Clinical Features
What are the symptoms of gallstones?
- Around 80% of people with gallstones have no symptoms. The individual may be unaware that they have them and they are often found coincidentally during investigation of other disease.
- Symptoms tend only to occur when the stones become dislodged from the gallbladder and pass into the bile ducts or when the gallbladder becomes inflamed or infected (cholecystitis).
- When a stone passes through a bile duct it causes a severe, spasmodic pain known as biliary colic. This can last for several hours while the stone passes along the duct or longer if the stone becomes lodged within the duct. Persistent blockage of the bile duct can result in biliary obstruction within the liver with consequent jaundice and potential liver failure.
- The presence of stones in the gallbladder may interfere with the normal digestive reflex that releases bile after a meal. This can cause general symptoms such as abdominal bloating, flatulence, nausea and discomfort in the upper abdomen or between the shoulders. These occur more commonly after a fatty meal and intolerance to dietary fat may be evident.
- The most common complication of gallstones is cholecystitis.
What is Cholecystitis?
Cholecystitis is inflammation of the gall bladder. The presence of gallstones can cause impairment of normal emptying of the gall bladder resulting in stagnation of bile within its cavity. In most cases cholecystitis is caused by a stone blocking the cystic duct that joins the gallbladder to the common bile duct resulting in a chemically induced inflammation of the wall of the gallbladder. Inflammation and stagnation within the gallbladder also forms an environment that encourages bacteria to invade and grow within the organ.
Who gets cholecystitis?
In the great majority of cases cholecystitis occurs in conjunction with gallstones and the general risk factors for these apply to this condition also. Only around 4% of people with gallstones develop cholecystitis but of those that do around 50% will get recurrent attacks and complications. Preventative removal of the gall bladder is not recommended for asymptomatic gallstones, as the risk of complications of surgery is greater than the risk from the stones themselves.
What are the symptoms of cholecystitis?
- Cholecystitis can present as an acute attack or in a chronic form where recurrent episodes of symptoms occur.
- Acute cholecystitis starts as a chemical irritation of the gallbladder and presents with sudden onset of pain in the right upper abdomen, tenderness of the abdomen and systemic symptoms of fever, nausea and vomiting. The symptoms may subside spontaneously in 24-48 hours.
- Complications can occur, particularly if the gallbladder becomes infected and there is a risk of the gallbladder becoming filled with pus (empyema). There is also a risk of perforation of the wall of the gallbladder with subsequent peritonitis.
- Other serious complications such as jaundice, inflammation of the liver (cholangitis) or of the pancreas (pancreatitis) can also occur, depending on at what level the bile duct is obstructed.
- Chronic cholecystitis is typified by recurrent episodes of a diffuse pain in the upper abdomen that may radiate around to the shoulder blade often associated with nausea and vomiting. It can sometimes present with an attack of biliary colic. Episodes of acute cholecystitis may be superimposed on this pattern.
