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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

Asymptomatic gallstones with no symptoms in the preceding 12 months do not need to be referred

 

Gallbladder polyps

IF Symptomatic OR >1cm OR Gallstones present

Surgery may be considered due to risk of malignancy

Refer to Upper GI surgical outpatients

Polyps < 1cm that are not referred for surgery should have a repeat USS in 1 year due to risk of malignancy

 

INVESTIGATIONS PRIOR TO REFERRAL

LFTs

Abdominal USS- attach results 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

 

 

Acute cholecystitis

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

Refer to General Surgery On Call

 

 

Suspected retained stones after gallbladder surgery

Check LFTs and amylase

Arrange urgent USS

Consider referral to jaundice clinic or hepatobiliary gastro depending in clinical urgency. MRCP and ERCP will then be arranged.

Note- a dilated CBD post gallbladder surgery on its own is quite common after surgery and not necessarily suggestive of a retained stone.

 

 

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