Expected and unexpected gallstones in primary care

OBJECTIVE: The aim of this prospective cohort study was to assess the differences in signs and symptoms of primary-care patients with expected and those with unexpected gallstones referred for upper abdominal ultrasound (US). MATERIAL AND METHODS: A total of 430 patients were referred by 76 general practitioners (GPs) for abdominal US to one of the three participating hospitals in The Netherlands. All GPs were asked to complete a standardized questionnaire before and after abdominal US. Patients with expected gallstones had a clinical suspicion of gallstones and cholelithiasis on abdominal US, patients with unexpected gallstones had cholelithiasis without a clinical suspicion of gallstones. RESULTS: Almost 50% of the patients were referred for abdominal US because of a clinical suspicion of gallstones. Cholelithiasis was detected by US in 29% of the patients with, and 11% of those without a clinical suspicion of gallstones. In patients suspected of gallstones, those with cholelithiasis detected by US were significantly less often of male gender, they had no prior cholecystectomies, were more likely to have colicky pain, and were more frequently referred to a medical specialist after US. Patients with unexpected gallstones were more often male, had fewer complaints of upper abdominal and colicky pain, and were less frequently referred to a medical specialist after US, in comparison with patients with expected gallstones. CONCLUSIONS: Gallstones were detected by upper abdominal US in 29% of the patients with, and 11% of those without a clinical suspicion of gallstones. This study showed marked differences in signs and symptoms of patients suspected of gallstones with and without cholelithiasis detected on abdominal US, and in patients with expected and unexpected gallstones.