From the Guidelines
Ultrasound (US) of the abdomen is the first choice of investigation for patients presenting with cholelithiasis symptoms, such as right upper quadrant abdominal pain, due to its high accuracy in diagnosing or excluding gallstones, with a reported accuracy of 96% for detection of gallstones 1. Cholelithiasis often presents with right upper quadrant abdominal pain that may radiate to the right shoulder or back, typically occurring after fatty meals. Common symptoms include nausea, vomiting, bloating, and indigestion. Some patients experience fever and chills if infection develops (cholecystitis). Many gallstones remain asymptomatic until they block bile ducts, causing biliary colic—intense pain lasting 30 minutes to several hours.
Key Symptoms and Risk Factors
- Right upper quadrant abdominal pain
- Nausea and vomiting
- Bloating and indigestion
- Fever and chills (if infected)
- Jaundice (yellowing of skin/eyes), dark urine, and light-colored stools (if common bile duct is blocked)
- Risk factors: female gender, obesity, rapid weight loss, pregnancy, and certain medications If experiencing these symptoms, especially recurring pain after meals, medical evaluation is recommended as complications can include inflammation, infection, and pancreatitis.
Diagnostic Approach
The initial imaging choice for suspected cholelithiasis is ultrasound (US) of the abdomen, which can diagnose or exclude gallstones with high accuracy, and may also differentiate cholelithiasis from other gallbladder pathologies, such as gallbladder sludge, polyps, or masses 1.
From the Research
Cholelithiasis Symptoms
- Cholelithiasis, cholecystitis, and pancreatitis are common conditions that may be challenging to recognize due to their variable clinical presentations and broad differential diagnoses 2
- Symptoms of cholelithiasis may occur when a stone passes into the common bile duct, causing biliary obstruction 3
- The clinical presentation of cholelithiasis can vary, and diagnosis is often made using imaging modalities such as magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP) 3, 4
- Acute cholangitis and gallstone pancreatitis are two major complications of cholelithiasis that require prompt recognition and timely intervention to limit morbidity and prevent mortality or recurrence 5
Diagnosis and Evaluation
- Diagnosis of cholelithiasis is performed stepwise through imaging modalities 4
- Noninvasive diagnostic studies, such as ultrasound and computed tomography, are used to evaluate patients with suspected cholelithiasis 5
- Advanced imaging techniques, such as ERCP and magnetic resonance cholangiopancreatography, are used to confirm the diagnosis and evaluate the severity of illness 3, 4
Clinical Management
- Treatment of cholelithiasis varies depending on the severity of illness and the presence of complications 2, 4
- ERCP with sphincterotomy is a common treatment for choledocholithiasis, with a high degree of success 3
- Surgical, endoscopic, and percutaneous techniques may be used to extract or expel biliary stones in difficult cases 3, 4