Hi, Thanks for posting in HCM. The ultrasound report of your wife clearly suggests that she has multiple gall stones. The largest on measuring 23.4 mm is quite a big stone. These multiple stones and such large stone cannot be flushed out naturally with medications or any other forms. She needs to undergo operation called cholecystectomy at the earliest. If left alone, it may obstruct the outflow of bile and can lead to obstructive jaundice and its complications. The operation is done now a days by laproscopic procedure, which gives an advantage of being less painful, more quicker, minimal scar formation and with less hospital stay duration. Kindly consult Laproscopic Surgeon in this regard for appropriate management. Hope the information provided is clear. All the best.