hepatic and biliary disorders
Cholelithiasis
Symptoms and Signs of Cholelithiasis
About 80% of people with gallstones are asymptomatic. The remainder have symptoms ranging from a characteristic type of pain (biliary colic) to cholecystitis to life-threatening cholangitis. Biliary colic is the most common symptom. Stones occasionally traverse the cystic duct without causing symptoms. However, most gallstone migration leads to cystic duct obstruction, which, even if transient, causes biliary colic. Biliary colic characteristically begins in the right upper quadrant but may occur elsewhere in the abdomen. It is often poorly localized, particularly in diabetics and older patients. The pain may radiate into the back or down the arm. Episodes begin suddenly, become intense within 15 minutes to 1 hour, remain at a steady intensity (not colicky) for up to 12 hours (usually<6 hours), and then gradually disappear over 30 to 90 minutes, leaving a dull ache. The pain is usually severe enough to send patients to the emergency department for relief. Nausea and some vomiting are common, but fever and chills do not occur unless cholecystitis has developed. Mild right upper quadrant or epigastric tenderness may be present; peritoneal findings are absent. Between episodes, patients feel well. Although biliary colic can follow a heavy meal, fatty food is not a specific precipitating factor. Nonspecific gastrointestinal symptoms, such as gas, bloating, and nausea, have been inaccurately ascribed to gallbladder disease. These symptoms are common, having about equal prevalence in cholelithiasis, Peptic Ulcer Disease , and functional gastrointestinal disorders. Fatty foods are not specific causes of biliary colic, and gas, bloating, and nausea are not specific symptoms of gallbladder disease. Little correlation exists between the severity and frequency of biliary colic and pathologic changes in the gallbladder. Biliary colic can occur in the absence of cholecystitis. If colic lasts>12 hours, particularly if it is accompanied by vomiting or fever, acute cholecystitis or pancreatitis is likely. 