Gallstone Disease

Abstract

What to do about stones in the asymptomatic patient remains a dilemma for the clinician. If the patient has sickle cell disease or a congenital hemolytic state or is an insulin- requiring diabetic, cholecystectomy is generally recommended.

Biliary drainage of duodenal contents may show lithogenic bile with cholesterol or calcium bilirubinate crystals, thus facilitating an otherwise difficult clinical assessment of a patient with epigastric pain, nausea, and vomiting and an apparently normal gallbladder. Biliary colic syndrome occurring in a patient with a normal gallbladder may indicate a biliary dyskinetic state. If typical symptoms can be reproduced by giving cholecystokininpancreozymin or a fatty meal, cholecystectomy may ameliorate the condition.

If the gallbladder cannot be visualized with standard single-dose oral cholecystography, and vomiting, pyloric obstruction, malabsorption, and liver disease are excluded as the cause, the patient probably has cystic duct obstruction or chronic cholecystitis or both. Double-dose cholecystography is best avoided, due to the risk of renal failure and infrequency of obtaining added information,—AR