SYMPTOMATIC GALLBLADDER LITHIASIS AND ACUTE CHOLECYSTITIS.

The main clinical sign of gallstones is biliary pain, characterised by a sudden onset of pain in the right hypochondrium or the epigastrium. Such pain often occurs just after meals or at night. It is persisting and often associated with nausea and vomiting, but may be non-existent among the elderly. Clinical examination identifies pain that prevents deep breath in-take (Murphy's sign), and localised guarding in the right hypochondrium. This table may be accompanied by general signs of inflammation and infection with fever. Two complementary examinations must be realised quickly :

- A blood test looking for infection and/or disruption of the liver functions.
- An ultrasound looking for stones in the gallbladder and signs of inflammation or infec-tion of the gallbladder.

In case of persistent pain and fever, it is urgent to consult a surgeon. The operation in-volves removing the gallbladder under laparoscopy. The faster the procedure is performed, the shorter the duration of hospitalisation. In case of late management (> 7 days), the risk of complication is higher and will require the surgeon to perform an opening under the right side of the ribs. Apart from emergency situations, the removal of the gallbladder is a simple pro-cedure, always feasible under laparoscopy.