Common Gallstone Symptoms
Most people with gallstones have no symptoms. In some people (between one and four out of 100) the stones can start to cause symptoms, including the following problems:
If you have gallstones they can migrate towards the exit site of the gallbladder as it squeezes. This commonly occurs after eating a fatty meal. The gallstones can then get stuck in the cystic duct which goes into spasm causing severe pain called biliary colic. This pain is often the worst pain ever experienced, worse than child labour, worse than having a heart attack or even breaking your leg. Contrary to its name, it is a constant pain in the upper abdomen, mainly on the right side and often radiates through to the back. It usually lasts between 2 and 8 hours. Typically the sufferer will be rolling around unable to find a comfortable position and will feel sick and hot. Many people experiencing biliary colic for the first time are seen in accident and emergency and often feel they are having a heart attack.
When a gallstone becomes impacted or stuck at the neck of the gallbladder it is unable to empty or fill and consequently becomes inflamed. This is acute cholecystitis. It is common to feel unwell for one or two days with moderate to severe pain in the right side of abdomen and to have a mild temperature.
Symptoms can often persist for months or years and can range from severe right sided abdominal pain to more subtle symptoms. Bloating, indigestion, excess wind and abdominal pain are all symptoms of gallstones and often related to food.
Sometimes a gallstone can pass all the way along the cystic duct and into the common bile duct. The stone may get stuck at the lower end of the bile duct and cause temporary blockage of the pancreatic duct which leads to inflammation of the pancreas. Gallstones are the commonest cause of acute pancreatitis in the UK. Patients with acute pancreatitis normally experience severe abdominal pain which often can be felt in their back as well. Most patients are admitted to hospital as an emergency. Following recovery from gallstone pancreatitis the gallbladder should be removed as soon as possible to prevent further episodes of acute pancreatitis.
A common bile duct gallstone can also cause blockage of the common bile duct which leads to obstructive jaundice, abdominal pain and fevers. The whites of the eyes are first to go yellow followed by skin. Pale stools and dark urine are also features. Pain with a fever suggests that sepsis is present. Hospital admission is essential in this serious condition.
Polyps of the gallbladder are often discovered as an incidental ultrasound finding. A polyp is an outgrowth of tissue on the inside wall of the gallbladder but invariably these ultrasound findings represent small sticky cholesterol stones not polyps. When a detailed history is taken there is often the suggestion of biliary pain or discomfort and this is due to stones. True polyps do not cause symptoms.
True polyps should be removed when greater than 5-10mm due to the very small risk of cancer.
When patients present with pain suggestive of gallstones but an ultrasound scan shows a normal looking gallbladder we consider a diagnosis of biliary dyskinesia. This means that the gallbladder does not contract to the normal signals and can cause pain. This diagnosis is often confirmed with a dynamic HIDA scan and cholecystectomy is usually successful in improving the symptoms.
Sphincter of Oddi Dysfunction
This is pain caused by spasm of the muscle that controls the flow of bile into the intestine. Patients present with pain that is consistent with gallbladder type pain. Often the patient will already have had their gallbladder removed. Associated with the pain, patients sometimes have abnormal liver function tests and a dilated biliary tree. The diagnosis can be confirmed by measuring the pressure in the sphincter using an endoscope (manometry). Treatment is the division of the muscle (sphincterotomy), either at surgery or endoscopically.