What are risk factors for biliary colic and cholecystitis?

Answer

Risk factors for biliary colic and cholecystitis include pregnancy, elderly population, obesity, certain ethnic groups (Northern European and Hispanic), weight loss, and liver transplant patients.^[6]

The phrase "fair, female, fat, and fertile" summarizes the major risk factors for development of gallstones. Although gallstones and cholecystitis are more common in women, men with gallstones are more likely to develop cholecystitis (and more severe cholecystitis) than women with gallstones.^[7]

Some oral contraceptives or estrogen replacement therapy may increase the risk of gallstones. Drugs that have been associated with cholecystitis include octreotide and ceftriaxone.^{[8, 9]}In addition, the incidence of sludge or stone formation during pregnancy is 5.1% in the second trimester, 7.9% in the third trimester, and 10.2% at 4-6 weeks postpartum.^{[10, 11]}

Age increases rates of gallstones, cholecystitis, and common bile duct stones. Elderly patients are more likely to go from asymptomatic gallstones to serious complications of gallstones without gallbladder colic.

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Media Gallery

The sonogram only shows gallstones within the gallbladder but no evidence of cholecystitis (ie, gallbladder wall thickening, pericholecystic fluid, common bile duct dilatation, sonographic Murphy sign).
Acute cholecystitis: sonogram findings. Multiple gallstones associated with gallbladder wall thickened are depicted in both longitudinal (a) and axial (b) images. Courtesy of Critical Ultrasound Journal, BioMed Central Ltd, Springer Nature (Mazzei MA, et al. The role of US examination in the management of acute abdomen. Crit Ultrasound J. 2013; 5(suppl 1): S6.)
Admission abdominal sonogram in a patient with acute gallbladder perforation and gallstones spillage. The mass (P) surrounding the gallbladder (GB) was considered to be blood, pus or, less likely, tumorous soft tissue, not ascites. The transparent arrow indicates a stone. Courtesy of World Journal of Emergency Surgery, BioMed Central Ltd, Springer Nature (Chiapponi C, et al. Acute gallbladder perforation with gallstones spillage in a cirrhotic patient. World J Emerg Surg. 2010; 5: 11.)

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Author

Peter A D Steel, MBBS, MA Associate Director, Department of Emergency Medicine, Lower Manhattan Hospital; Assistant Director of Operations, Department of Emergency Medicine, Assistant Professor of Medicine, Weill Cornell Medical Center

Peter A D Steel, MBBS, MA is a member of the following medical societies: American College of Emergency Physicians, British Medical Association, Emergency Medicine Residents' Association, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Rahul Sharma, MD, MBA, FACEP Medical Director and Associate Chief of Service, NYU Langone Medical Center, Tisch Hospital Emergency Department; Assistant Professor of Emergency Medicine, New York University School of Medicine

Rahul Sharma, MD, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Association for Physician Leadership, Phi Beta Kappa, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program Director for Emergency Medicine, Sanz Laniado Medical Center, Netanya, Israel

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, New York Academy of Medicine, New York Academy of Sciences, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Samuel M Keim, MD, MS Professor and Chair, Department of Emergency Medicine, University of Arizona College of Medicine

Samuel M Keim, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Public Health Association, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Eugene Hardin, MD, FAAEM, FACEP Former Chair and Associate Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science; Former Chair, Department of Emergency Medicine, Martin Luther King Jr/Drew Medical Center

Disclosure: Nothing to disclose.

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