstone formation within the gallbladder-
Very common, I would say that 20-30% of adult patients have gallstones visible on ultrasound or CT.
Not everyone is symptomatic
When they do cause symptoms, they are often non-specific and it is quite difficult to attribute these symptoms to gallstones.
the phrase “biliary colic” refers to a collection of symptoms including post-prandial pain and discomfort, as well as bloating
This causes a lot of difficulty for clinicians, because these symptoms cross over with many other pathologies. Often surgeons will take out the gallbladder without being 100% sure that the patients symptoms are caused by the gallbladder, usually because all other options have been exhausted. However, there is of course a lot of potential for excessive surgical intervention in this population.
and No, you can’t go in and “pluck” out gallstones, because more of them will form.
Cholecystitis
Acute: a gallstone becomes lodged in the cystic duct, which is the duct that connects the gallbladder to the common bile duct for drainage into the bowel.
presents with RUQ pain, fever
Often has classic imaging findings on ultrasound and CT, making diagnosis more straight forward. The patient is treated with antibiotics and generally “cooled” off before gallbladder removal to prevent recurrence.
Chronic: gallbladder does not function properly
often the gallbladder will have a low “ejection fraction”, meaning it does not squeeze out bile very well. This predisposes to bile stasis, bacterial overgrowth, and stone formation. This sets patients up for biliary colic OR acute cholecystitis.
removal is the best treatment.
Cholangitis:
gallstone lodged in the common bile duct resulting in biliary tree infection.
patients very sick, with jaundice, elevated LFTs, fever, and pain.
treated with antibiotics and removal of stone by endoscopy.