<prompt> First treatment in asymptomatic gall bladder stone?Immediate surgeryOral dissolution agentsEndoscopic sphincter ablationWait and watch  <response>: ANSWER: D Wait and watchREF: Schwartz pretest 7th ed p-204, CSDT 11th ed p-546, Bailey Love 25th ed page 1121Because fewpatients develop complications without previous biliary symptoms, prophylactic cholecystectomy in asymptomatic persons with gallstones is rarely indicatedSurgical treatment for asymptomatic gall stonesPrerequisites of medical therapy for gall stones Diabetes Radiolucent stones Patients due to undergo bariatricsurgery for morbid obesity Size10mm Functioning GB Congenital hemolytic anemia Non acute symptoms Increased risk of complications1. Immunosuppressed2. Post-transplant Increased risk of gall bladder cancer1. Large stone 3cm2. Polyps of Gall bladder, especially if 10 mm3. Porcelain gallbladderCalcified gall bladder wall 