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Gallstones & Gallbladder Polyps

WHO TO REFER

 

Symptomatic gallstones

Stones found on imaging and causing symptoms within the last 12 months

Refer to Upper GI surgical outpatients

 

Gallbladder polyps IF Symptomatic OR >1cm OR Gallstones present

Surgery may be considered due to risk of malignancy

Refer to Upper GI surgical outpatients

 

Acute cholecystitis

Should be admitted as a surgical emergency for early laparoscopic cholecystectomy (within 1 week of diagnosis)

Refer to General Surgery On Call

 

 

WHO NOT TO REFER

Asymptomatic gallstones

Incidentally found on imaging and patient has been completely symptom free for 12 months before diagnosis. No treatment needed.

Reassurance only

 

 

Investigations prior to referral

LFTs

Abdominal USS

(Results should be attached to referral)

 

Primary care management

Advise patients to avoid food and drink that triggers their symptoms until gallbladder or gallstones removed – i.e. low fat diet

 

 

Gallstone sifter information

  • Retained stones after gallbladder surgery: 

o    Refer to Hepatobilary gastro for further investigation +/- ERCP

 

  • Dilated CBD post gallbladder surgery:

o    On its own this is quite common after surgery and not necessarily suggestive of a retained stone.

o    If symptomatic or deranged LFTs with it then would refer to Hepatobilary gastro for investigation +/- ERCP 

 

  • Pain post gallbladder surgery:

o    See surgeon who did procedure first to exclude a post-surgical problem or look for alternative primary diagnosis

 

References

NICE guidelines Gallstone disease: diagnosis and initial management 29th October 2014. Nice.org.uk/guidance/cg188

Mr Paul Peyser and Mr Mike Clarke – Upper GI surgeons Royal Cornwall Hospital Trust