clinical presentation of gallstone disease

Last reviewed 01/2018

Gallstone patients may present as:

  • asymptomatic
    • approximately 50-70% of patients with gallstones are asymptomatic at the time of diagnosis (1)
    • usually patients becomes symptomatic after many years, once stones reach a certain size (>8mm) (1)
  • symptomatic and/or with complication - around 1-2% of patients with cholelithiasis develop the following symptoms or complications per year:
    • biliary colic
      • is the main symptom of uncomplicated cholelithiasis and is present in around 56% of patients (3)
      • caused when the gallbladder contracts against an outlet obstruction (obstruction of the gall bladder neck or the cystic duct by a stone)
      • severe and cramping right upper quadrant abdominal pain which may radiate round to the back in the interscapular region
        • it may also be felt in the epigastrium, left upper quadrant and occasionally praecordially
        • may last minutes to hours (not more than about six hours)
        • often occurs post-prandially
    • there can be associated nausea, vomiting and GI symptoms (belching, bloating, dyspepsia and flatulence)
    • uncomplicated cases usually resolve spontaneously or with analgesics (4)

  • acute cholecystitis
    • present in around 36% of patients (3)
    • right upper quadrant pain which may radiate to the right shoulder
      • may be preceded by attacks of biliary colic
      • pain lasts for more than 12 hours
      • worse on movement and inspiration (4)
    • nausea, vomiting
    • fever
    • tenderness, guarding in the right upper quadrant and occasionally a palpable, tender mass
    • Murphys sign may be positive (4)

  • other complications include:
    • obstructive jaundice
    • acute cholangitis
    • acute pancreatitis
    • gallstone ileus
    • mucocele of gallbladder
    • empyema of gallbladder
    • biliary peritonitis
    • gallbladder cancer.

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