Kidney stones and gallstones are only two of the most common health problems forcing patients into the emergency room, and sometimes into the operating table as well. They have something else in common: Kidney stones and gallstones feature abnormal sedimentation, accumulation, and solidification of material that usually runs through the kidneys and the gallbladder respectively. However, their symptoms are radically different from each other, and the clinical management is not the same either.
While you can break down and remove kidney stones in various ways, the same is not true about gallstones. They require surgery, and it will be more difficult and risky if you delay your diagnosis and treatment. Therefore, we will give you the most important signs and symptoms of gallstones, so you can suspect having them as soon as possible and ask your physician for further instruction to rule them out.
1) Severe abdominal pain
The first symptoms of gallstones are not always severe and does not always lead patients into the emergency room, but sometimes that’s the case. This happens because the stones in the gallbladder start moving along with the bile and get stuck in various parts of the bile duct. Therefore, the bile duct tries to push forward the bile and start performing jerking movements while sending pain signals to the brain.
A stuck gallstone might be painful enough to lead patients into the emergency room, and sometimes they would require emergency surgery to fix the problem. This pain is often located at the upper right portion of the abdomen, in the middle of the right costal arc (the lower border of the ribcage). But sometimes the gallbladder has not the usual location and would give out pain in the center of the abdomen or any other abdominal area.
Having a gallstone stuck in the bile duct is a serious health problem and should be attended readily by a health professional. The associated pain is sometimes unbearable, but not every time. Some patients would have a slowly aggravating pain that only becomes intolerable when the disease has aggravated into a life-threatening condition. Therefore, it is essential to pay attention to any uncommon abdominal pain, especially when it starts right after a fatty meal.
2) Abdominal discomfort
As we have mentioned, the abdominal pain might not be unbearable at first. Some patients would feel some abdominal discomfort instead of excruciating pain. However, some additional signs and symptoms would lead us to suspect there’s something to investigate about this abdominal discomfort.
Mild abdominal pain is often located in the same region, in the middle of the right costal arc or the center of the abdomen. However, there are three main clues to differentiate gallstone pain from other types of abdominal pain. First off, this pain would arise or aggravate after eating a fatty meal or a very large one. This is because, in the event of a fatty meal, the gallbladder would try to empty its contents on the intestines and aggravate the pain.
The second clue to differentiate gallstone discomfort to other types of abdominal discomfort is that it is not a common colic pain we feel along with a bowel movement. It is another type of pain and often stays for a longer time than stomach cramps. And finally, gallstone pain or discomfort is often accompanied by many other symptoms, including nausea and vomiting.
3) Nausea, vomiting
In the event of abdominal pain or discomfort, nausea and vomiting might be a leading symptom to suspect gallstone problems. Some patients would have gallstones for a couple of years, and they do not get stuck in the bile duct. Instead, they tend to block the bile duct when the gallbladder contracts to release bile into the intestines. In this case, nausea might not be severe, and may even go undetected.
However, it is not the same thing when the gallbladder starts to get inflamed in the event of a gallstone blocking the bile duct. In some cases, the gallbladder would start getting infected, and the severe inflammatory response might cause intense episodes of vomiting that would even lead some patients to dehydration, especially when other organs such as the pancreas gets involved.
Severe nausea in the event of gallstones should make a clinician suspect of involvement of the pancreatic tissue. When the gallstone gets stuck in the common bile duct, the bile and pancreatic juice start flowing backward and causing severe inflammation of both organs. Additionally, the pancreas would start releasing a series of enzymes that destroy the organ from within, and nausea and vomiting become even worse.
4) Bloating
Different from severe vomiting episodes and severe abdominal pain, bloating is a common symptom in patients with undiagnosed gallstones. Sometimes these stones become challenging to diagnose because the only thing patients feel is a sensation of bloating along with abdominal discomfort right after having a large meal. They usually think it’s a digestive problem and they might have eaten too much, so they do not pay much attention to this symptom. However, this could be a leading symptom to suspect gallstones.
In the event of bloating and abdominal discomfort –sometimes even abdominal pain- after a large meal, it is advisable to perform an abdominal ultrasound as a part of the complementary check-up and visit your doctor for a physical exam and further instructions. If you are able to detect gallstones before they turn into an emergency, it will be easier to program a safe surgery or recommend a helpful diet to control these symptoms. Instead, waiting and delaying the diagnose would make patients face the consequences if the gallstone ever gets stuck, and nobody wants a risky and unplanned emergency surgery if we can prevent it.
5) Yellowing of the skin (jaundice)
The bile contains a substance called bilirubin, which is a waste substance of the human metabolism. Bilirubin has a characteristic yellowish color, and when a gallstone gets stuck in the bile duct, the bile –and the bilirubin within the bile- starts to flow backward to the liver cells, which are directly connected to the bloodstream.
Traveling backwards, the bilirubin starts to run through the bloodstream, changing the color of the skin and mucosa as it gets deposited in these tissues. This turns the skin into a yellowish color, which is called jaundice. It is important to differentiate jaundice from a normal yellowish skin that results from consuming too much food with carotenoids (another pigment in foods such as carrots). Both of them feature a yellowish skin, but only jaundice would cause a yellowish appearance in the white portion of the eyes.
6) Fever
Another common symptom of gallstones is fever, but this should be more a warning symptom than a preventative one. As we have discussed, gallstones get stuck in the bile duct and cause inflammation in the gallbladder. If the problem continues long enough, the gallbladder becomes infected, and the inflammation becomes worse. This is a complication of gallstones and might be a life-threatening condition requiring immediate surgical removal of the gallstones along with the infected gallbladder.
Fever in the event of gallstone problems would be a persistent, high-grade fever, and would be accompanied with severe abdominal pain, nausea, and vomiting caused by the inflammation of the organ. This is a very dangerous clinical setting and requires urgent medical attention.
7) Chills
As we have mentioned, fever is the result of an infection in the gallbladder, which releases a series of inflammatory signals to the brain. The brain centers start to increase the temperature threshold to fight off the pathogen microorganisms with a higher temperature. By increasing the temperature threshold, the rest of the body acts as if we were in a lower temperature and start doing something to create more heat.
The pulse, the blood vessels, the skin, and even the muscles respond to this increased temperature threshold, and that’s why we start feeling chills. By contracting repeatedly, the muscles are attempting to create more heat from energy, and you get goosebumps because the skin is trying to increase its surface to catch up as more heat as possible.
8) Long-standing diarrhea
The primary function of the gallbladder is to emulsify the fatty portion of the meal, easing up the digestion of fats. Long-standing gallstone problems might lead to chronic diarrhea when there’s an insufficient release of bile to the intestines, and the absorption of the fatty portion of the meal becomes inadequate.
The excess fat starts running through the large intestines, it won’t get digested properly and starts increasing the bulk of the stools. Additional water might start to get dragged into the large intestine, especially in the event of sugary foods, and this adds up to the diarrhea. We have to mention this diarrhea often feels greasy and fatty due to the incorrect absorption of fats.
9) Dark urine
We previously mentioned bilirubin, and how this waste substance flows backward along with the bile and enters the bloodstream to cause jaundice. However, that’s not the end of the story. Bilirubin runs along with the blood and needs to be released because it’s a waste product. Since it’s not possible to expel bilirubin into the intestines, the alternative pathway of elimination is the kidneys.
Thus, bilirubin starts to get accumulated and eliminated by the kidneys, and since this substance has a very strong color, it starts making the urine look darker. Darkened urine might be caused by gallstones, but also by kidney infections, hepatitis, and other liver problems. For this reason, it is important to visit your doctor and get your tests done to rule out any possibilities and reach a correct diagnosis.
10) Light-colored stools
Directly associated with dark urine, light-colored stools are related to bilirubin as well. Since bile is not released to the intestines, the bile does not change the color of the stools. The brownish or yellowish color of the stools is not given by food itself. It is mainly given by the bile that’s being released into the intestines to help absorbing the fatty portion of the meal. Therefore, not having bile in the intestines because of a gallstone stuck in the bile duct would get your stools lighter and greasy.
We should point out that light-colored stools appear when the condition stays long enough to allow the intestinal transit to clear out. In the event of a gallstone stuck in the bile duct, it is often an emergency and patients have severe symptoms that will not let them wait enough hours. However, it is possible to have this finding in some cases. It should be differentiated with other problems causing light-colored stools, and it is a symptom we often pair up with dark urine and other leading signs in order to reach a correct diagnosis.
- As you can see, gallstones can be either an emergency or a long-standing situation, depending on the position of the stones in the gallbladder or the bile duct. It will be only an emergency and will turn out to be life-threatening when the gallstones get stuck. However, we should not wait for that. Prevention is of the utmost importance to avoid the lethal complications of gallstones, and even if surgery is the only solution to the problem, your doctor will give you suitable options and preventative measures adapted to your current health and medical condition. So, do not delay your diagnosis out of fear, and remember a carefully designed surgery adapted to you is a lot better than an unplanned emergency visit to the operating table.
References
Rutledge, D., Jones, D., & Rege, R. (2000). Consequences of delay in surgical treatment of biliary disease. The American journal of surgery, 180(6), 466-469.
Portincasa, P., Palasciano, G., & VanBerge-Henegouwen, G. P. (1997). An update on the pathogenesis and treatment of cholesterol gallstones. Scandinavian journal of gastroenterology. Supplement, 223, 60-69.
Lammert, F., Neubrand, M. W., Bittner, R., Feussner, H., Greiner, L., Hagenmüller, F., … & Riemann, J. F. (2007). S3-guidelines for diagnosis and treatment of gallstones. German Society for Digestive and Metabolic Diseases and German Society for Surgery of the Alimentary Tract. Zeitschrift fur Gastroenterologie, 45(9), 971-1001.
Lammert, F., Acalovschi, M., Ercolani, G., van Erpecum, K. J., Gurusamy, K., van Laarhoven, C. J., & Portincasa, P. (2016). EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones.