Gallbladder Disease

1

What is the prevalence of gallstones in Western society for women and men 60 years of age?

Women, 50%; men, 15%, although there is formidable ethnic predilection with gallstones endemic in American Indians.

2

What is the difference between cholelithiasis, cholecystitis, choledocholithiasis, and cholangitis?

Cholelithiasis refers to the presence of gallbladder stones. Symptomatic cholelithiasis is the most common indication for cholecystectomy. Cholecystitis is an inflammatory condition of the gallbladder, usually initiated by gallstone impaction in the gallbladder neck with obstruction of the cystic duct. Choledocholithiasis is the presence of stones in the common bile duct (CBD). Cholangitis is an infection of the biliary tree, generally as a result of obstruction, usually secondary to choledocholithiasis.

3

What percentage of asymptomatic gallstones becomes symptomatic?

Ten percent at 5 years, 15% at 10 years, and 18% by 15 years.

4

Should patients with asymptomatic gallstones undergo cholecystectomy?

No. The risk of observation of patients with asymptomatic gallstones is less than or equal to the risk of operation.

5

In what groups of patients with asymptomatic gallstones is prophylactic cholecystectomy beneficial?

• Patients with congenital hemolytic anemia who have gallstones at the time of splenectomy

• Patients undergoing small bowel resection for carcinoid tumor in whom somatostatin therapy or hepatic angioembolization is anticipated

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