Cholesterol stones: large, solitary, older, obesity, female sex

Mixed stones: faceted, calcium salts, pigment, cholesterol

Risk factors for stones becoming symptomatic include smoking and parity (having given birth)

Main difference from biliary colic is the inflammatory component which leads to local peritonism, fever, high WCC

Treat with analgesia, fluids and elective laparoscopic cholecystectomy (within 24 hours)

This is a condition in where gallstones are symptomatic with cystic duct obstruction or if passed into the common bile duct

If surgery is not done within 24 hours, complications such as acute pancreatitis can occur

If the stone moves to the common bile duct, there is obstructive jaundice and cholangitis

Can cause continuous epigastric or RUQ pain (this is referred to the right shoulder, dermatomes C3-C5)

Acute cholecystitis follows stone or sludge impaction at the neck of the gallbladder

Murphy's Sign = Put two fingers over RUQ and ask to breathe in. Causes pain and arrest of inspiration as the inflamed gallbladder impinges on your fingers

Ultrasound: thick walled, shrunken gallbladder, pericholecystic fluid, stones, common bile duct dilation

Plain AXR (abdominal radiograph) - only identifies 10% of stones, may show porcelain GB

Laparoscopic cholecystectomy - this is the treatment of choice, done within 7 days of episode. 1/4 of patients who have delayed surgery have recurrent or worsening symptoms