Gallstones, Suggestions & Next Steps.

Based on the symptoms and investigation findings you have described, your wife's condition is suggestive of symptomatic gallstone disease (biliary colic). Let me address your concerns individually. 1. Are these symptoms due to gallstones? Yes, recurrent upper abdominal pain radiating to the right side of the back, associated with nausea and vomiting and lasting 2–3 hours, is quite characteristic of biliary colic. The absence of gallbladder inflammation on ultrasound does not exclude symptomatic gallstone disease. 2. Is surgery necessary, and how urgently should it be performed? For symptomatic gallstones, laparoscopic cholecystectomy is the recommended definitive treatment. Since she has experienced recurrent episodes, I would advise planning an elective laparoscopic cholecystectomy soon rather than waiting indefinitely. It may not be an emergency at present if she is comfortable and has no fever, jaundice, or persistent pain. However, recurrent attacks can occasionally lead to complications such as acute cholecystitis, common bile duct stones, or acute pancreatitis. 3. Are further investigations required? Her liver enzymes (AST 88, ALT 114) and direct bilirubin (0.88) are elevated. These abnormalities may be associated with temporary obstruction of the bile duct by a passing stone, although other causes are also possible. I would recommend: 1. Repeat LFT, including total/direct bilirubin, AST, ALT, ALP, and GGT. 2. Review the ultrasound findings, particularly the common bile duct diameter. 3. Consider MRCP or endoscopic ultrasound (EUS) to exclude common bile duct stones if the liver tests remain abnormal or clinical suspicion persists. Upper GI endoscopy is not routinely necessary unless there are significant symptoms suggesting another gastrointestinal condition. 4. What about fatty liver? Grade 1 fatty liver is usually managed with dietary modification, regular exercise, and weight management. It is generally not a contraindication to laparoscopic cholecystectomy. My recommendation: Arrange a surgical consultation soon and plan elective laparoscopic cholecystectomy after appropriate preoperative evaluation. I would not recommend prolonged observation in someone experiencing recurrent typical biliary colic. If she develops persistent severe abdominal pain, fever, jaundice, or repeated vomiting, please seek immediate hospital evaluation.