Gallstones
Gallstones affect 10–15% of the Western population. Most are asymptomatic — but the minority who develop symptoms account for a significant surgical workload. Knowing the risk factors, types, and complications is essential.
✦ The Mnemonic
"FORD Drives Gallstone Risk"
Female · Obese · Rapid weight loss · Diabetes — the classic Gallstone risk factors
Clinical Breakdown
80% of gallstones are cholesterol stones (formed when bile is supersaturated with cholesterol — Admirand-Small triangle). 15% are pigment stones (black: haemolytic anaemias such as sickle cell, hereditary spherocytosis; brown: infected bile/biliary stasis). Cholesterol stones are radiolucent; pigment stones may be radio-opaque.
Complications follow a predictable anatomical sequence: biliary colic (stone impacted in cystic duct → colicky RUQ pain) → cholecystitis (stone obstructing cystic duct → bacterial infection) → common bile duct stone (choledocholithiasis → obstructive jaundice, cholangitis, pancreatitis) → Mirizzi syndrome (external compression of CHD by a stone in Hartmann's pouch).
Charcot's triad (acute cholangitis): fever + rigors, jaundice, RUQ pain. Suggests CBD stone with ascending cholangitis. Add hypotension and confusion = Reynold's pentad (suppurative cholangitis) — needs urgent ERCP for biliary decompression and IV antibiotics.
⭐ Clinical Pearl
Mirizzi syndrome: a large gallstone impacted in Hartmann's pouch (or cystic duct) compresses the common hepatic duct from outside — causing obstructive jaundice and mimicking a cholangiocarcinoma on imaging. Types I–IV based on whether a cholecystocholedochal fistula has formed. Requires careful surgical planning — ERCP may fail and open surgery is often needed.