What are the symptoms of gallstone disease?
As already mentioned, 75% of gallstones do not cause any symptoms. Mostly they are too small or remain inconspicuous in the gall bladder. The remaining 25% of gallstones can either not pass through the gallbladder, i.e. they are of a size that makes it impossible for them to pass through into the bile duct system.
Whenever the gallbladder is moved, the stones bump against the gallbladder wall and cause pain. Sometimes these gallstones also lie exactly in the opening of the gallbladder and block the exit, which can lead not only to pain but also to a backlog of bile in the gallbladder. In this case it can also lead to jaundice (icterus).
If the gallstones are small enough to be swept from the gallbladder into the bile duct system, there is a risk that the stones will get caught in the ducts, rub against the walls of the bile ducts or block them. This can also lead to congestion and jaundice symptoms. In almost every case, however, this process of stone wandering is associated with symptoms such as severe pain (so-called colic).
Colics (gallstones) are of typical painful character. They are described as very strong to severe pain that appears in waves but disappears just as quickly. Usually the patient is bathed in sweat and restless, often unable to locate the site of pain exactly.
Frequently mentioned are right and middle upper abdomen, radiating into the back and right shoulder. Some patients report nausea and vomiting during colic. Similar symptoms can also occur with the so-called kidney stones.
If the gallstones remain in the gallbladder, they often lead to gallstone disease (biliary colic) after eating fatty food (the gallbladder then makes particularly strong kneading movements) or while lying down at night (here gallstones can be pushed against the gallbladder wall). Patients localize this pain mainly in the upper abdomen (a few cm above the navel). Although fatigue is not one of the main symptoms of gallstone disease (cholelithiasis), it can occur simultaneously.
The contact of gallstones with the walls of the gallbladder and the bile ducts, or a possible obstruction of the bile ducts, can cause an inflammatory reaction, resulting in a general feeling of illness, fatigue and reduced ability to cope with stress. These symptoms are caused by the release of messenger substances (inflammatory mediators) during an inflammatory reaction. These symptoms occur particularly in chronic inflammation.
Elevated bilirubin levels in the blood can also cause fatigue. Bilirubin is a substance that is produced during the breakdown of red blood cells (erythrocytes) and normally reaches the intestine via the bile and is excreted from there via the stool. In the case of a gallstone disease, the obstruction of the bile ducts can block this route of excretion, causing the bilirubin to back up and the bilirubin content of the blood to increase.
If the level rises to such an extent that the bilirubin can no longer be prepared by the liver for the bile (in this case, the bilirubin changes from the originally fat-soluble to a water-soluble state), it can cause neurological symptoms. The fat-soluble bilirubin is able to penetrate the brain to a certain extent. In mild forms, this can initially trigger fatigue, but if the bilirubin level in the blood is very high, this is known as a kernicterus or bilirubin encephalopathy.
At this point, the bilirubin values are already so high that jaundice (icterus) has been present for a long time, which becomes noticeable by a yellowing of the eye white (medical: sclerenicterus) and the skin (skinticterus). In addition to tiredness and apathy there is also confusion. Normally this only occurs in infants and only rarely in adults.
The bile contains important substances for the complete digestion of food. In a gallstone disease with a blockage of the bile ducts, the bile can no longer reach the intestines and digest the food there. Due to incomplete digestion, constipation can quickly occur.
Hand in hand with the constipation goes an excessive feeling of fullness, as well as an increased formation of gas in the intestine (meteorism), due to bacteria that use the incompletely digested food.Since bile is mainly needed for the digestion of fats, these symptoms occur especially when eating very fatty foods. Paradoxically, however, diarrhea can also occur as a result of fatty foods. Generalized itching in gallstone disease occurs when the bile fluid can no longer drain properly due to the obstruction of the bile ducts by stones.
The human body needs the bile to digest fats through bile acids and to get rid of harmful substances. First and foremost is bilirubin, a substance that is produced when red blood cells are broken down. If the bilirubin can no longer flow off through the bile, it accumulates in the body, just like bile acid.
According to the current state of research, it is assumed that itching (pruritus) is caused by the backlog of these substances. The bile acids irritate nerve endings in the skin, causing the sensation of itching. This effect is intensified by the bilirubin, which, if it cannot flow off, can be deposited in the skin after some time, causing jaundice (icterus), i.e. a yellowing of the skin.
This is caused by the yellow color of the bilirubin. Abdominal pain is a very common symptom of gallstone disease. The pain is usually located in the upper right part of the abdomen, directly under the costal arch, since this is where the gall bladder is located under the skin and a part of the liver.
Slight abdominal pain occurs mainly after meals. Especially if the meals contained a lot of fatty foods, because at this time the gallbladder is working at full speed. Humans need the bile to digest fatty food, which is why the gallbladder, after eating fatty food, tries to move the bile into the intestine by contracting and thus pressing the bile into the intestine.
If there are gallstones in the gallbladder, the movement of the gallbladder rubs them against its wall, which is painful. It is also possible for small gallstones to come off, i.e. to enter the intestine through the bile duct. Here too, the gallstones irritate the walls of the bile duct and may expand it somewhat.
This process can be painful. If the gallstone disease leads to an inflammation of the gall bladder (cholecystitis) or the bile ducts (cholangitis), this can also be painful. If the bile duct is acutely obstructed by a trapped gallstone, the gallbladder can usually no longer empty at all.
This can lead to severe, acute pain, the so-called biliary colic (see below). Diarrhea in gallstones occurs mainly after eating fatty foods. The human body needs the bile to digest fats.
If the bile drain is blocked by a stone, these fats can no longer be digested properly. This leads to the fact that the fats are deposited in the stool and so-called fatty stools can develop. Fat stools can vary in consistency from soft to liquid, shine greasy and smell terrible.
Pain in gallstones, especially in biliary colic (see below) is usually located in the upper right part of the abdomen. In the case of a painful gallstone disease, however, it is not uncommon for the pain to radiate. Especially in the case of sudden onset of very severe pain, radiating into the back or shoulder can occur.
Even in the case of mild, chronic pain, it is often difficult to determine the exact location of the pain. In addition to the classic right-sided upper abdominal pain, side or back pain can also occur, usually on the right side of the body. The reason for the pain may be a gall bladder located further back or a collection of different nerve fibers responsible for the perception of pain.
In the latter case, the brain may no longer be able to clearly determine the origin of the pain stimulus and therefore sometimes does not determine it correctly. Nausea is considered a very unspecific symptom in diseases of the digestive tract, which includes the gallbladder and the bile ducts. It can occur in almost every inflammatory disease and in diseases that are associated with incomplete digestion of food and affect the digestive tract.
Pain can also cause nausea through the release of stress hormones or through the contraction of the muscles of the gall bladder and intestines. The human body needs bile to digest fats.If the drainage of bile is blocked by gallstones, this can no longer take place properly. The undigested fats can cause nausea, especially when they reach later sections of the intestine.
Gallstones can usually cause two different types of pain. On the one hand, slight, often chronic pain, usually after eating, especially if the food was rich in fat. On the other hand, strong, cramp-like pain, the so-called biliary colics can occur.
As a rule, this is abdominal pain, especially in the right upper part of the abdomen below the ribcage. Often the pain radiates into the right shoulder or back. If the gallbladder or bile ducts become inflamed due to the impact of the stones on the walls of the gallbladder and bile ducts, this can cause severe pain, but the quality and course of the pain is different from that of a biliary colic.
As a rule, they begin less acutely, but are gradual and permanent, without swelling or decay. Flatulence (meteorism) is a common symptom when the bile ducts are blocked by gallstones. The bile is needed for the digestion of fats.
If gallstones get into the bile ducts, the bile can no longer flow into the intestine, where it helps digestion. After some time, the undigested fats end up in later intestinal sections, especially in the large intestine, which is naturally heavily colonized by bacteria. These bacteria utilize the undigested fats, this happens primarily through fermentation (anaerobic metabolism, where no oxygen is needed).
During fermentation, gases are produced that cause flatulence. The more fat-rich the food is, the worse the flatulence is. If gallstones disrupt the flow of bile because a stone obstructs the bile ducts, this usually results in light, discolored, almost white stool.
Through the bile, the body excretes the so-called bilirubin, a waste product that is produced when old red blood cells are broken down. This substance is converted in the large intestine by intestinal bacteria into the dark colorants stercobilin and urobilin, which give the stool its brown color. If no more bilirubin reaches the intestine, these dyes can no longer be produced and the stool is light and discolored.
Heartburn has also been reported in gallstone disease. Since the bile, which is important for the digestion of fats, can no longer flow out if the bile ducts are blocked, digestive disorders occur. These digestive disorders can affect the stomach, which can lead to acidic belching and heartburn.
However, heartburn alone is rarely associated with gallstones. If one assumes that heartburn is caused by gallstones, there are usually other symptoms that are more clearly indicative of a gallstone disorder. In gallstones, the pain is usually located in the upper right part of the abdomen, which corresponds to the anatomical position of the gallbladder.
However, pain is often reported to radiate into the right shoulder. This symptomatology is based on the phenomenon of transmitted pain caused by a convergence of different nerve fibers. The nerve fibers that report the pain of the gallbladder to the brain converge with pain fibers from the right shoulder, so that the brain reports stimuli from both regions, especially in the case of severe pain. In medicine, such clearly assigned regions are referred to as Head‘s zones. The Head‘s zone for the gallbladder is therefore the right shoulder.
