This document outlines the policy for managing gallstones disease and emergency admissions related to biliary colic or acute cholecystitis. It describes the appropriate diagnostic investigations and treatment approaches based on ultrasound findings and liver function test results. For biliary colic with normal ultrasound and tests, elective laparoscopic cholecystectomy is discussed. For abnormal ultrasound or tests, further imaging and potential endoscopic retrograde cholangiopancreatography is recommended before considering early cholecystectomy. For acute cholecystitis, the priority is emergency laparoscopic cholecystectomy within 3-4 days if the patient is fit, with conservative treatment or percutaneous cholecystostomy as alternatives if not.

1. POLICY
MANAGEMENT
GALL STONES DISEASE
Dr Mohamad Al-Gailani FRCS
‫د‬.‫الكيالني‬ ‫محمد‬
‫العامة‬ ‫الجراحة‬ ‫استشاري‬
‫الرياض‬
‫السعودية‬ ‫العربية‬ ‫المملكة‬
Consultant Surgeon
Al Hammadi Hospital, Suwaidi
Riyadh
KSA

2. I
EMERGENCY ADMISSIONS
WITH SUSPECTED
BILIARY COLIC

3. I: EMERGENCY ADMISSIONS WITH
SUSPECTED BILIARY COLIC:
Investigations:
 CBC
 U&E
 LFT: bilirubin, SGPT, SGOT, alkaline phosphatase
 Lipase
 Erect Chest (CXR) & Abdominal X-ray (AXR)
 Abdominal US
Policy of Management of Gall Stones Disease DR. MOHAMAD AL-GAILANI FRCS 2016
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4. A-US CONFIRMS GALLSTONES AND CBD /
LFT NORMAL
Management:
Fit for surgery > Discuss Elective Laparoscopic
Cholecystectomy (LC)
Unfit and can be improved > manage accordingly
and plan surgery once fit
Unfit and cannot be improved > symptom control
& discharge with clinic follow-up
Policy of Management of Gall Stones Disease DR. MOHAMAD AL-GAILANI FRCS 2016
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5. B- US SHOWS DILATED CBD AND/OR
DERANGED LFT:
Management:
B- US shows dilated CBD and/or deranged
LFT:
Arrange MRCP
Gastroenterology referral for ERCP
Policy of Management of Gall Stones Disease DR. MOHAMAD AL-GAILANI FRCS 2016
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6. POST ERCP:
ERCP: stones removed >
Plan Early Elective LC
Normal ERCP >
Discuss Elective LC?
Policy of Management of Gall Stones Disease DR. MOHAMAD AL-GAILANI FRCS 2016
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7. II
EMERGENCY ADMISSIONS
WITH SUSPECTED
ACUTE CHOLECYSTITIS
Policy of Management of Gall Stones Disease DR. MOHAMAD AL-GAILANI FRCS 2016
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8. II: EMERGENCY ADMISSIONS WITH
SUSPECTED ACUTE CHOLECYSTITIS
Investigations:
 CBC
 U&E
 LFT: bilirubin, SGPT, SGOT, alkaline phosphatase
 Lipase
 Erect CXR & AXR
 Abdominal US
Policy of Management of Gall Stones Disease DR. MOHAMAD AL-GAILANI FRCS 2016
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9. I-US CONFIRMS CHOLECYSTITIS AND CBD /
LFT NORMAL:
Management:
 Fit for surgery > Emergency LC (ideally within first 3 to 4
days of the Index admission)
 Unfit for surgery but can be improved > manage
conservatively initially followed by LC.
 Not responding to antibiotics > discuss with radiologist,
consider Percutaneous Cholecystostomy (PC)
Policy of Management of Gall Stones Disease DR. MOHAMAD AL-GAILANI FRCS 2016
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10. I-US CONFIRMS CHOLECYSTITIS AND CBD /
LFT NORMAL:
 Unfit for surgery and cannot be improved > treat conservatively +/-
PTC
 If patients are discharged with a view to outpatient Elective LC:
1. Risks and complications of surgery should be discussed with the
patient and recorded in the notes
2. Patient placed directly on the waiting list rather than brought back to
the clinic to discuss again
3. Unless there are issues which may preclude surgery such as co-
morbidities.
Policy of Management of Gall Stones Disease DR. MOHAMAD AL-GAILANI FRCS 2016
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11. II-US CONFIRMS CHOLECYSTITIS AND
ABNORMAL LFT/CBD
Management:
Arrange MRCP
Stone in CBD > Gastroenterology referral for ERCP
Consider LC following ERCP
No stone in CBD > Emergency LC
Policy of Management of Gall Stones Disease DR. MOHAMAD AL-GAILANI FRCS 2016
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12. Management
Findings
Management
Findings
Diagnosis
Suspected Gall Stones?
US
Biliary Colic
Normal
CBD/LFT
Abnormal
CBD/LFT
Acute
Cholecystitis
Abnormal
CBD/LFT
Normal
CBD/LFT
ERCP
EMERGENCY (INDEX ADMISSION) LAPAROSCOPIC CHOLECYSTECTOMY
MRCP
Normal
CBD
Stone
Discuss
Elective
LC?
Policy of Management of Gall Stones Disease DR. MOHAMAD AL-GAILANI FRCS 2016
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