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Approximately 500,000 cholecystectomies are performed annually in the United States. Symptomatic gallstones are the most common indication for cholecystectomy. A review by Ahmad and colleagues stressed the importance of differentiating biliary colic and acute cholecystitis. Overlapping symptoms may result in misinterpretation.
Approximately 90 percent of gallstones are composed of cholesterol. Gallstones are most likely to develop in patients with supersaturation of bile products, bile stasis or nucleation factors (i.e., mucin, glycoproteins and calcium around which a stone may form). Risk factors for cholesterol gallstone formation include age, obesity, rapid weight loss, pregnancy, female sex, use of exogenous estrogens, diabetes, certain gastrointestinal conditions and certain medications.
About one third of patients with gallstones develop biliary colic or other complications. Colic pain is precipitated by spasm of a dilated cystic duct that is obstructed by gallstones. Attacks of biliary colic are more common at night, possibly because the gallbladder...