What next steps for non-moving gallstones?

Question

Hi doctor,

I am a 54 year old male. I got a bypass heart surgery 12 years ago. During that time, my gallbladder had multiple small stones, which were silent according to the doctor. The location and position of these stones were found static during regular ultrasound tests. Four years back, I consulted a doctor, he also said that as it is silent and non-movable stones, there is no need to operate till there is no pain. I got an ultrasound two months back. Please see the attached report, and let me know what action needs to be taken? I do not have any pain or discomfort.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through the reports (attachment removed to protect patient identity).

The reports show chronic calculous cholecystitis. And as you do not have any symptoms like biliary colic or acute severe abdominal pain, it is asymptomatic chronic cholecystitis.
- Asymptomatic cholecystitis is managed expectantly, that is when symptoms or complications develop. The ultrasound shows no gallbladder wall thickening, edema, or distended gallbladder. Most commonly, stones are due to lithogenic bile or stasis of bile within the gallbladder.
  1. What is your abdominal girth?
  2. Do you have diabetes?
  3. Are you on any medication?
  4. Recent lipid profile result?
    - I suggest you try using tablet Udiliv (Ursodeoxycholic acid) 300 mg twice daily. This decreases lithogenicity of the bile. Take less fatty meal.
      - As a final note, chronic fibrotic and static gallbladder poses a minimal risk of adenocarcinoma.
        
        In your case, the wall and size of the gallbladder are not mentioned. Your common bile duct is also fine, and hence, surgery can be planned expectantly.
        
        Revert with more information to an internal medicine physician online.

Answer 2

Hi,

Welcome back to icliniq.com.

I have seen all your reports (attachment removed to protect patient identity).

Your lipid profile is perfect, and your prescription is complete, so do continue your treatment.

You may start tablet Udiliv 300 mg twice daily, after consulting your doctor.

Get ultrasound abdomen done after three months of starting the medication. You need to continue the medication for three months, following the radiological dissolution of stones.

For more information consult an internal medicine physician online.