Gallstones cause irritation to the lining of the gallbladder wall which can lead to inflammation (cholecystitis). The symptoms of this condition are mainly pain in the right upper and central parts of the abdomen (frequently going around to the back and shoulder tip), sickness, vomiting and sometimes fevers if the gallbladder becomes infected.
Sometimes a stone tries to leaves the gallbladder (may be due to contraction after a meal) and it enters the very narrow cystic duct. Here the pain can be extremely intense (biliary colic) and only stops when the stone passes through, or falls back into the gallbladder. This condition can last for several hours.
If a gallstone does pass into the common bile duct, it can irritate or get stuck at the point where it enters the duodenum. Here it can cause inflammation to the pancreas, resulting in acute pancreatitis, which is a potentially life threating condition.
Jaundice (yellow skin colouration due to high levels of bile in the bloodstream) may occur if the bile duct becomes blocked. Patients notice that their urine becomes dark (contains bile) but their stools paler (no excreted bile). This condition can also be very serious and cause kidney and liver damage. An infection of the bile ducts in this situation (cholangitis) can rapidly become life-threatening.
The gallbladder becomes diseased because of gallstones. This can become so severe that it perforates, causing peritonitis, another potentially life-threating condition. It may develop an abnormal connection with other parts of the bowel (fistula) and this can cause other problems including bowel blockage (gallstone ileus) which may require emergency surgery. Left untreated for many years, the diseased gallbladder can develop into a cancer.
Some other conditions of the bowel such as gastritis, duodenitis, ulcer disease and functional bowel disorder can give symptoms like those of gallstones.
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The simplest and most common way to confirm the diagnosis of gallstones is with an ultrasound scan. This can identify stones, inflammation (thickening) of the gallbladder and give an indication about whether stones are within the common bile duct.
Magnetic resonance imaging (MRI) of the gallbladder and biliary tree (referred to as magnetic resonance cholangio-pancreatography, MRCP) is a more sensitive way of looking at the bile ducts for stones and is very useful for this purpose. It also provides an accurate picture of the gallbladder and bile ducts in and out of the liver.
CT scans demonstrate the gallbladder and sometimes gallstones, but are not as good as ultrasound or MRI. The reasons this test is sometimes performed however is to exclude other abdominal conditions.
Similarly, endoscopy (camera looking at the oesophagus, stomach and duodenum) may be required to rule out other conditions with similar symptoms to gallstones.
