Cholelithiasis: Diagnosis and Treatment

Diagnosis

Right–upper–quadrant ultrasound will directly reveal the presence of gallstones and show evidence of cholecystitis, if present.

Hydroxy iminodiacetic acid (HIDA) scan is sometimes indicated to rule out cystic duct obstruction and acute cholecystitis.

Endoscopic retrograde cholangiopancreatography (ERCP) or magnetic resonance cholangiopancreatography (MRCP) assesses the presence of gallstones within the bile ducts. ERCP also extracts stones when they are found, avoiding the need for surgery.

Laboratory tests include complete blood count (CBC), liver function tests, amylase, and lipase.

Treatment

Asymptomatic gallstones are generally not treated.

It is important to avoid fatty foods and other dietary triggers.

Cholecystectomy is the treatment of choice for symptomatic disease.

Lithotripsy, which breaks up stones, and oral bile acids (eg, ursodeoxycholic acid), which dissolve small stones and stone fragments, are indicated for patients who are not surgical candidates.