Symptoms of gallstone disease
Asymptomatic Gallstones:
Most do not develop symptoms even after follow up periods as long as 20 years. Approximately 20% of patients develop symptoms by 15 years. Asymptomatic gallstone disease does not need surgery but there are important exceptions tabulated below.
1.High risk for gallbladder cancer
North Indian women with gallstones
Gallstones larger than 3 cm in diameter
Porcelain gallbladder (calcification in the wall)
Gallbladder polyps larger than 12 mm
Note:- The role of prophylactic cholecystectomy in young patients from various parts of India has been emphasized in many recent papers.
2.Diabetes
Infection in the gallbladder in patients with gallstones can be life threatening
3.Lifestyle
Working for prolonged periods in remote parts of the world with poor medical facilities
Symptomatic Gallstone Disease:
Although dyspepsia (upper abdominal fullness, flatulence or gas formation, heart burn, hyperacidity) are not considered typical symptoms of gallstones, in a study from AIIMS new Delhi of the 1,680 consecutive dyspeptic patients, 500 (29.8%) had gallstones. The common presentation of patients with gallstones is:-
Biliary pain: The typical first symptom is frequently characterized as pain in the right upper abdomen after a meal, more so after fatty foods.
Complications of gallstone disease
a. Acute Cholecystitis: Often patients will have history of biliary pain which lasts for > 3 hours, associated with fever and right upper quadrant tenderness (Murphy?s sign).
b. Chronic Chlolecystitis: Patients will have episodic epigastric or right upper abdominal pain lasting for more than 30 minutes
c. Choledocholithiasis: When a stone from the gallbladder slips into the common bile duct it can lead to biliary colic, obstructive jaundice followed by acute cholangitis or pancreatitis.
d. Acute Cholangitis: is a medical emergency. Patients may present with right upper quadrant abdominal pain, fever and jaundice. (Charcot?s triad)
e. Pancreatitis: A most dreaded and life threatening complication of gallstones presents with very severe, persistent central upper abdominal pain, retching and prostration.