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Symptoms of Gallstones


Majority of people are unaware of their gallstones. Gallstones which do not cause any problem are termed as ‘silent stones’. These gallstones are often discovered accidentally as a result of tests ( e.g., ultrasound or X-ray examination of the abdomen) performed while evaluating medical conditions other than gallstones. Silent gallstones may be small enough to pass through the ducts and out of the body. They may also be large, and remain in the gall bladder. However, they can cause problem any time. Once symptoms develop, they are likely to recur. 
Gall stones cause the following problems : 


1. When they partially block the flow of bile out of the gall bladder, the bile remaining in the gall bladder becomes more concentrated. This irritates the bladder walls, causing inflammation of the gall bladder. This condition is also known as cholecystitis. 


2. When they get stuck in ducts that carry bile from the liver to the small intestine, they cause sudden severe pain called biliary colic. This is the most common symptom of gallstones. Biliary colic comes on suddenly or builds rapidly to a peak over a few minutes. It is a constant pain; it does not come and go though it may vary in intensity. It is usually severe. Patients experiencing biliary colic feel so restless due to pain that they often walk about or twist their body in order to find a comfortable position. Biliary colic is most often felt in the middle of the upper abdomen or in the right upper abdomen just below the margin of the ribs. Occasionally, the pain may also be felt in the back at the lower tip of the scapula on the right side. If the pain lasts more than 4-5 hours , it means that cholecystitis or a complication has developed. An episode of biliary colic subsides gradually once the gallstone shifts from its position and the obstruction is released. Biliary colic is a recurring symptom. Once the first episode occurs, there are likely to be others. Along with the pain there may be nausea, vomiting, bloated sensation in the abdomen, and yellowish colour of the eyes. 

Complications


Jaundice : Jaundice occurs when gallstones obstruct the common bile duct. There is yellowing of the eyes, the urine turns dark yellow and stools become pale and whitish like clay. When a stone shifts and the block is cleared, the jaundice improves. The stone can block the bile flow and again cause jaundice. Therefore, in cases of recurrent jaundice, obstruction due to gallstones must not be ruled out. 

Cholecystitis : Cholecystitis is an inflammatory condition of the gall bladder that causes constant pain in the right upper abdomen. Unlike patients with biliary colic, individuals with cholecystitis usually lie still as movement causes pain. The patient has fever, and the white blood cell count is elevated. 

Cholangitis : In this condition the bile in the duct becomes infected. The patient has very high fever and elevated white blood cell counts. 

Pancreatitis : Pancreatitits is an inflammatory condition of the pancreas. If a gallstone obstructs the common bile duct just beyond where the pancreatic duct joins it, flow from the pancreas is blocked. This results in inflammation within the pancreas. 
Intestinal obstruction : A gallstone may erode the wall of the gall bladder and enter into the stomach or small intestine. The stone is propelled through the intestine until it reaches the ileo-cecal valve, which is located where the small intestine joins the colon. If the gallstone is too large to pass through the valve, it can obstruct the small intestine. 

Cancer : Cancer of gall bladder almost always is associated with gallstones, but it is not clear which comes first. Cancer of the gall bladder arises in less than 1 per cent of individuals with gallstones. Therefore, concern about future development of cancer alone is not a valid reason for removing the gall bladder when gallstones are present.