The gallbladder is a pouch-like organ located just under the liver; it stores bile, which is released into the small intestine to aid digestion. When bile becomes supersaturated, some of its chemicals come out of the solution as microscopic crystals. Crystal-laden bile is called biliary sludge. Gallstones form when the crystals in biliary sludge aggregate into a solid mass. The overwhelming majority of people with biliary sludge or gallstones are asymptomatic. However, when symptoms develop, they may herald complications.
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Abdominal or Shoulder-Related Pain
Gallstones--and less frequently biliary sludge--can cause episodic pain called biliary colic. An attack often begins several hours after eating. The pain characteristically begins suddenly and quickly builds in intensity. It is most commonly in the right upper abdomen, although it may be experienced in the midline below the breastbone, between the shoulder blades, or under the right shoulder. The pain is steady and severe; it is not relieved by changing position. Episodes of biliary colic last from 30 minutes to several hours. As the episode ends, the pain gradually recedes into a dull ache. With resolution of the pain episode (commonly called a gallbladder attack), no residual illness or discomfort remains. Attacks can be separated by as little as a week or may not recur for years.
Nausea and Vomiting
Nausea and vomiting frequently accompany an episode of biliary colic. These symptoms subside when the pain episode resolves.
Sweating is a common symptom of biliary colic; it is typically related to the nausea and intense pain of the episode.
Fever and Chills
Fever and chills do not typically occur with biliary colic unless a complication such as acute cholecystitis or pancreatitis has developed. Acute cholecystitis is inflammation of the gallbladder, which may include bacterial infection. Acute pancreatitis is sudden-onset inflammation of the pancreas.
Chronic Diarrhea, Abdominal Gas and Bloating
Chronic diarrhea (lasting 3 months or more) along with abdominal gas and bloating may indicate gallstone-related chronic cholecystitis. This condition is marked by low-grade, ongoing gallbladder inflammation, which may cause scarring.
Jaundice, Pale Stools and Dark Urine
Jaundice (yellowing of the skin and whites of the eyes), light colored stools and dark urine may indicate a gallstone is lodged in the common bile duct, blocking flow of both bile and pancreatic fluid. This condition is called choledocholithiasis. A yellow substance called bilirubin--which is normally excreted in the bile--backs up in the circulation causing these symptoms. Rapid heart rate, low blood pressure and severe unrelenting abdominal pain typically accompany this condition.
REFERENCES & RESOURCES
- “Harrison’s Principles of Internal Medicine, 16th Edition”; Dennis L. Kasper, M.D., et al, Editors; 2004
- Merck Manual: Cholelithiasis
- Mayo Clinic: Gallstones, Symptoms
- National Institute of Diabetes and Digestive and Kidney Diseases: Gallstones
- Merck Manual, Home Edition: Gallstones