Overview
Liver calculi, also known as gallstones, are solid particles originating in the gallbladder, often composed of cholesterol or bilirubin. They can cause biliary obstruction, pain, and complications such as cholangitis and pancreatitis 1.Diagnosis
Clinical Presentation: Abdominal pain, particularly in the right upper quadrant, nausea, and vomiting 1.
Imaging: Ultrasonography is the primary imaging modality for diagnosis, with sensitivity exceeding 95% 1.
HIDA Scan: Useful for evaluating gallbladder ejection fraction and diagnosing acute cholecystitis 1.
Grading: Not typically graded but complications like cholangitis or pancreatitis may require severity assessment 1.Management
Surgical Intervention: Laparoscopic cholecystectomy is the standard treatment for symptomatic gallstones 1.
Endoscopic Procedures: Endoscopic retrograde cholangiopancreatography (ERCP) for common bile duct stones 1.
Medical Therapy: Ursodeoxycholic acid may be used preoperatively to dissolve stones in selected cases, though efficacy varies 1.
Pain Management: Analgesics for symptomatic relief; NSAIDs cautiously to avoid gastrointestinal complications 1.Special Populations
Pregnancy: Conservative management preferred initially; surgery deferred until postpartum if possible 1.
Pediatrics: Laparoscopic cholecystectomy is also the standard approach, with careful consideration of anesthesia risks 1.
Elderly: Increased risk of complications; multidisciplinary assessment recommended before surgery 1.
Comorbidities: Patients with cardiovascular disease or respiratory issues require careful perioperative management 1.Key Recommendations
Laparoscopic cholecystectomy is recommended for symptomatic gallstone disease (Evidence: Strong 1).
ERCP should be considered for patients with common bile duct stones to prevent complications (Evidence: Moderate 1).
Ursodeoxycholic acid may be used preoperatively for small cholesterol stones, though efficacy is variable (Evidence: Weak 1).References
1 Debets MPM, Scheepers RA, Boerebach BCM, Arah OA, Lombarts KMJMH. Variability of residents' ratings of faculty's teaching performance measured by five- and seven-point response scales. BMC medical education 2020. link