Gallstones : Clinical Features

Comments:
Clinical Features: About 75% to 80% of gallstones remain asymptomatic as shown by autopsy studies. Asymptomatic gallstones discovered incidentally are associated with low risk of complications and prophylactic cholecystectomy is not recommended except in following situations: pediatric age group, large stone/s filling up gallbladder, high-risk patients e.g. sickle cell anemia, and Native Americans.

About one-third of patients eventually develop symptoms. The cardinal symptom is right upper quadrant or epigastric pain (discussed further with the next image), often accompanied by vomiting and retching. Fever is usually absent. Jaundice develops in about 20% of patients following an attack of biliary colic, usually due to obstruction of the common bile duct. In symptomatic patients, biliary complications develop at the rate of 1% to 2% per year. Once symptoms develop, cholecystectomy is recommended.

Saint's Triad: Gallstones, diverticulosis of colon, and hiatus hernia often coexist as they share some common risk factors, and are referred to as Saint's Triad.

This image shows cholesterol stones in an acutely inflamed gallbladder.