Gallstones (Cholelithiasis): Symptoms and Diagnosis

Gallstones are common – about one in six adults in Germany has them. Especially women (5-F rule: “Female, fair, fat, forty, fertile”, i.e. female, fair-skinned, overweight, (over)forty and fertile), overweight and elderly people are affected, also a familial accumulation is known.

But by no means everyone knows that they are carrying these potential pests – only about one in four people have symptoms. Not infrequently, they are discovered by chance during an ultrasound examination of the right upper abdomen.

Gallstones: typical symptoms

Complaints (gallstone disease) usually occur when the stones block the ducts. Cramp-like abdominal pain results from the gallbladder’s attempt to push the stone forward by alternately contracting and relaxing. These severe colics in the right and middle upper abdomen may radiate to the shoulder and back and are often accompanied by nausea and vomiting.

Many of those affected also suffer from a feeling of pressure in the gallbladder area, bloating, flatulence and malaise, especially when eating high-fat foods and cold drinks.

If a stone completely obstructs the bile duct, an infection and inflammation of the bile duct or gallbladder can occur (cholecystitis = gallbladder inflammation). Then the pain is accompanied by fever. If a stone blocks the excretory duct of the pancreas (which often opens into the intestine together with the bile duct), pancreatitis (inflammation of the pancreas) may occur.

Diagnosis of gallstones

Often, the medical history already gives the doctor the first clues; during the physical examination, it can sometimes trigger a pressure pain in the right upper abdomen. The simplest method, which is not stressful for the patient, is ultrasound examination. However, not all stones can be seen. Therefore, in cases of doubt, computer tomography or magnetic resonance imaging is used.

Endoscopy can detect gallstones in the bile ducts and often even remove them. This examination is called ERC(P) (endoscopic retrograde cholangio-[pancreato-]graphy) and proceeds like a gastroscopy. A contrast medium is injected into the bile ducts through the tube that is advanced into the duodenum, which can then be seen and assessed on an X-ray.

Blood tests can be used to show inflammation of the gallbladder and liver and the passage of bile into the blood.