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Gallstones and gallbladder disease

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of gallstones.

Alternative Names

Cholecystitis; Choledocholithiasis; Bile duct stones

Symptoms

About 90% of gallstones provoke no symptoms at all. If problems do develop, the chance of developing pain is about 2% per year for the first 10 years after stone formation, after which the chance for developing symptoms declines . On average, symptoms take about 8 years to develop. The reason for the decline in incidence after 10 years is not known, although some doctors suggest that "younger," smaller stones may be more likely to cause symptoms than larger ones.

Biliary Pain

The mildest and most common symptom of gallbladder disease is intermittent pain called biliary colic , which occurs either in the mid- or the right portion of the upper abdomen. A typical attack has several features:

• The primary symptom is typically a steady gripping or gnawing pain in the upper right abdomen near the rib cage, which can be quite severe and can radiate to the upper back. Some patients with biliary colic experience the pain behind the breast bone.
• Nausea or vomiting may occur.
• Changes in position, over-the-counter pain relievers, and passage of gas do not relieve the symptoms.
• Biliary colic typically disappears after 1 to several hours. If it persists beyond this point then acute cholecystitis or more serious conditions may be present.
• The episodes typically occur at the same time of day but less frequently than once a week. Large or fatty meals can precipitate the pain, but it usually occurs several hours after eating and often wakes the patient during the night.
• Recurrence is common but attacks can be years apart. In one study, for example, 30% of people who had had 1 or 2 attacks experienced no further biliary pain over the next 10 years.

Digestive complaints such as belching, feeling unduly full after meals, bloating, heartburn (burning feeling behind the breast bone), or regurgitation (acid back-up in the food pipe) are not likely to be caused by gallbladder disease. Conditions that may cause these symptoms include peptic ulcer, gastroesophageal reflux disease, or indigestion of unknown cause. [For more information, see In-Depth Reports #19 Peptic Ulcers or #85 Gastroesophageal Reflux Disease.]

Symptoms of Gallbladder Inflammation (Acute Cholecystitis)

Between 1 - 3% of people with symptomatic gallstones develop inflammation in the gallbladder ( acute cholecystitis ), which occurs when stones or sludge obstruct the duct. The symptoms are similar to those of biliary colic but are more persistent and severe. They include the following:

• Pain in the upper right abdomen is severe and constant and can last for days. Pain frequently increases when drawing a breath.
• Pain also may radiate to the back or occur under the shoulder blades, behind the breast bone, or on the left side.
• About a third of patients have fever and chills.
• Nausea and vomiting may occur.

Anyone who experiences such symptoms should seek medical attention. Infection develops in about 20% of these cases, which increases the danger. Acute cholecystitis can progress to gangrene or perforation of the gallbladder if left untreated. (People with diabetes are at particular risk for serious complications.)

Symptoms of Chronic Cholecystitis or Dysfunctional Gallbladders

Chronic gallbladder disease ( chronic cholecystitis ) is marked by gallstones and low-grade inflammation. In such cases the gallbladder may become scarred and stiff. Symptoms of chronic gallbladder disease include the following:

• Complaints of gas, nausea, and abdominal discomfort after meals are the most common, but they may be vague and indistinguishable from similar complaints in people without gallbladder disease.
• Chronic diarrhea (4 to 10 bowel movements every day for at least 3 months) may be a common symptom of gallbladder dysfunction.

Symptoms of Stones in the Common Bile Duct (Choledocholithiasis)

Stones lodged in the common bile duct ( choledocholithiasis ) can cause symptoms that are similar to those produced by stones that lodge in the gallbladder, but they may also cause the following symptoms:

• Jaundice (yellowish skin).
• Dark urine, lighter stools, or both.
• Heartbeat may become rapid and blood pressure may drop abruptly.
• Fever, chills, nausea and vomiting, and severe pain in the upper right abdomen. These symptoms suggest an infection in the bile duct (called cholangitis).

As in acute cholecystitis, patients who have these symptoms should seek medical help immediately. They may require emergency treatment.

• Review Date: 6/12/2006
• Reviewed By: Harvey Simon, M.D., Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital

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