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Gallstones & Biliary Colic: Symptomatic gallstones can cause excruciating right upper quadrant or epigastric pain which may radiate to shoulders or interscapular region. The pain is often referred to as "biliary colic" which is a misnomer as it is usually constant. Pain may also be generated by gallstone-induced acute cholecystitis.

Biliary colic is of sudden onset and usually occurs at night, as small calculi tend to aggregate at the neck of the gallbladder when the patient lies down. The pain may be triggered by a fatty meal which induces gallbladder contraction, causing the stones to press against the gallbladder outlet, increasing the pressure. The pain generally lasts for a couple of hours and subsides as suddenly as it started.

The image shows two cholesterol gallstones in a cholecystectomy specimen.

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