Symptoms of Gallstones 

This is the most common complication of gallstones.  When a gallstone becomes impacted in the cystic duct, stasis of bile in the gallbladder triggers the release of inflammatory enzymes that lead to acute inflammation, and bacterial infection may supervene.  Most patients with acute cholecystitis have prior attacks of biliary colic.  The pain in acute cholecystitis is similar to biliary colic, but lasts longer (>6 hours), is constant and more severe.  Fever is common and laboratory tests show systemic inflammatory response (raised white cell count and CRP).  Without treatment 10% develop perforation of the gallbladder and 1% develop peritonitis.  Other complications include obstruction of the common bile duct (Mirizzi syndrome), chronic cholecystitis or cholecystoenteric fistula (communication between gallbladder and small bowel or colon).  Diagnosis of acute cholecystitis requires USS and/or CT imaging with laboratory tests.  Treatment usually requires hospital admission for supportive care, removal of the gallbladder (cholecystectomy), or percutaneous transhepatic cholecystostomy tube placement.  

Chronic cholecystitis almost always results from prior episodes of recurrent acute cholecystitis.  Repeated episodes of inflammation results in chronic inflammation within the gallbladder wall with associated fibrosis.  Extensive calcification can result and is called a porcelain gallbladder.  The diagnosis is suspected in patients with chronic symptoms, and imaging findings by USS, CT or MRI of gallstones in the presence of a thickened, shrunken gallbladder.  Treatment requires removal of the gallbladder by cholecystectomy. 

Gallstones can become lodged within the common bile duct (duct draining bile from the liver into the gut). The medical term for this is choledocholithiasis. Patients usually present with symptoms of biliary colic associated with jaundice. Diagnosis is made by a combination or blood tests and imaging (USS, MRI or rarely CT) that show dilation of the upstream bile duct.  The stones need to be removed, and can either be done at the time of surgery or endoscopically by a procedure referred to as ERCP (Endoscopic Retrograde Cholangiopancreatography).

If a gallstone becomes lodged within the common bile duct (duct draining bile from the liver to the gut) and the flow of bile from the liver is completely obstructed, the stagnant bile within the liver can become infected leading to a condition termed cholangitis. Symptoms include jaundice (yellow colour), rigors (involuntary shaking) and high temperature. This is a life threatening condition that requires immediate specialist care.  Diagnosis usually requires blood tests and imaging by USS or MRI.  Treatment requires removal of the biliary obstruction by endoscopic retrograde cholangiopancreatography (ERCP), percutaneous cholangiography (PTC) or rarely surgery.

Gallstones expelled out of the gallbladder, can block the pancreatic duct, preventing pancreatic enzymes from being excreted into the duodenum (first part of the small intestine). The enzymes accumulate within the pancreas and irritate the pancreatic cells.  The associated inflammation is called pancreatitis. Diagnosis requires laboratory tests and imaging by USS, CT or MRI.  This can be life threatening, and usually requires a period of hospital admission for supportive care.  Patients should be considered for laparoscopic cholecystectomy, to remove the gallbladder if gallstones are the cause of the pancreatitis.  

Gallstones are the most common risk factor for gallbladder cancer (also called gallbladder carcinoma). The basis for the development of cancer in the setting of gallstones likely occurs through chronic irritation and local production of carcinogens such as secondary bile acids, leading to epithelial dysplasia and carcinoma. The larger the gallstones (>2–3 cm in diameter), the greater the association with the development of gallbladder cancer.  There is often a family history.