Gallstones & Gallbladder Polyps
Gallstones are common and occur when there is a problem relating to the chemical composition of bile. Most people with gallstone disease are asymptomatic and will remain asymptomatic. However, each year about 2-4% previously asymptomatic patients develop symptoms or complications.
The two most common complications are biliary colic, followed by acute cholecystitis. Other complications are rare, but some are life-threatening such as cholangitis (fever/rigors, jaundice, RUQ pain) and pancreatitis.
Same day discussion with general surgeon on-call:
- Systemically unwell with complications of gallbladder disease, i.e. acute cholecystitis, cholangitis or pancreatitis
- Known gallstones and jaundice
Clinical suspicion of biliary obstruction i.e. significantly deranged LFTs
Routine/urgent referral to UGI surgery (dependent on clinical judgement):
- Stones found on imaging and causing symptoms, within the last 12 months
- Asymptomatic gallstones found in the CBD (for consideration of bile duct clearance and laparoscopic cholecystectomy)
- Asymptomatic gallstones outside the CBD do not need to be referred
2. Gallbladder polyps
- Symptomatic, or
- Larger than 1cm, or
- Gallstones present
- Polyps less than 1cm in size, not referred for surgery, should have a repeat USS in 1 year due to risk of malignancy
Investigations prior to referral
- Abdominal USS (please attach results to referral)
Management of suspected retained stones after gallbladder surgery
- LFTs and amylase
- Urgent USS
- Depending on clinical urgency, referral to jaundice clinic or if systemically unwell, discuss with UGI surgeon on-call via switch. MRCP and ERCP will then be arranged.
Nb. A dilated CBD post gallbladder surgery on its own is quite common after surgery and not necessarily suggestive of a retained stone.
Review Date March 2022
Next Review Date March 2023
GP Sifter Dr Laura Vines
Contributor Mr Mike Clarke
Mr Paul Peyser