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Gallstones (Cholelithiasis), Biliary Colic — UKMLA MCQ

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MediumGastroenterologyGallstones (Cholelithiasis), Biliary ColicUKMLAMRCGP AKTPARAMRCP Part 1

A 42-year-old woman presents with recurrent episodes of right upper quadrant (RUQ) abdominal pain, typically occurring 30-60 minutes after eating fatty meals. The pain is colicky and radiates to her right shoulder. She denies fever, jaundice, or changes in bowel habit. An abdominal ultrasound scan confirms the presence of multiple gallstones within the gallbladder, a normal common bile duct diameter, and no other abnormalities. Her liver function tests are normal. What is the most appropriate definitive management?

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Correct answer: B — Elective Laparoscopic Cholecystectomy

Explanation lettering: C = shown as A · D = shown as B · E = shown as C · B = shown as D · A = shown as E

The patient has symptomatic gallstones (biliary colic) confirmed on ultrasound, with no evidence of complications like cholecystitis or choledocholithiasis. The definitive treatment for symptomatic gallstones is cholecystectomy (gallbladder removal). Laparoscopic cholecystectomy is the standard approach. Dietary modification (A) may reduce symptom frequency but doesn't resolve the underlying issue. Ursodeoxycholic acid (B) has a limited role in dissolving small cholesterol stones but recurrence is common. ERCP (C) is indicated for common bile duct stones. ESWL (E) is rarely used for gallstones.

Reference: NICE CG188: Gallstone disease: diagnosis and management