Salient feature of cholelithiasis
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"Cholelithiasis"[MeSH Terms]
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Merck Manual cholelithiasis symptoms salient features
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https://www.merckmanuals.com/professional/hepatic-and-biliar…
Cholelithiasis means gallstones in the gallbladder.
Salient clinical features
- Most patients are asymptomatic.
- The typical symptom is biliary colic:
- Sudden, steady severe pain in the right upper quadrant or epigastrium
- May radiate to the right shoulder, scapula, or back
- Often follows a meal, but fatty food is not a specific trigger
- Usually lasts 30 minutes to several hours
- Associated nausea and vomiting may occur
- Between episodes, the patient is usually well with a normal abdominal examination.
- No fever, jaundice, or marked leukocytosis in uncomplicated gallstones.
Features suggesting a complication
- Pain lasting more than 6-12 hours, fever, and right-upper-quadrant tenderness/Murphy sign: acute cholecystitis.
- Jaundice, dark urine, pale stool: possible common bile duct stone (choledocholithiasis).
- Fever with jaundice and pain: acute cholangitis.
- Severe epigastric pain radiating to the back: gallstone pancreatitis.
Diagnosis: abdominal ultrasonography is the first-line test.
Gas, bloating, dyspepsia, and vague nausea are nonspecific and should not by themselves be attributed to gallstones. Merck Manual overview supports that biliary colic, rather than dyspepsia, is the characteristic presentation.
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