Symptomatic cholelithiasis


Anatomy & Pathophysiology

  • Gallstones are classified as cholesterol stones and pigmented stones (black and brown), and are present in approx 20% of females and 8% of males in the United States
  • These stones cause the majority of all biliary tract problems, and depending on where the stone become impacted, specific problems occur.
  • Bile flows out the gallbladder, down the cystic duct into the common bile duct, and ultimately into the 1st portion of the duodenum.

Gallbladder disease types

Clinical Features


  • RUQ pain that is constant, lasts 1-5hr, and then remits
    • Pain >5hr suggests cholecystitis, cholangitis, or pancreatitis
  • Usually does not occur during fasting
  • Radiation to the right shoulder increases likelihood, but is not sensitive

Physical Exam

  • Often benign; as compared to cholecystitis, usually negative Murphy's Sign

Differential Diagnosis

RUQ Pain




  • Discharge

See Also


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