INTERNATIONAL JOURNAL OF

Int J Med Rev 2020 July;7(3): 98-101

MEDICAL
10.30491/ijmr.2020.230530.1102
REVIEWS
Mini Review

Cholelithiasis: A Brief Review on Diagnostic Approach and

Management in Clinical Practice
Febyan Febyan 1*
1Department of Medicine, Bhayangkara Denpasar Hospital, Bali, Indonesia
Corresponding Author: Febyan Febyan, Department of Medicine, Bhayangkara Denpasar Hospital, Bali, Mawar Raya St. No.56,
Lembah Hijau, Lippo Cikarang, Bekasi, Indonesia, Postcode 17550. Tel: +62 82299684335, Email: [email protected]

Received May 09, 2020; Accepted June 08, 2020; Online Published September 07, 2020

Abstract
Cholelithiasis is one of the most prevalent diseases in gastroenterology. There are many factors in cholelithiasis, such as genetic, lack of physical
activity, obesity, dietary, age, and other comorbidities. Commonly, cholelithiasis occurs asymptomatically; however, Murphy’s sign is one of the
most frequent pathognomonic findings in abdominal examination. Ultrasonography is known as the gold standard imaging examination in
diagnosing cholelithiasis. The management of cholelithiasis can be divided into two categories, such as medical treatment and surgical treatment,
which depends on the patient’s condition.

Keywords: Gallstones, Cholelithiasis, Adults, Ultrasonography, Ursodeoxycholic Acid, Cholecystectomy

Copyright © 2020 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://
creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.
 Cholelithiasis: Diagnostic & Management in Clinical Practice

Figure 1. Cholelithiasis by Ultrasonographic.

*step wisely
Figure 2. Flowchart for Diagnosis of Cholelithiasis [20]

International Journal of Medical Reviews. 2020;7(3):98-101 | 99

Febyan

Table 1. Indications and Contraindications of Laparoscopic Cholecystectomy29

Indications
Biliary dyskinesia, acute cholecystitis, gallstones (symptomatic or asymptomatic), complications related to common bile duct
stones.
Contraindications
Absolute: uncontrolled coagulopathy, inability to tolerate general anesthesia, all types of gallbladder cancer.
Relative: severe acute peritonitis, septic shock, advanced cirrhosis/liver failure, previous upper abdominal surgeries, peritonitis.

1. Chung AY, Duke MC. Acute biliary disease. Surg Clin North Am
2018;98(5):877-94. doi: 10.1016/j.suc.2018.05.003
2. Stinton LM, Myers RP, Shaffer EA. Epidemiology of gallstones.
Gastroenterol Clin North Am 2010;39:157-69. doi:
10.1016/j.gtc.2010.02.003
3. Festi D, Reggiani MLB, Attili AF, Loria P, Pazzi P, Scaioli E, et al.
Natural history of gallstone disease: Expectant management or
active treatment? Results from a population-based cohort
study. J Gastroenterol Hepatol 2010;25:719-24. doi:
10.1111/j.1440-1746.2009.06146.x

100 | International Journal of Medical Reviews. 2020;7(3):98-101

 Cholelithiasis: Diagnostic & Management in Clinical Practice

4. Cojocaru DC, Mitu F, Dascalu CG, Manole A, Cozma CD. The American Journal of Roentgenology. 2007 Feb;188(2):495-501.
predictor of cholelithiasis in female patients with metabolic doi: 10.2214/AJR.05.1712
syndrome. Cent. Eur J Med 2014;9(1):108-14. 19. Alobaidi M, Gupta R, Jafri SZ, Fink-Bennet DM. Current trends in
5. Pimpale R, Katakwar P, Akhtar M. Cholelithiasis: causative imaging evaluation of acute cholecystitis. Emergency radiology.
factors, clinical manifestations and management. Int Surg J 2004 Apr 1;10(5):256-8. doi: 10.1007/s10140-004-0325-8
2019;6(6):2133-38. doi: http://dx.doi.org/10.18203/2349- 20. Tazuma S, Unno M, Igarashi Y, Inui K, Uchiyama K, Kai M,
2902.isj20192380 Tsuyuguchi T, Maguchi H, Mori T, Yamaguchi K, Ryozawa S.
6. Peswani AR, Sequeira VJ, D’silva M, Ghanwat S, Shah PP, Pinto Evidence-based clinical practice guidelines for cholelithiasis
AC. Association between gallstone disease and metabolic 2016. Journal of gastroenterology. 2017 Mar 1;52(3):276-300.
syndrome. IJCMR 2019;6(10):J1-J5 doi: 10.1007/s00535-016-1289-7
7. Chen Y, Kong J, Wu S. Cholesterol gallstone disease: focusing on 21. Henderson SO, Swadron S, Newton E. Comparison of
the role of gallbladder. Laboratory Investigation. 2015 intravenous ketorolac and meperidine in the treatment of biliary
Feb;95(2):124-31. doi: 10.1038/labinvest.2014.140 colic. J Emerg Med 2022;23(3):237-41. doi: 10.1016/s0736-
8. Lammert F, Gurusamy K, Ko CW, Miquel JF, Mendez-Sanchez N, 4679(02)00524-3
Portincasa P, et al. Gallstones. Nat Rev Dis Primers 2016;2:16025. 22. Kumar A, Deed JS, Bhasin B, Kumar A, Thomas S. Comparison of
doi: 10.1038/nrdp.2016.24 the effect of diclofenac with hyoscine-N-butylbromide in the
9. Shabanzadeh DM. Incidence of gallstone disease and symptomatic treatment of acute biliary colic. ANZ J Surg
complications. Curr Opin Gastroenterol 2018;34:81-9. doi: 2004;74(7):573-76. https://doi.org/10.1111/j.1445-
10.1097/MOG.0000000000000418 2197.2004.03058.x
10. Portincasa P, Moschetta A, Palasciano G. Cholesterol gallstone 23. European Association for the Study of the Liver. EASL clinical
disease. The Lancet. 2006 Jul 15;368(9531):230-9. doi: practice guidelines on the prevention, diagnosis and treatment
10.1016/S0140-6736(06)69044-2 of gallstones. Journal of Hepatology 2016;65:146-81
11. Reshetnyak VI. Concept of the pathogenesis and treatment of 24. Gutt C, Schlafer S, Lammert F. The treatment of gallstone
cholelithiasis. World J Hepatol 2012;4(2):18-34. doi: disease. Dtsch Arztebl Int 2020;117:148-58. doi:
10.4254/wjh.v4.i2.18 10.3238/arztebl.2020.0148
12. Gore JM. Cholelithiasis. Journal of the American Academy of 25. Kotb MB. Molecular mechanism of ursodeoxycholic acid toxicity
PAs. 2013 Dec 1;26(12):54-5. & side effects: ursodeoxycholic acid freezes regeneration &
13. Thomas S. Differentiating abdominal pain using Murphy’s sign. induces hibernation mode. Int J Mol Sci 2012;12(7):8882-914.
Practice Nurs 2013;24(3):141. doi: 10.3390/ijms13078882
https://doi.org/10.12968/pnur.2013.24.3.141 26. Guarino MP, Cocca S, Altomare A, Emerenziani S, Cicala M.
14. Aslam HM, Saleem S, Edhi MM, Shaikh HA, Hafiz M, Saleem M. Ursodeoxycholic acid therapy in gallbladder disease, a story not
Assessment of gallstone predictor: comparative analysis of yet completed. World Journal of Gastroenterology: WJG. 2013
ultrasonographic and biochemical parameters. International Aug 21;19(31):5029. doi: 10.3748/wjg.v19.i31.5029
archives of medicine. 2013 Dec 1;6(1):17. doi: 10.1186/1755- 27. Keus F, de Jong J, Gooszen HG, Laarhoven CJ. Laparoscopic
7682-6-17 versus open cholecystectomy for patients with symptomatic
15. Giljaca V, Gurusamy KS, Takwoingi Y, Higgie D, Poropat G, cholecystolithiasis. Cochrane Database of Systematic Reviews.
Štimac D, Davidson BR. Endoscopic ultrasound versus magnetic 2006(4). doi: 10.1002/14651858.CD006231
resonance cholangiopancreatography for common bile duct 28. Tayeb M, Raza SA, Khan MR, Azami R. Conversion from
stones. Cochrane Database of Systematic Reviews. 2015(2). doi: laparoscopic to open cholecystectomy: multivariate analysis of
10.1002/14651858.CD011549 preoperative risk factors. Journal of postgraduate medicine.
16. Scruggs W, Fox JC, Potts B, Zlidenny A, McDonough J, Anderson 2005;51(1):17.
CL, Larson J, Barajas G, Langdorf MI. Accuracy of ED bedside 29. Peitzman AB, Watson GA, Marsh JW. Acute cholecystitis: when
ultrasound for identification of gallstones: retrospective analysis to operate and how to do it safely. J Trauma Acute Care Surg
of 575 studies. Western Journal of Emergency Medicine. 2008 2014;78(1):1-12. doi: 10.1097/TA.0000000000000476
Jan;9(1):1. 30. Manes G, Paspatis G, Aabakken L, Anderloni A, Arvanitakis M,
17. Khan SP, Izhar S. Ultrasound as a first line investigation of choice Ah-Saune P, et al. Endoscopic management of common bile
in diagnosis acute cholicystitis. IJAR 2018;6(11):65-9. duct stone: European society of gastrointestinal endoscopy
18. van Breda Vriesman AC, Engelbrecht MR, Smithuis RH, Puylaert (ESGE) guideline. Endoscopy 2019;51:472-91. doi: 10.1055/a-
JB. Diffuse gallbladder wall thickening: differential diagnosis. 0862-0346

International Journal of Medical Reviews. 2020;7(3):98-101 | 101