Fast Five Quiz: Gallbladder Disease

B.S. Anand, MD


December 08, 2021

Ursodeoxycholic acid treatment can prevent gallstone formation. This has been demonstrated in the setting of rapid weight loss caused by very low-calorie diets or by bariatric surgery, which are associated with a high risk for new cholesterol gallstones. Administration of ursodeoxycholic acid at a dose of 600 mg daily for 16 weeks significantly reduces the incidence of gallstones in this setting. Recommending dietary changes of decreased fat intake is also prudent; this may decrease the incidence of biliary colic attacks. However, it has not been shown to cause dissolution of stones.

Surgical treatment of asymptomatic gallstones without medically complicating diseases is discouraged. The risk for complications arising from interventions is higher than the risk for symptomatic disease. However, cholecystectomy for asymptomatic gallstones may be indicated in these patients:

  • Patients with large gallstones (> 2 cm in diameter)

  • Patients with nonfunctional or calcified (porcelain) gallbladder observed on imaging studies and who are at a high risk for gallbladder carcinoma

  • Patients with spinal cord injuries or sensory neuropathies affecting the abdomen

  • Patients with sickle cell anemia in whom the distinction between painful crisis and cholecystitis may be difficult

Patients with risk factors for complications of gallstones may be offered elective cholecystectomy, even if they have asymptomatic gallstones. These groups include persons with these conditions and demographics:

  • Cirrhosis

  • Portal hypertension

  • Children

  • Transplant candidates

  • Diabetes with minor symptoms

Once gallstones become symptomatic, definitive surgical intervention with cholecystectomy is usually indicated (typically, laparoscopic cholecystectomy is the first-line therapy at centers with experience in this procedure). Careful selection of patients is warranted and should fulfill these criteria:

  • Small stone size (< 0.5 to 1 cm)

  • Good gallbladder function (eg, normal filling and emptying)

  • Minimal or no calcification

Medical treatments for gallstones, used alone or in combination, include:

  • Oral bile salt therapy (ursodeoxycholic acid) (particularly for radiograph-negative cholesterol gallstones in patients with normal gallbladder function)

  • Extracorporeal shockwave lithotripsy (particularly for noncalcified cholesterol gallstones in patients with normal gallbladder function)

Medical management is more effective in patients with good gallbladder function who have small stones (< 1 cm) with a high cholesterol content. Bile salt therapy may be required for more than 6 months and is successful in less than half of cases.

Learn more about the treatment of gallstones.

This Fast Five Quiz was excerpted and adapted from the Medscape Drugs & Diseases articles Gallstones (Cholelithiasis), Cholecystitis, Acalculous Cholecystitis, and Gallbladder Tumors.

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