Information for Patients:

Cholelithiasis
Introduction
Cholelithiasis is the medical term that
describes the presence of gallstones in the
gallbladder (Fig. 1).

Figure 2 The gallbladder is the small green organ

underneath the liver.

Clinical Presentation
Abdominal pain underneath the right rib
cage that comes on after eating fatty,
greasy meals that lasts for several hours is
classic for gallstone related colic. If the pain
persists for more than several hours and
there is fever, then an infection called
cholecystitis is a possibility.

Figure 1 Numerous gallstones are found within this

gallbladder.

Normally, the cystic duct allows bile to drain

out of the gallbladder. Pain occurs because
a stone may be impacted in the cystic duct
and bile is unable to be released causing a
build up of pressure inside. The pain is
relieved if the stone is able to dislodge
itself. Impacted stones that are really stuck
can lead to infections.

Gallstones are typically formed because of

elevated levels of cholesterol in the bile,
which is stored in the gallbladder. The liver
secretes bile during meals to help with the
absorption of fats. It may take years for
gallstones to form. It is entirely random the
shape and number that gallstones form.
Some people have large stones and some
have smaller and more numerable ones.

If a stone escapes into the common bile

duct, then jaundice, clay-coloured stools
and dark tea coloured urine can occur. This
condition is called choledocholithiasis.

Gallstone disease is very common;

however, the majority of people who have
them do not necessarily develop problems.
Only 15%-20% of people who have
gallstones develop complications such as
biliary colic, cholecystitis,
choledocholithiasis and pancreatitis.

The diagnosis of gallstones is based on

clinical presentation as well as the
presence of gallstones on ultrasound or CT
scan. Ultrasound is usually the first test
because gallstones are demonstrated well.

The gallbladder is found tucked up

underneath the right side of the liver (Fig.
2).

Blood work may demonstrate an elevated

white cell count to indicate infection. An
elevated bilirubin or abnormal liver tests
may suggest choledocholithiasis.
1

Information for Patients:

Cholelithiasis
Treatment

day. If the open technique is done, patients

may be required to be admitted to hospital
for several days.

The treatment for symptomatic gallstones is

laparoscopic cholecystectomy (Fig. 3).

There are rare occasions when the

gallbladder is too inflamed to remove. If this
is the case, a CT scan is done and a drain
may be placed to resolve the infection.
Once the inflammation has settled down,
which may take several months, a repeat
CT scan is done and elective surgery
booked to remove the gallbladder.
Follow-Up
Laparoscopic cholecystectomy is a
common procedure performed. It is usually
day surgery with the patient arriving in the
morning and then being discharged later on
in the afternoon. All sutures used are
hidden in the skin and will dissolve on its
own. A follow-up appointment is made 4
weeks afterwards to review the pathology
and to inspect the incisions.

Figure 3 Laparoscopic cholecystectomy.

This procedure is done with small incisions

and inserting a video camera into the
abdominal cavity. Long, thin instruments
are then used to find the gallbladder and to
remove it.
Occasionally, if there is severe
inflammation, bleeding or any other
difficulty, the laparoscopic approach may
not be technically possible and the surgery
is converted to the open technique.
The benefits of the laparoscopic approach
are that the recovery time from surgery is
much faster and there is less pain. Patients
typically arrive in the morning, have their
surgery and are discharged later the same