Gallstones are hard, rock-like deposits that are formed in the gallbladder. Gallstones are formed from the components of the bile. The presence of gallstones in the gallbladder is medically referred to as cholelcystolithiasis, and the presence of gallstones in the biliary duct is medically referred to as choledocholithiasis. The size of gallstones varies widely on a case-by-case basis.
Most gallstones are tiny, and do not cause any symptoms. They are referred to as silent gallstones. No treatment is requried in these cases. Some gallstones are large enough to get stuck in the biliary passages and cause various symptoms. Pain is the most common symptom of gallstone disease. Uncomplicated gallstone disease often presents with pain as the only symptom but some people may also experience fatty stool, nausea, vomiting and diarrhea.
In complicated gallstone disease, signs and symptoms may arise due to further complications (such as jaundice). When painful symptoms arise due to gallstones, surgical removal of the gallbladder is usually required to treat the condition. Biliary sludge and small gallstones are mostly responsible for the severe pain attacks that are characteristic of the gallstone disease.
Severe pain is the most common symptom of gallstones. Gallstone pain is also referred to as biliary colic or biliary pain. Biliary colic is usually a result of obstruction of the bile duct. Obstruction in the gallbladder is a less frequent cause of biliary pain. The gallstones that lodge in the bile duct may break free and pass out in the bile. In such cases, gallstone pain resolves spontaneously.
In other cases, the pain may worsen due to inflammation of the bile duct or the gallbladder. Medically, inflammation of the bile duct is referred to as cholangitis, whereas inflammation of the gallbladder is referred to as cholecystitis. Cholangitis and cholecystitis arise as complications of gallstones. In some cases, cholangitis and cholecystitis occur together.
In other cases, cholecystitis may occur without cholangitis. Bacterial infections are usually the cause of gallstones, cholecystitis, and cholangitis. Gallstone pain may also occur as a result of other complications of gallstones and gallbladder disease. Examples of such complications include pus formation in the gallbladder (empyema), distention of the gallbladder caused by mucus or water collection (mucocele or hydrops), intestinal obstruction, acute pancreatitis, and fistula or perforation in the gallbladder.
In most cases, pain due to gallstones is felt in the epigastric region of the abdomen (upper middle part of the abdomen). In some cases, gallstone pain may also be felt in the upper right quadrant of the abdomen. The pain due to gallstones may also radiate to the upper left quadrant of the abdomen, scapula in the back, and the chest. Due to the various locations in which the pain may appear, gallstone pain is frequently mistaken for pain caused by gastritis, peptic ulcer, and heart attack (myocardial infarction).
Pain due to the presence of gallstones can be very severe. Gallstone pain is frequently described as excruciating pain. An attack of gallstone pain arises suddenly. The pain can remain constant for a period of thirty minutes to a couple of hours. In some cases, the pain may even last for up to 5 hours. When the pain persists beyond 6 hours, one should suspect the presence of complications such as pancreatitis or cholecystitis.
Gallstone pain may also be accompanied by abdominal distention. However, this is not caused by an enlargement of the gallbladder. The gallbladder is not big enough to be palpable from the outside. In such cases, the mass felt in the upper right quadrant of the abdomen may be due to inflamed bowel or omentum.
Murphy’s sign is an indication of the presence of acute cholecystitis. This is usually caused by the presence of gallstones. To check for Murphy’s sign, the patient is asked to breathe in while the doctor presses two fingers or the entire hand against the upper right quadrant of the abdomen. A positive Murphy’s sign is indicated by the occurrence of pain (and cessation of breathing) when pressure is applied to the upper right quadrant, but not when the pressure is applied to the upper left quadrant of the abdomen.
Other Signs and Symptoms
Obstruction of the cystic duct or the common bile duct by gallstones causes obstructive jaundice. A yellowish discoloration of the sclera, skin, and mouth is a characteristic feature of jaundice. The urine may turn dark yellow, and the stools may become clay-colored or pale. Itching or pruritis is another characteristic symptom of jaundice. If an individual appears jaundiced, and has a palpable but painless gallbladder, one should suspect the presence of gallbladder or pancreatic cancer.
Patients with gallstones may also show a mild or low-grade fever. High fever is rare and rigors are usually not present. The presence of rigors and abdominal pain may indicate the presence of ascending cholangitis.
Nausea and vomiting
Gallstone pain may also be accompanied by nausea. Eating anything may increase the nausea. One may mistake nausea and vomiting due to gallstones as an indication of a gastrointestinal disturbance or indigestion. However, unlike in gastrointestinal problems, abdominal bloating and belching are absent in the case of gallstones.
Complications of Gallstones
Acute pancreatitis (inflammation of the pancreas) is a complication of gallstones that is caused when the passing of gallstones results in swelling of the ampulla of Vater. The signs and symptoms of acute pancreatitis are similar to that of gallstones, and may include a rapid pulse rate, sweating, and pain that radiates to the back region. Bending forwards may provide some relief from the pain. The signs and symptoms of acute pancreatitis may persist even after the gallstone passes out into the duodenum.
In some rare cases, a big gallstone may be able to enter the intestine and cause obstruction. Such a condition is medically referred to as gallstone ileus. Intestinal obstruction due to gallstones may be characterized by swelling in the stomach (ascites), constipation, vomiting, and severe abdominal pain.
Perforation or fistula in gallbladder
A perforation or fistula in the gallbladder is another complication of gallstones. This usually occurs in complicated gallbladder disease.