What are the signs of gallbladder stones?

Signs of Gallbladder Stones

The most characteristic sign of gallbladder stones is episodic, severe upper abdominal pain in the epigastrium and/or right upper quadrant (biliary colic), though the majority of patients with gallstones remain completely asymptomatic. 1, 2

Clinical Presentation Patterns

Asymptomatic Gallstones (Most Common)

• Approximately 67-70% of patients with gallstones have no symptoms at all and stones are discovered incidentally on imaging 3, 4
• Asymptomatic stones develop symptoms at a rate of only 2-5% per year initially, with complications occurring at less than 1% annually 2
• This asymptomatic pattern is consistent across all age groups 3

Symptomatic Gallstones: Biliary Colic

When gallstones do cause symptoms, the hallmark presentation includes:

• Severe, steady pain (not truly "colicky" despite the name) located in the epigastrium and/or right upper quadrant 2, 5
• Abrupt onset that often awakens patients from sleep 2
• Duration of hours up to a full day (not brief or fleeting) 2
• Radiation to the upper back or between the shoulder blades 2
• Associated nausea and vomiting 1, 2

Acute Cholecystitis (Complicated Gallstone Disease)

When gallstones cause inflammation of the gallbladder, additional signs emerge:

• Right upper quadrant pain and tenderness 1, 5
• Fever (indicating infection/inflammation) 1, 5
• Murphy's sign: focal tenderness when palpating the gallbladder area, which can be elicited both on physical examination and during ultrasound 1
• Palpable gallbladder mass (suggests complicated acute cholecystitis) 1, 5
• Leukocytosis (elevated white blood cell count) 5
• Anorexia 1

Common Bile Duct Stones (CBDS)

When gallstones migrate into the bile duct, a distinct clinical picture develops:

• Epigastric or right upper quadrant pain associated with jaundice and/or fever 1, 6
• Jaundice (yellowing of skin and eyes) from bile duct obstruction 1, 6, 5
• Charcot's triad (pain, jaundice, and fever) indicates acute cholangitis, a serious complication 5
• Acute pancreatitis presentation (gallstones cause up to 50% of acute pancreatitis cases) 1, 6, 7

Important Clinical Pitfalls

What Gallstones Do NOT Typically Cause

• Dyspeptic symptoms (indigestion, belching, bloating, heartburn, food intolerance) are common in people with gallstones but are probably unrelated to the stones themselves and frequently persist after surgery 2, 5
• These vague symptoms should not be attributed to gallstones without the presence of typical biliary colic 2

Diagnostic Imaging Findings

While not clinical "signs," ultrasound findings that support the diagnosis include:

• Gallstones visualized on ultrasound (96% accuracy for detection) 1
• Gallbladder wall thickening and edema 1
• Pericholecystic fluid (fluid around the gallbladder) 1
• Distended gallbladder 1
• Sonographic Murphy's sign (though this has relatively low specificity) 1

Laboratory Findings in Complicated Disease

• Elevated bilirubin (particularly with common bile duct stones) 1
• Elevated alkaline phosphatase and GGT (suggests biliary obstruction) 1
• Elevated ALT and AST (may indicate bile duct stones) 1
• Leukocytosis (suggests acute cholecystitis or cholangitis) 1, 5

Critical Clinical Caveat

Normal liver function tests and normal ultrasound do NOT exclude common bile duct stones if clinical suspicion remains high, and further investigation with MRCP or endoscopic ultrasound should be pursued 1, 6