Basic Science and Pathophysiology

Gall stone disease presents a spectrum of pathology, ranging from asymptomatic gall stones, to acute cholecystitis and ascending cholangitis [4].

The position of the stone within the gastrointestinal tract relates to the clinical problems that are produced:

• It can pass freely (asymptomatic gall stone)
• It can get intermittently stuck in the biliary tract (biliary colic/chronic cholecystitis)
• It can get stuck for a more prolonged period (acute cholecystitis, ascending cholangitis, acute pancreatitis, gall bladder perforation and empyema)

The gall stone may also get stuck outside the biliary tract (gall stone ileus). However, 70% of gall stones are asymptomatic, with a yearly risk of developing pain of 1-4% [1,8].

Acalculous cholecystitis occurs in 5-10% of cases of acute cholecystitis and tends to be more severe. It is more common in the elderly and those with diabetes mellitus. It may occur as a complication of burns or multiple trauma, and patients are very ill on presentation [5].

Learning Bite

7 in 10 patients with gall stones are likely to be asymptomatic.