The Symptomatology of Gallstones

The Symptomatology of Gallstones

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Gallstones can cause intense pain in the upper abdomen.

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Approximately 10 to 15 percent of Americans have gallstones, a condition called cholelithiasis, but less than half of these patients experience symptoms. Certain people are at higher risk of forming gallstones, including women, the elderly, the obese and those from ethnic groups such as American Indians and Mexican Americans. Gallstones are formed when bile, the fluid manufactured in the liver to help digest fat, hardens into pebble-like deposits. For the most part, symptoms occur when gallstones obstruct passages, or bile ducts, between the gallbladder and other organs.

Biliary Colic

The most common symptom of gallstone disease is biliary colic, caused by a gallstone blocking the cystic bile duct that allows bile to flow from the gallbladder to the common bile duct. When the gallbladder contracts to release bile after a meal, it is unable to do so because of the blockage. As a result, the person may feel sudden and intense pain, nausea and vomiting. Typically, the pain is in the area of the gallbladder in the right upper quadrant of the abdomen, but some people complain of pain in the right shoulder or back instead. The pain lasts from a few minutes to several hours, then decreases in intensity when the gallbladder stops contracting or the blockage resolves. People with gallstones may also complain of bloating, heartburn, acid reflux, burping or an early feeling of fullness after eating, but these symptoms may be caused by other conditions, such as peptic ulcer disease.


Acute cholecystitis, inflammation of the gallbladder, is the most common complication of gallstones. Blockage in the cystic duct causes the gallbladder to become inflamed, resulting in persistent right upper quadrant pain, fever, sweating, rapid heartbeat, loss of appetite, nausea and vomiting. Most people feel better within 7 to 10 days, but an estimated 25 percent require emergency surgery to relieve the pain and prevent serious infection. A low-grade level of inflammation along with the presence of gallstones is associated with a long-term or chronic form of cholecystitis that causes repeated attacks of right upper quadrant pain, nausea, vomiting and fatty food intolerance even though no obstruction is present.

Choledocholithiasis and Cholangitis

Choledocholithiasis, the presence of stones in the common bile duct, causes biliary colic if the duct becomes partially obstructed. If the duct becomes completely obstructed, the person experiences symptoms similar to biliary colic. Bacteria can enter from the small intestine, causing a serious infection in the duct, a condition called cholangitis. The person may have jaundice -- yellowing of the skin and the whites of the eyes -- and dark urine due to excessive levels of bilirubin, a byproduct of the breakdown of red blood cells. The infection can lead to chills, fever, rapid heartbeat and low blood pressure, and it can be life-threatening.

Management of Symptoms

Episodes of gallstone-related pain and other symptoms tend to recur, although the interval between episodes may be as long as several years. In extreme cases, emergency surgery may be needed to save the patient's life. Otherwise, an elective surgical procedure called a cholecystectomy may be scheduled to remove the gallbladder. If gallstones are located in the common bile duct, a procedure called ERCP -- endoscopic retrograde cholangiopancreatography -- may be used to remove the stones. Patients who are not good surgical candidates may try bile acid therapy, medication given by mouth to dissolve the stones. Unfortunately, 25 percent of patients taking bile acids develop new gallstones within 5 years.