Gallstones and gallbladder inflammation

Gallstones are not one single condition

Gallstones are stones in the gallbladder or in the bile ducts. Many people have gallstones without noticing them, and stones found by chance without symptoms are not in themselves a disease that needs treatment. It is the symptoms and complications that decide what should happen. 1

Condition	Typical picture
Stones without symptoms	Found by chance, no complaints, usually no treatment needed
Biliary colic	Severe pain in the right upper abdomen, up to some hours, often with nausea
Acute cholecystitis	More constant pain, tenderness, fever and feeling unwell
Stone in the bile duct	Jaundice, dark urine, pale stools, risk of bile duct infection
Gallstone pancreatitis	Severe upper abdominal pain, often radiating to the back, vomiting

Biliary colic usually lasts some hours and then settles, while acute cholecystitis is more persistently painful and usually comes with fever. 2

Typical symptoms

• Pain under the right rib margin or in the upper abdomen, often after a fatty meal.
• Radiation to the right shoulder blade or the back.
• Nausea and vomiting.
• Fever, jaundice or feeling generally unwell when complications develop. 1

Examination

The diagnosis rests on the history, the clinical examination, blood tests and an ultrasound scan of the gallbladder. In acute cholecystitis stones are typically seen together with a thickened gallbladder wall. Raised inflammatory markers alone do not settle the diagnosis. If a stone in the bile duct is suspected or liver values are affected, further hospital investigations follow. 3

Treatment and referral

Symptomatic gallstones are most often treated by removing the gallbladder with keyhole surgery, and results are good. Acute cholecystitis is treated in a surgical department, where early surgery is preferred in many cases. In selected patients a conservative approach, drainage or later surgery is chosen instead. A stone in the bile duct with jaundice always needs treatment. 1, 3

Gallbladder surgery itself is not carried out at the clinic. Contact the clinic to clarify whether your referral belongs here.

Urgent route

Seek help the same day if you have:

• persistent severe upper abdominal pain that does not settle
• fever and shivering
• jaundice, dark urine or pale stools
• repeated vomiting, or you feel generally unwell.

Call 112 if you are severely affected. Otherwise call 1813 in the Capital Region or your out-of-hours doctor. Email is not an emergency channel. 2

What you can do yourself

• Notice whether symptoms follow fatty meals, and try smaller portions.
• Write down how long the attacks last and whether there is fever. It helps the assessment.
• Contact a doctor the same day if you know you have gallstones and develop fever or persistent pain.
• If your symptoms are more diffuse, it may help to read about gastroscopy or irritable bowel.

Sources

• Gallstone disease, Patienthåndbogen at sundhed.dk
• Cholecystitis, Patienthåndbogen at sundhed.dk
• Acute cholecystitis, Lægehåndbogen at sundhed.dk