Cholelithiasis, defined as the presence of gallstones in the gallbladder, affects approximately 10–20% of adults in Western populations. Around 80% of affected individuals remain asymptomatic. Among patients with asymptomatic gallstones, symptoms develop at a rate of approximately 1–4% per year, and about 20% become symptomatic within 20 years. Complications are uncommon while gallstones remain asymptomatic but become more likely after the first episode of biliary colic. Major complications include acute cholecystitis, choledocholithiasis, obstructive jaundice, ascending cholangitis, and gallstone pancreatitis. Routine treatment is generally not recommended for incidentally detected asymptomatic gallbladder stones. (EASL-The Home of Hepatology.)
Obesity is an important modifiable risk factor, particularly for the formation of cholesterol gallstones. The risk increases progressively with body mass index and appears to be more pronounced in women. However, a more than fivefold increase cannot generally be attributed to all women with a BMI above 30 kg/m². Population-based data suggest that obesity is associated with an approximately twofold increase in the risk of clinically significant gallstone disease, whereas severe obesity may confer a substantially higher risk. In one large cohort, women with a BMI above 45 kg/m² had approximately seven times the risk of symptomatic gallstones compared with women with a BMI below 24 kg/m². (PubMed)
Avoiding excessive weight gain and maintaining a stable, healthy body weight may reduce the risk of gallstone formation. In people with overweight or obesity, gradual and sustained weight loss is preferable. In contrast, rapid weight loss—particularly at rates exceeding approximately 1.5 kg per week—very-low-calorie diets, repeated weight loss and regain, and the substantial weight loss following metabolic or bariatric surgery increase the risk of gallstone formation. In selected patients undergoing rapid weight loss, temporary prophylaxis with ursodeoxycholic acid may be considered until body weight has stabilised; this decision should be made by the treating physician. (EASL-The Home of Hepatology.)
Other recognised risk factors include increasing age, female sex, pregnancy, oestrogen exposure, genetic or familial predisposition, insulin resistance, diabetes mellitus, and disorders associated with increased bilirubin production or impaired bile-acid circulation. These factors influence both the composition of bile and gallbladder motility. (EASL-The Home of Hepatology.)
Acute calculous cholecystitis usually develops when a gallstone persistently obstructs the cystic duct. Typical clinical features include sustained right upper-quadrant or epigastric pain, local tenderness or a positive Murphy’s sign, fever, nausea, vomiting, leukocytosis, and elevated inflammatory markers. Abdominal ultrasonography is generally the first-line imaging examination. In patients who are suitable for surgery, early laparoscopic cholecystectomy is the standard treatment and should usually be performed during the same hospital admission, preferably within one week of diagnosis. Supportive treatment includes analgesia, intravenous fluids, and antibiotics when infection or complicated inflammation is suspected. (MSD Manuals)
Chronic cholecystitis is a long-standing inflammatory and fibrotic disorder of the gallbladder that is almost always associated with gallstones and previous episodes of cystic-duct obstruction or gallbladder inflammation. Patients commonly experience recurrent biliary colic, usually presenting as episodic upper abdominal or right upper-quadrant pain. Fever is generally absent unless acute inflammation has developed. Ultrasonography may demonstrate gallstones and a thickened, contracted, or fibrotic gallbladder. Laparoscopic cholecystectomy is generally considered for persistent or recurrent biliary symptoms. (MSD Manuals)
Persistent severe abdominal pain, fever, jaundice, dark urine, pale stools, repeated vomiting, or signs of systemic illness require prompt medical assessment because they may indicate acute cholecystitis, bile-duct obstruction, cholangitis, or pancreatitis. (nhs.uk)