Gallbladder stones are an extremely common disorder and are usually asymptomatic. Some patients experience biliary colic, intermittent and often severe pain in the epigastrium or right upper quadrant, and at times between the scapula because of temporary obstruction of the cystic duct with a gallstone. If the cystic duct obstruction persists, the gallbladder becomes inflamed and the patient develops cholecystitis, acute inflammation, and infection of the gallbladder. It is estimated that there are 20.5 million cases of gallbladder disease in the United States, 14.2 million of whom are in women. More than 600,000 cholecystectomies per year are performed in the United States, most of which are for symptomatic gallstone disease. Epidemiologic studies have shown variations in the prevalence of gallstones in different ethnic populations, with particularly high rates in Native Americans. In addition to ethnic background, other risk factors for the development of gallstones include diabetes, rapid weight loss, morbid obesity, cirrhosis, and conditions associated with infrequent gallbladder emptying, such as total parenteral nutrition. Most gallstones are composed primarily of cholesterol, with smaller amounts of mucus, calcium bilirubin, and protein. Pigment stones, a result of hemolysis, are less common and are made primarily of calcium bilirubin. Symptoms occur with gallstones when the gallbladder contracts, often after a meal, resulting in occlusion of the cystic duct with a stone that produces symptoms, typically pain.
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