PROBABLE SYMPTOMS OF GALL STONE DISEASE

PAIN ABDOMEN

Pain is the commonest presentation of gall stone disease. Usually, pain is in the upper abdomen more after food especially after fatty food. Pain is usually intermittent in nature known as colicky pain. Pain radiates to back and after some time it will be localized to right upper part of the abdomen. Specifically voluntary stoppage of respiration when the doctor exerts a constant pressure under the right costal margin, known as Murphy’s sign is suggestive of acute cholecystitis (Gall bladder infection).

VOMITING

Upper abdominal pain after taking food along with vomiting in a middle- aged woman gives clinical suspiciousness of gall stone disease. Though sometime other conditions like food poisoning will have the similar symptoms, ultrasonography of the abdomen will differentiate gall stone disease from other conditions.

FEVER

Fever is one of the common clinical features of calculus cholecystitis. The presence of fever indicates the presence of possible infection in the body. If it is associated with upper abdominal pain with vomiting, there is a high possibility of infection due to gall stone disease. The severity of fever depends on nature of the organism affecting the gall bladder. Fever can be there in patients with calculus cholecystitis or in patient with common bile duct stone and differentiated by various investigations.

Fever is not the initial symptom in gall stone disease. Appearance of fever few hours or few days after the appearance of abdominal pain may be due to the gall stone disease or common bile duct stone with infection.

JAUNDICE

Jaundice is one of the manifestations of gall stone disease. There are various mechanisms for the development of jaundice due to gall stone disease. Normal serum bilirubin level is 1.2mg%. In patient with jaundice the serum bilirubin level will be more than 2mg%. Yellowish discoloration of eye will be noticed if the serum bilirubin is more than 2.5mg%. Yellowish discoloration of skin is noticed if the serum bilirubin level is more than 5mg%.

TACHYCARDIA AND HYPOTENSION (SHOCK)

Tachycardia means increase in the pulse rate and hypotension means low blood pressures are features of severe infection. These features are more common in patients with common bile duct stones. In gall stone disease patients with pain abdomen, fever, jaundice along with increased pulse rate and fall in blood pressure need early proper evaluation. These features are due to ongoing systemic infection from calculus cholecystitis or bile duct stones with cholangitis.

ALTERED SENSORIUM

This is a rare feature caused by severe infection which affects the brain due to septic shock. In patient with gall stone disease having pain abdomen, jaundice, fever, increased pulse rate with fall in blood pressure and associated altered sensorium has to be taken seriously and needs emergency attention.

ASSOCIATED OTHER SYMPTOMS

These are due to the systemic manifestations of severe infection involving gall bladder or biliary system. The common manifestation of other system is damage to kidney known as acute kidney injury (AKI) in which the urine output will be decreased with increase in blood urea and serum creatinine.

Bleeding tendency (Coagulopathy)and change in the blood cell counts are other manifestations of the gall stone disease with severe infection.

Difficulty in breathing can be there in case of severe systemic infection due to severe gall bladder or bile duct infection (ARDS). There will be decreased oxygen saturation with less SpO2 level in the blood (Normal SpO2 is in between 96 to 99%).

WHAT WILL DOCTOR SEE ON YOU TO MAKE A DIAGNOSIS OF GALL STONE DISEASE!

(CLINICAL SIGNS OF GALL STONE DISEASE)

AMDOMINAL TENDER POINTS

Pain on touch will be there on right upper quadrant of the abdomen which indicates possible gall stone disease with infection.

PALPABLE MASS IN THE ABDOMEN

There can be mass in the right upper abdomen. This can be due to severe infection associated with gall bladder gangrene or gall bladder perforation in which omentum or a part of large intestine come to the area of infection and form an adhesion with mass.

PERITONITIS

During the palpation of abdomen, there will be severe pain on touch (Guarding) and tightness (Rigidity) usually due to diffuse infection of the abdominal cavity. This is common with any intestinal perforation involving duodenum, ileum or large intestine. The same can be observed in case gall bladder perforation also.

TEMPERATURE

The presence of pain abdomen with fever in patient with gall stone disease indicates the presence of infection in the gall bladder or bile duct.

JAUNDICE

The presence of jaundice in patient with gall stone disease is an indicator of associated bile duct stone or associated severe infection.

PULSE RATE

The increased pulse rate in patient with gall stone disease is an indicator of severe ongoing infection with possible other organ involvement.

BLOOD PRESSURE

Fall in blood pressure is also an indicator of severe ongoing infection with possible multi system involvement.

SENSORIUM OF THE PATIENT

The level of consciousness is an important indicator of the severity of the infection and it indicates severe systemic infection (sepsis). Presence of altered sensorium is an indicator of multisystem involvement including neurological involvement.