Gallstone disease (summary)

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This is a basic article for medical students and other non-radiologists

Gallstone disease represents a group of conditions that are linked to, or caused by, gallstones. These stones are formed from sludge in the gallbladder and may range from millimeters in diameter to several centimeters. 90% of gallstones are asymptomatic, but they may become impacted, causing pain or jaundice.

Reference article

This is a summary article; read more in our article on gallstones.

Summary

  • anatomy
  • epidemiology
    • 20-40 years
    • female > male
    • overweight
  • presentation
    • chronic gallbladder disease
      • bloating, gas and abdominal discomfort after meals
      • diarrhea
    • acute cholecystitis
      • pain, nausea and vomiting
      • (if infection) fever
    • choledocholithiasis (gallstone in common bile duct)
      • jaundice
      • (if infection) fever and severe upper abdominal pain
  • pathophysiology
    • gallstones may be composed of a variety of compounds
      • 70% formed from cholesterol
    • 90% of gallstones are asymptomatic
      • found incidentally on routine imaging
  • investigation
    • assess whether gallstones are likely to be the cause of symptoms
    • look for any other cause of symptoms
  • treatment
    • asymptomatic gallstones: no treatment is required
    • chronic gallbladder disease: laparoscopic cholecystectomy
    • acute cholecystitis: fast, fluids and pain relief (cold cholecystectomy)
    • CBD stone: endoscopic sphincterotomy

Role of imaging

  • assess whether there are gallstones
  • determine if they are likely to be causing symptoms
  • locate the gallstones, e.g. gallbladder, CBD
  • look for complications
  • look for associations, e.g. liver disease

Radiographic features

Ultrasound

Ultrasound is the first best test when assessing the gallbladder. It is cheap, quick and easy and requires no exposure to radiation. Patients need to fast before their ultrasound to ensure that the gallbladder is as filled with bile as possible. It is impossible to assess the gallbladder wall when it is non-distended.

  • gallstones are hyperechoic (bright) structures
  • shadowing behind the stones
  • dependent within the fluid-filled (dark) gallbladder
  • dilatation of the biliary tree if there is a CBD stone
CT

CT is not the best test for detection of stones - some stones are not visible on CT. However, it is helpful when looking for complications including perforation.

MRI

MRI can be used to assess the biliary tree and identify the level of obstruction using MR cholangiopancreatography (MRCP).

  • gallstones are filling defects in the gallbladder and duct system
  • dilated biliary tree proximal to the level of obstruction
Medical student radiology curriculum