Gallstones

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Cholecystolithiasis	Cholelithiasis	Digestive system	Gallbladder
Gallbladder	Gallbladder removal - series	Gallstones, cholangiogram	Kidney cyst with gallstones, CT scan

Cholelithiasis

Symptoms usually start after a stone of sufficient size (larger than 8 mm) blocks the cystic duct or the common bile duct. The cystic duct drains the gallbladder, and the common bile duct is the main duct draining into the duodenum. Together, these ducts form part of the biliary system.

A stone blocking the opening from the gallbladder or cystic duct usually produces symptoms of biliary colic, which is right upper abdominal pain that feels like cramping. If the stone does not pass into the duodenum, but continues to block the cystic duct, acute cholecystitis results.

If the common bile duct is blocked for a long period of time, bacteria may grow behind the stone in the stagnant bile, producing symptoms of cholangitis. Cholangitis is a serious condition and usually requires hospitalization. Continued blockage of normal bile flow may produce jaundice (yellow skin and eyes).

Stones blocking the lower end of the common bile duct (where it enters the duodenum) may obstruct secretion from the pancreas, producing pancreatitis. This condition can also be serious and may require hospitalization.

In general, pay attention to the following symptoms:

• Abdominal pain in the right upper abdomen or in the middle of the upper abdomen, which:
  • May be recurrent
  • May be sharp, cramping, or dull
  • May radiate to the back or below the right shoulder blade
  • May be made worse by fatty or greasy foods
  • Occurs within minutes of a meal
• Jaundice
• Fever

Additional symptoms that may be associated with this disease include:

• Clay-colored stools
• Nausea and vomiting
• Heartburn
• Excess gas
• Abdominal indigestion
• Abdominal fullness

Gallstones are present in about 80% of people with gallbladder cancer. Symptoms of gallbladder cancer are usually not present until the disease has reached an advanced stage and may include weight loss, anemia, recurrent vomiting, and a lump in the abdomen. When the cancer is caught at an early stage and has not spread deeper than the mucosa (the inner lining), removal of the gallbladder results in five-year survival rates of 68%. If cancer has spread to deeper layers, more extensive surgery or other treatments may be required.

This cancer is very rare, however, even among people with gallstones.

There are numerous tests to detect the presence of gallstones or gallbladder inflammation:

• Abdominal ultrasound
• Abdominal CT scan
• Abdominal x-ray
• Oral cholecystogram
• Gallbladder radionuclide scan
• Endoscopic retrograde cholangiopancreatography (ERCP)

This disease may also alter the results of the following tests:

• Fecal fat
• Urine bilirubin
• Abdominal MRI

Review Date: 10/27/2005
Reviewed By: Courtney W. Houchen, M.D., Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO. Review provided by VeriMed Healthcare Network.