Gallstone disease and benign biliary occlusions
1. Big picture
Gallstone disease is one of the most common surgical diseases of the biliary tract. The examiner wants you to recognize which gallstone patient can go home, which needs elective laparoscopic cholecystectomy, and which has a life-threatening biliary emergency.
The core surgical pattern is:
Stone in gallbladder → biliary colic or acute cholecystitis
Stone in common bile duct → obstructive jaundice / cholangitis / pancreatitis
Stone compressing common hepatic duct → Mirizzi syndrome
Benign stricture → chronic obstructive jaundice ± cholangitis
Most gallstones are asymptomatic. Surgery is mainly indicated when stones become symptomatic or complicated. In acute calculous cholecystitis, guidelines recommend laparoscopic cholecystectomy as first-line treatment, avoiding it mainly in septic shock or absolute anesthetic contraindication. ([SpringerLink][1])
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