Curriculum · Gastroenterology
Gallstone disease and biliary colic
What it is
Cholelithiasis is gallstones in the gallbladder, and choledocholithiasis is gallstones in the common bile duct. The types of stone are cholesterol, pigmented from chronic hemolysis, and mixed. What the stone does depends on where it stops: at the neck or cystic duct it obstructs and causes pain, then goes back or passes, and that is biliary colic; if it stays longer, about 6 hours, it causes the inflammation called acute cholecystitis; a stone in the common bile duct causes obstructive jaundice that can be complicated by cholangitis; and a stone obstructing at the ampulla of Vater causes biliary pancreatitis.
Causes and risk
Gallstones carry the F risk factor features: female, fat, forty, fertile.
How it presents
Gallstones are often asymptomatic and found incidentally on imaging. When symptomatic they usually cause pain in the right upper quadrant or epigastrium, and biliary pain is the episodic onset of acute, severe epigastric or RUQ pain. Episodes of biliary pain generally last 15 minutes to several hours and are often accompanied by nausea and vomiting. Most patients with symptomatic gallstones present with chronic cholecystitis, which causes recurrent attacks of pain, and that pain is constant, increases in severity at the beginning, and lasts from 1 to 5 hours. It often starts during the night after a fatty meal and may be associated with nausea and vomiting. Fever, leukocytosis and elevated liver enzymes are not part of biliary pain alone; they indicate acute cholecystitis or obstruction of the common bile duct.