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J Clin Outcomes Manage
2009 Jan;16(1):37-48
Gallstone disease: from dyspepsia to biliary complications
Shaffer E
Educational Needs Addressed Gallstones are common, affecting over 10% of adults in the Western world and representing a major health burden. Yet most people with gallstones are asymptomatic. Only 10% of people harboring gallstones develop symptoms by 5 years, and only 20% by 20 years. The classic symptom of cholelithiasis is biliary colic: steady epigastric or right upper quadrant pain lasting more than 30 minutes and often radiating to the back or right scapula. Gallstones also can lead to major complications: cholecystitis, pancreatitis, and cholangitis. Biliary sludge, a forerunner of cholelithiasis, develops rather commonly during pregnancy but usually resolves in the postpartum period without causing complications. Biliary-type pain in people without gallstones represents a clinical dilemma. Many have functional bowel problems that will not resolve following cholecystectomy. Primary care physicians represent the front lines to identify true biliary pain and manage biliary complications. Educational Objectives After participating in this CME activity, primary care physicians should be able to 1. Understand the risk factors for gallstone formation 2. Discern the clinical features of true biliary pain 3. Know the natural history of gallstone disease 4. Develop a management strategy for biliary pain in the absence of gallstones 5. Recognize and manage functional bowel disease, particularly acalculous gallbladder disease 6. Diagnose and treat postcholecystectomy diarrhea
Case-Based Review, CME
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