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Gallstone disease - Symptoms.
Last reviewed: 06.07.2025
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Gallstone disease according to clinical course:
- latent form (carrying stones);
- primary chronic cholecystitis;
- biliary colic;
- chronic recurrent cholecystitis.
The main symptom of cholelithiasis is biliary colic (usually due to transient obstruction of the cystic duct by a stone). It is characterized by acute visceral pain localized in the epigastric or right hypochondrium, less often pain occurs only in the left hypochondrium, precordial region or lower abdomen, which significantly complicates diagnosis.
In 50% of patients, pain radiates to the back and right shoulder blade, interscapular region, right shoulder, and less often to the left half of the body.
The duration of biliary colic ranges from 15 minutes to 5-6 hours. Pain lasting more than 5-6 hours should alert the doctor to the possibility of complications, primarily acute cholecystitis.
The pain syndrome is accompanied by increased sweating, a grimace of pain on the face and a forced position - on the side with the legs tucked up to the stomach. Sometimes nausea and vomiting occur.
The onset of pain may be preceded by the consumption of fatty, spicy, hot foods, alcohol, physical activity, and emotional experiences.
The pain is associated with overstretching of the gallbladder wall due to increased intravesical pressure and spastic contraction of the sphincter of Oddi or cystic duct. Biliary colic may cause an increase in body temperature, but prolonged and significant hyperthermia (above 38 °C) combined with symptoms of intoxication (asthenovegetative syndrome, dryness and coating of the tongue) usually indicate the addition of acute cholecystitis.
The presence of jaundice is usually considered a sign of biliary obstruction.
When collecting anamnesis, it is necessary to ask the patient especially carefully about episodes of abdominal pain in the past, since with the progression of cholelithiasis, episodes of biliary colic recur, become protracted, and the intensity of pain increases.
Non-specific symptoms are also possible, such as heaviness in the right hypochondrium, flatulence, and dyspeptic symptoms.
Physical examination
It is possible to detect the symptom of muscular protection, increased pain during palpation in the area of the right hypochondrium and tapping with the edge of the palm along the right costal arch, as well as Murphy's symptom (involuntary holding of breath at the height of inhalation during palpation of the gallbladder due to increased pain). The addition of acute cholecystitis is characterized by the appearance of specific inflammatory symptoms from the gallbladder.
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