Gall Stones

Gall stone is formation of stone in gall bladder.

Gall stones (Cholelithiasis) are divided in following types:

1) Metabolic:
a) Cholesterol stones
b) Pigment stones
2) Infective: Mixed stones


Metabolic: These result from derangement in metabolism either of cholesterol or of bile pigments.
Infective: These are preceded by infection in the Gall bladder.
Seen 2-3 times more commonly in women than men & incidence increases with age, women taking exogenous oestrogen or contraceptive pills. Obesity & high calorie diet predisposes it.

8 to 10% of patient do not show any symptoms(Silent stones) and are seen incidentally during a routine health check-up or during an operation.
Normally patient presents with Pain in right upper side of abdomen with Acidity & Heart burn with occassional nausea & vomiting.
Discomfort in abdomen after fatty food is specifically seen in this.
Jaundice can be seen due to cholangitis or stone blocking the bile duct.

Acute Cholecystitis: Gall Bladder becomes inflamed & distended, causing abdominal pain & tenderness.
Patient presents with sudden onset of pain in right upper part of abdomen, Lasting several days instead of hours, severe nausea vomiting, abdominal pain may also radiates to between the shoulder blade.


The 1st line of the treatment is as follows:

  1. Patient is adviced to take Bed-rest & Stopping oral feeding & Ryles tube aspiration
  2. Intravenous fluids must be given as there will be no oral intake.
  3. Antibiotics, Anagesics & Sedatives should be given & a close watch is kept to assess the progress.

If Temperature does not come down & any complication occure then immediate surgery is Mandatory.

Surgical Rx:

  1. Cholecystectomy : Removal of Gall Bladder.
  2. Cholecystostomy:

If the structures at the neck of Gall bladder are very oedematous & friable then Cholecystostomy is done to drain the gall bladder & large bore tube within the lumen of the gall bladder is left for continued postoperative drainage,then subsequent removal of tube & elective Cholecystectomy is arranged when patient is fit fir surgery. Laparoscopic Cholecystectomy is the gold standard method which routinely being done now a days.

Possible Complications:

  1. If Cholecystitis does not resolve it may progress to empyema (Lumen gets filled with pus).
  2. Perforation: It is rare but when occurs, results in: a) Generalised peritonitis. b) Localised abscess c) Fistula formation with common bile duct, duodenum, colon,stomach.
  3. Mucocele
  4. Gangrene
  5. Acute Pancreatitis
  6. Obstructive Jaundice
  7. Cholangitis
  8. Carcinoma