List of Risk Factors For Gallstones

List of Risk Factors for Gallstones
The list of risk factors mentioned for Gallstones in various sources includes:
• Age - especially over 60
• Obesity
• Dieting
• Gastric bypass surgery - stomach reduction surgery
• Race - High risk for Native Americans
• Native Americans
• Pima Indians
• Mexican-Americans
• Gender - women twice as likely
• Cholesterol-lowering drugs
• Diabetes
• Rapid weight loss
• Fasting
Gallstones Risk Factors: Book Excerpts
• Cholelithiasis - risk factors - Cholelithiasis
Risk factors discussion:
Dieting and Gallstones: NIDDK (Excerpt)
Overweight people are at greater risk of developing gallstones that people of average weight.
However, people who are considering a diet program requiring very low intake of calories each
day should be aware that during rapid or substantial weight loss, a person's risk of developing
gallstones is increased. (Source: excerpt from Dieting and Gallstones: NIDDK)
Why obesity is a risk factor for gallstones is unclear. But researchers believe that in obese
people, the liver produces too much cholesterol. The excess cholesterol leads to supersaturation
in the gallbladder. (Source: excerpt from Dieting and Gallstones: NIDDK)
People who lose a lot of weight rapidly are at greater risk for developing gallstones. Gallstones
are one of the most medically important complications of voluntary weight loss. The relationship
of dieting to gallstones has only recently received attention.
One major study found that women who lost from 9 to 22 pounds (over a 2-year period) were 44
percent more likely to develop gallstones than women who did not lose weight. Women who lost
more than 22 pounds were almost twice as likely to develop gallstones.
Other studies have shown that 10 to 25 percent of obese people develop gallstones while on a
very-low-calorie diet. (Very-low-calorie diets are usually defined as diets containing 800 calories
a day or less. The food is often in liquid form and taken for a prolonged period, typically 12 to 16
weeks.) The gallstones that developed in people on very-low-calorie diets were usually silent and
did not produce any symptoms. However, about a third of the dieters who developed gallstones
did have symptoms, and a proportion of these required gallbladder surgery.
In short, the likelihood of a person developing symptomatic gallstones during or shortly after
rapid weight loss is about 4 to 6 percent. This estimate is based on reviewing just a few clinical
studies, however, and is not conclusive. (Source: excerpt from Dieting and Gallstones: NIDDK)
Researchers believe dieting may cause a shift in the balance of bile salts and cholesterol in the
gallbladder. The cholesterol level is increased and the amount of bile salts is decreased. Going
for long periods without eating (skipping breakfast, for example), a common practice among
dieters, also may decrease gallbladder contractions. If the gallbladder does not contract often
enough to empty out the bile, gallstones may form. (Source: excerpt from Dieting and
Gallstones: NIDDK)
Gallstones are common among obese patients who lose weight rapidly after gastric bypass
surgery. (In gastric bypass surgery, the size of the stomach is reduced, preventing the person
from overeating.)
One study found that more than a third (38 percent) of patients who had gastric bypass surgery
developed gallstones afterward. Gallstones are most likely to occur within the first few months
after surgery. (Source: excerpt from Dieting and Gallstones: NIDDK)
Smoking and Your Digestive System: NIDDK (Excerpt)
Several studies suggest that smoking may increase the risk of developing gallstones and that the
risk may be higher for women. However, research results on this topic are not consistent, and
more study is needed. (Source: excerpt from Smoking and Your Digestive System: NIDDK)
Gallstones: NWHIC (Excerpt)
Risk factors for gallstones include obesity ; a large clinical study showed that being even
moderately overweight increases one's risk for developing gallstones. This is probably true
because obesity tends to cause excess cholesterol in bile, low bile salts, and decreased
gallbladder emptying. Very low calorie, rapid weight-loss diets, and prolonged fasting, seem to
also cause gallstone formation.
No clear relationship has been proven between diet and gallstone formation. However, low-fiber,
high-cholesterol, high protein diets, and diets high in starchy foods have been suggested as
contributing to gallstone formation. (Source: excerpt from Gallstones: NWHIC)
Gallstones: NWHIC (Excerpt)
Those who are most likely to develop gallstones are:
• Women between 20 and 60 years of age. They are twice as likely to develop gallstones
than men.
• Men and women over age 60.
• Pregnant women or women who have used birth control pills or estrogen replacement
therapy.
• Native Americans. They have the highest prevalence of gallstones in the United States. A
majority of Native American men have gallstones by age 60. Among the Pima Indians of
Arizona, 70 percent of women have gallstones by age 30.
• Mexican-American men and women of all ages.
• Men and women who are overweight.
• People who go on "crash" diets or who lose a lot of weight quickly.
(Source: excerpt from Gallstones: NWHIC)
Risks factors for Gallstones: medical news summaries:
The following medical news items are relevant to risk factors for Gallstones:
• All about obesity
• More news »
About risk factors:
Risk factors for Gallstones are factors that do not seem to be a direct cause of the disease, but
seem to be associated in some way. Having a risk factor for Gallstones makes the chances of
getting a condition higher but does not always lead to Gallstones. Also, the absence of any risk
factors or having a protective factor does not necessarily guard you against getting Gallstones.
For general information and a list of risk factors, see the risk center.
Cholelithiasis, cholecystitis, and related disorders: Excerpt
from Handbook of Diseases
Diseases of the gallbladder and biliary tract are common, typically painful conditions that usually
require surgery and may be life-threatening. They’re commonly associated with deposition of
calculi and inflammation. (See Common sites of calculus formation.)
In most cases, gallbladder and bile duct diseases occur during middle age. Between ages 20 and
50, they’re six times more common in women, but the incidence in men and women becomes
equal after age 50. After that, incidence rises with each succeeding decade.
Causes
The origin and frequency of gallbladder and biliary tract disease vary with the particular
disorder.
Cholelithiasis
The presence of stones or calculi (gallstones) in the gallbladder results from changes in bile
components. Gallstones are made of cholesterol, calcium bilirubinate, or a mixture of cholesterol
and bilirubin pigment. They arise during periods of sluggishness in the gallbladder resulting from
pregnancy, use of oral contraceptives, diabetes mellitus, Crohn’s disease, cirrhosis of the liver,
pancreatitis, obesity, and rapid weight loss.
Cholelithiasis is the fifth leading cause of hospitalization among adults and accounts for 90% of
all gallbladder and duct diseases. The prognosis is usually good with treatment unless infection
occurs, in which case the prognosis depends on the infection’s severity and response to
antibiotics.
Cholecystitis
Cholecystitis, an acute or chronic inflammation of the gallbladder, is usually associated with a
gallstone impacted in the cystic duct; the inflammation develops behind the obstruction.
Cholecystitis accounts for 10% to 25% of all patients requiring gallbladder surgery.
The acute form is most common during middle age; the chronic form, among elderly people. The
prognosis is good with treatment.
Biliary cirrhosis
Primary biliary cirrhosis is a chronic, progressive disease of the liver characterized by
autoimmune destruction of the intrahepatic bile ducts and cholestasis. This condition usually
leads to obstructive jaundice and pruritus and involves the portal and periportal spaces of the
liver. It affects women between the ages of 40 and 60 nine times more often than men. The
prognosis is poor without liver transplantation.
Cholangitis
An infection of the bile duct, cholangitis is commonly associated with choledocholithiasis and
may follow percutaneous transhepatic cholangiography. Predisposing factors include bacterial or
metabolic alteration of bile acids. Widespread inflammation may cause fibrosis and stenosis of
the common bile duct. The prognosis for this rare condition is poor without stenting or surgery.
Choledocholithiasis
One out of every 10 patients with gallstones develops choledocholithiasis, or gallstones in the
common bile duct (sometimes called common duct stones). This occurs when stones passed out
of the gallbladder lodge in the hepatic and common bile ducts and obstruct the flow of bile into
the duodenum. The prognosis is good unless infection occurs.
Cholesterolosis
Cholesterol polyps or cholesterol crystal deposits in the gallbladder’s submucosa may result from
bile secretions containing high concentrations of cholesterol and insufficient bile salts. The
polyps may be localized or may speckle the entire gallbladder. Cholesterolosis, the most
common pseudotumor, isn’t related to widespread inflammation of the mucosa or lining of the
gallbladder. The prognosis is good with surgery.
Gallstone ileus
Gallstone ileus results from a gallstone lodging in the terminal ileum. It’s more common in
elderly people. The prognosis is good with surgery.
Postcholecystectomy syndrome
Postcholecystectomy syndrome commonly results from retained or recurrent common bile duct
stones, spasm of the sphincter of Oddi, functional bowel disorder, technical errors, or mistaken
diagnoses. It occurs in 1% to 5% of all patients whose gallbladders have been surgically removed
and may produce right upper quadrant abdominal pain, biliary colic, fatty food intolerance,
dyspepsia, and indigestion. The prognosis is good with selected radiologic procedures,
endoscopic procedures, or surgery.
Complications
Each disorder produces its own set of complications. Cholelithiasis may lead to any of the
disorders associated with gallstone formation: cholangitis, cholecystitis, choledocholithiasis, or
gallstone ileus.
Cholecystitis can progress to gallbladder complications, such as empyema, hydrops or mucocele,
or gangrene. Gangrene may lead to perforation, resulting in peritonitis, fistula formation,
pancreatitis, limy bile, and porcelain gallbladder. Other complications include chronic
cholecystitis and cholangitis.
Choledocholithiasis may lead to cholangitis, obstructive jaundice, pancreatitis, and secondary
biliary cirrhosis. Cholangitis, especially in the suppurative form, may progress to septic shock
and death. Gallstone ileus may cause bowel obstruction, which can lead to intestinal perforation,
peritonitis, septicemia, secondary infection, and septic shock.
Cholelithiasis
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Cholelithiasis is the presence of one or more calculi (gallstones) in the

gallbladder. In developed countries, about 10% of adults and 20% of people > 65
yr have gallstones. Gallstones tend to be asymptomatic. The most common
symptom is biliary colic; gallstones do not cause dyspepsia or fatty food
intolerance. More serious complications include cholecystitis; biliary tract
obstruction (from stones in the bile ducts or choledocholithiasis), sometimes with
infection (cholangitis); and gallstone pancreatitis. Diagnosis is usually by
ultrasonography. If cholelithiasis causes symptoms or complications,
cholecystectomy is necessary.
Risk factors for gallstones include female sex, obesity, increased age, American
Indian ethnicity, a Western diet, and a family history. Most disorders of the
biliary tract result from gallstones.
Pathophysiology
Biliary sludge is often a precursor of gallstones. It consists of Ca bilirubinate (a
polymer of bilirubin), cholesterol microcrystals, and mucin. Sludge develops
during gallbladder stasis, as occurs during pregnancy or while receiving TPN.
Most sludge is asymptomatic and disappears when the primary condition
resolves. Alternatively, sludge can evolve into gallstones or migrate into the
biliary tract, obstructing the ducts and leading to biliary colic, cholangitis, or
pancreatitis.
There are several types of gallstones.
Cholesterol stones account for > 85% of gallstones in the Western world. For
cholesterol gallstones to form, the following is required:
• Bile must be supersaturated with cholesterol. Normally, water-insoluble
cholesterol is made water-soluble by combining with bile salts and
lecithin to form mixed micelles. Supersaturation of bile with cholesterol
most commonly results from excessive cholesterol secretion (as occurs in
obesity or diabetes) but may result from a decrease in bile salt secretion
(eg, in cystic fibrosis because of bile salt malabsorption) or in lecithin
secretion (eg, in a rare genetic disorder that causes a form of progressive
intrahepatic familial cholestasis).
• The excess cholesterol must precipitate from solution as solid
microcrystals. Such precipitation in the gallbladder is accelerated by
mucin, a glycoprotein, or other proteins in bile.
• The microcrystals must aggregate and grow. This is facilitated by the
binding effect of mucin forming a scaffold and retention in the
gallbladder (impaired contractility from the excess cholesterol in bile).
Black pigment stones are small, hard gallstones composed of Ca bilirubinate
and inorganic Ca salts (eg, Ca carbonate, Ca phosphate). Factors that accelerate
their development include alcoholic liver disease, chronic hemolysis, and older
age.
Brown pigment stones are soft and greasy, consisting of bilirubinate and fatty
acids (Ca palmitate or stearate). They form during infection, inflammation, and
parasitic infestation (eg, liver flukes in Asia).
Gallstones grow at about 1 to 2 mm/yr, taking 5 to 20 yr before becoming large
enough to cause problems. Most gallstones form within the gallbladder, but
brown pigment stones form in the ducts. Gallstones may migrate to the bile duct
after cholecystectomy or, particularly in the case of brown pigment stones,
develop behind strictures as a result of stasis and infection.
Symptoms and Signs
About 80% of people with gallstones are asymptomatic. The remainder have
symptoms ranging from biliary-type pain (biliary colic) to cholecystitis to life-
threatening cholangitis. Biliary colic is the most common symptom.
Stones occasionally may traverse the cystic duct without causing symptoms.
Most gallstone migration, however, leads to cystic duct obstruction, which, even
if transient, causes biliary colic. Biliary colic characteristically begins in the right
upper quadrant but may occur elsewhere in the abdomen. It is often poorly
localized, particularly in diabetics and the elderly. The pain may radiate into the
back or down the arm. Episodes begin suddenly, become intense within 15 min
to 1 h, remain at a steady intensity (not colicky) for up to 12 h (usually < 6 h),
and then gradually disappear over 30 to 90 min, leaving a dull ache. The pain is
usually severe enough to send patients to the emergency department for relief.
Nausea and some vomiting are common, but fever and chills do not occur unless
cholecystitis has developed. Mild right upper quadrant or epigastric tenderness
may be present; peritoneal findings are absent. Between episodes, patients feel
well.
Although biliary-type pain can follow a heavy meal, fatty food is not a specific
precipitating factor. Nonspecific GI symptoms, such as gas, bloating, and nausea,
have been inaccurately ascribed to gallbladder disease. These symptoms are
common, having about equal prevalence in cholelithiasis, peptic ulcer disease,
and functional GI disorders.
Little correlation exists between the severity and frequency of biliary colic and
pathologic changes in the gallbladder. Biliary colic can occur in the absence of
cholecystitis. Should colic last > 12 h, particularly if accompanied by vomiting
or fever, acute cholecystitis or pancreatitis is likely.
Diagnosis
• Ultrasonography
Gallstones are suspected in patients with biliary colic. Abdominal
ultrasonography is the method of choice for detecting gallbladder stones;
sensitivity and specificity are 95%. Ultrasonography also accurately detects
sludge. CT, MRI, and oral cholecystography (rarely available now, although
quite accurate) are alternatives (see Testing for Hepatic and Biliary Disorders:
Imaging Tests). Endoscopic ultrasonography accurately detects small gallstones
(< 3 mm) and may be needed if other tests are equivocal. Laboratory tests
usually are not helpful; typically, results are normal unless complications
develop. Asymptomatic gallstones and biliary sludge are often detected
incidentally when imaging, usually ultrasonography, is done for other reasons.
About 10 to 15% of gallstones are calcified and visible on plain x-rays.
Prognosis
Those with asymptomatic gallstones become symptomatic at a rate of about
2%/yr. The symptom that develops most commonly is biliary colic rather than a
major biliary complication. Once biliary symptoms begin, they are likely to
recur; pain returns in 20 to 40% of patients/yr, while about 1 to 2% of patients/yr
develop complications such as cholecystitis, choledocholithiasis, cholangitis, and
gallstone pancreatitis.
Treatment
• Laparoscopic cholecystectomy for symptomatic stones
• Expectant for asymptomatic stones; sometimes stone dissolution
Most asymptomatic patients decide that the discomfort, expense, and risk of
elective surgery are not worth removing an organ that may never cause clinical
illness. However, if symptoms occur, gallbladder removal (cholecystectomy) is
indicated because pain is likely to recur and serious complications can develop.
Surgery: Surgery can be done with an open or laparoscopic technique.
Open cholecystectomy, which involves a large abdominal incision and direct
exploration, is safe and effective. Its overall mortality rate is about 0.1% when
done electively during a period free of complications.
Laparoscopic cholecystectomy is the treatment of choice. Using video endoscopy
and instrumentation through small abdominal incisions, the procedure is less
invasive than open cholecystectomy. The result is a much shorter convalescence,
decreased postoperative discomfort, improved cosmetic results, yet no increase
in morbidity or mortality. Laparoscopic cholecystectomy is converted to an open
procedure in 2 to 5% of patients, usually because biliary anatomy cannot be
identified or a complication cannot be managed. Older age typically increases the
risks of any type of surgery.
Cholecystectomy effectively prevents future biliary colic but is less effective for
preventing atypical symptoms such as dyspepsia. Cholecystectomy does not
result in nutritional problems or a need for dietary limitations. Some patients
develop diarrhea, often because bile salt malabsorption in the ileum is unmasked.
Prophylactic cholecystectomy in asymptomatic patients with cholelithiasis is not
warranted except in those with quite large gallstones (> 3 cm) or those with a
calcified gallbladder (porcelain gallbladder) because of an increased risk of
gallbladder carcinoma.
Stone dissolution: For patients who decline surgery or who are at high surgical
risk (eg, because of concomitant medical disorders or advanced age), gallbladder
stones can sometimes be dissolved by ingesting bile acids orally for many
months. The best candidates for this treatment are those with small, radiolucent
stones (more likely to be composed of cholesterol) in a functioning
nonobstructed gallbladder—normal filling on cholescintigraphy or oral
cholecystography or absence of stones in the neck.
Ursodeoxycholic acid 8 to 10 mg/kg/day po dissolves 80% of tiny stones < 0.5
cm in diameter within 6 mo. For larger stones (the majority), the success rate is
much lower, even with higher doses of ursodeoxycholic acid. Further, after
successful dissolution, stones recur in 50% within 5 yr. Most patients are thus
not candidates and prefer laparoscopic cholecystectomy. Stone fragmentation
(extracorporeal shock wave lithotripsy) to assist stone dissolution and clearance
is now unavailable. Ursodeoxycholic acid, however, has value in preventing
stone formation in morbidly obese patients who are losing weight rapidly after
bariatric surgery or while on a very low calorie diet.
Cholecystitis
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Pronunciations
ampulla of Vater
biliary
cholecystectomy
cholecystitis
cholescintigraphy
cholestasis
electrolytes
ileus
lipase
pancreas
pancreatitis
radionuclide
sepsis
sphincter of Oddi
sphincterotomy
ultrasonography
Cholecystitis is inflammation of the gallbladder, usually resulting from a

gallstone blocking the cystic duct.
• Gallbladder inflammation usually results from a gallstone blocking the
flow of bile.
• Typically, people have abdominal pain that lasts more than 6 hours,
fever, and nausea.
• Ultrasonography can usually detect signs of gallbladder inflammation.
• The gallbladder is removed, often using a laparoscope.
Cholecystitis is the most common problem resulting from gallbladder stones. It
occurs when a stone blocks the cystic duct, which carries bile from the
gallbladder.
Cholecystitis is classified as acute or chronic.
Acute Cholecystitis: Acute cholecystitis begins suddenly, resulting in severe,
steady pain in the upper abdomen. At least 95% of people with acute
cholecystitis have gallstones. The inflammation almost always begins without
infection, although infection may follow later. Inflammation may cause the
gallbladder to fill with fluid and its walls to thicken.
Rarely, a form of acute cholecystitis without gallstones (acalculous cholecystitis)
occurs. Acalculous cholecystitis is more serious than other types of cholecystitis.
It tends to occur after the following:
• Major surgery
• Critical illnesses such as serious injuries, major burns, and bodywide
infections (sepsis)
• Intravenous feedings for a long time
• Fasting for a prolonged time
• A deficiency in the immune system
It can occur in young children, perhaps developing from a viral or another
infection.
Chronic Cholecystitis: Chronic cholecystitis is gallbladder inflammation that has
lasted a long time. It almost always results from gallstones. It is characterized by
repeated attacks of pain (biliary colic). In chronic cholecystitis, the gallbladder is
damaged by repeated attacks of acute inflammation, usually due to gallstones,
and may become thick-walled, scarred, and small. The gallbladder usually
contains sludge (microscopic particles of materials similar to those in gallstones),
or gallstones that either block its opening into the cystic duct or reside in the
cystic duct itself.
Symptoms
A gallbladder attack, whether in acute or chronic cholecystitis, begins as pain.
The pain of cholecystitis is similar to that caused by gallstones (biliary colic) but
is more severe and lasts longer—more than 6 hours and often more than 12
hours. The pain peaks after 15 to 60 minutes and remains constant. It usually
occurs in the upper right part of the abdomen. The pain may become
excruciating. Most people feel a sharp pain when a doctor presses on the upper
right part of the abdomen. Breathing deeply may worsen the pain. The pain often
extends to the lower part of the right shoulder blade or to the back. Nausea and
vomiting are common.
Within a few hours, the abdominal muscles on the right side may become rigid.
Fever occurs in about one third of people with acute cholecystitis. The fever
tends to rise gradually to above 100.4° F (38° C) and may be accompanied by
chills. Fever rarely occurs in people with chronic cholecystitis.
In older people, the first or only symptoms of cholecystitis may be rather
general. For example, older people may lose their appetite, feel tired or weak, or
vomit. They may not develop a fever.
Typically, an attack subsides in 2 to 3 days and completely resolves in a week. If
the acute episode persists, it may signal a serious complication. A high fever,
chills, a marked increase in the white blood cell count, and cessation of the
normal rhythmic contractions of the intestine (ileus—see Gastrointestinal
Emergencies: Appendicitis) suggest pockets of pus (abscesses) in the abdomen
near the gallbladder from gangrene (which develops when tissue dies) or a
perforated gallbladder.
If people develop jaundice (see Manifestations of Liver Disease: Jaundice) or
pass dark urine and light-colored stools, the common bile duct is probably
blocked by a stone, causing a backup of bile in the liver (cholestasis).
Inflammation of the pancreas (pancreatitis) can develop. It is caused by a stone
blocking the ampulla of Vater, near the exit of the pancreatic duct.
Acalculous cholecystitis typically causes sudden, excruciating pain in the upper
abdomen in people with no previous symptoms or other evidence of a
gallbladder disorder. The inflammation is often very severe and can lead to
gangrene or rupture of the gallbladder. In people with other severe problems
(including people in the intensive care unit for another reason), acalculous
cholecystitis may be overlooked at first. The only symptoms may be a swollen
(distended), tender abdomen or a fever with no known cause. If untreated,
acalculous cholecystitis results in death for 65% of people.
Diagnosis
Doctors diagnose cholecystitis based mainly on symptoms and results of imaging
tests. Ultrasonography is the best way to detect gallstones in the gallbladder.
Ultrasonography can also detect fluid around the gallbladder or thickening of its
wall, which are typical of acute cholecystitis. Often, when the ultrasound probe
is moved across the upper abdomen above the gallbladder, people report
tenderness.
Cholescintigraphy, another imaging test, is useful when acute cholecystitis is
difficult to diagnose. For this test, a radioactive substance (radionuclide) is
injected intravenously. A gamma camera detects the radioactivity given off, and
a computer is used to produce an image. Thus, movement of the radionuclide
from the liver through the biliary tract can be followed. Images of the liver, bile
ducts, gallbladder, and upper part of the small intestine are taken. If the
radionuclide does not fill the gallbladder, the cystic duct is probably blocked by a
gallstone.
Liver blood tests are often normal unless the person has an obstructed bile duct.
Other blood tests can detect some complications such as a high level of a
pancreatic enzyme (lipase or amylase) in pancreatitis. A high white blood cell
count suggests inflammation, an abscess, gangrene, or a perforated gallbladder.
Treatment
People with acute or chronic cholecystitis need to be hospitalized. They are not
allowed to eat or drink and are given fluids and electrolytes intravenously. A
doctor may pass a tube through the nose and into the stomach, so that suctioning
can be used to keep the stomach empty and reduce fluid accumulating in the
intestine if the intestine is not contracting normally. Usually, antibiotics are
given intravenously, and pain relievers are given.
If acute cholecystitis is confirmed and the risk of surgery is small, the gallbladder
is usually removed within 24 to 48 hours after symptoms start. If necessary,
surgery can be delayed for 6 weeks or more while the attack subsides. Delay is
often necessary for people with a disorder that makes surgery too risky (such as a
heart, lung, or kidney disorder). If a complication such as an abscess, gangrene,
or perforated gallbladder is suspected, immediate surgery is necessary.
In chronic cholecystitis, the gallbladder is usually removed after the acute
episode subsides.
In acalculous cholecystitis, immediate surgery is necessary to remove the
diseased gallbladder.
Surgical removal of the gallbladder (cholecystectomy) is usually done using a
flexible viewing tube called a laparoscope. After small incisions are made in the
abdomen, the laparoscope and other tubes are inserted, and surgical tools are
passed through the incisions and used to remove the gallbladder.
Pain After Surgery: A few people have new or recurring episodes of pain that
feel like gallbladder attacks even though the gallbladder (and the stones) have
been removed. The cause is not known, but it may be malfunction of the
sphincter of Oddi, the muscles that control the release of bile and pancreatic
secretions through the opening of the bile and pancreatic ducts into the small
intestine. Pain may occur because pressure in the ducts is increased by sphincter
spasms, which hinders the flow of bile and pancreatic secretions. Pain also may
result from small gallstones that remain in the ducts after the gallbladder is
removed. More commonly, the cause is another problem, such as irritable bowel
syndrome or even peptic ulcer disease.
Endoscopic retrograde cholangiopancreatography (ERCP) may be necessary to
determine if the cause of pain is increased pressure. For this procedure, a flexible
viewing tube (endoscope) is inserted through the mouth and into the intestine,
and a device to measure pressure is inserted through the tube. If pressure is
increased, surgical instruments are inserted into the tube and used to cut and thus
widen the sphincter of Oddi. This procedure (called endoscopic sphincterotomy)
can relieve symptoms in people who have an abnormality of the sphincter.
Cholecystitis: Introduction
Cholecystitis: Inflammation of the gallbladder which concentrates and stores bile. The condition
may occur suddenly (acute) or persist over a longer period of time (chronic). More detailed
information about the symptoms, causes, and treatments of Cholecystitis is available below.
Symptoms of Cholecystitis
Click to Check
• Upper right-side abdominal pain
• Biliary colic - spasmodic upper abdominal pain
• Biliary colic after a fatty meal
• Abdominal discomfort
• Pain under right shoulder blade
• more symptoms...»
See full list of 21 symptoms of Cholecystitis
Treatments for Cholecystitis
• Bed rest
• Antibiotics
• Pain medications
• Hospitalization
• Gallstone treatments - see treatments for gallstones
• more treatments...»
See full list of 7 treatments for Cholecystitis
Home Diagnostic Testing
Home medical testing related to Cholecystitis:
• Bladder & Urinary Health: Home Testing:
○ Home Bladder Testing
○ Home Urinary Tract Infection Tests
• more...»
Wrongly Diagnosed with Cholecystitis?
• Misdiagnosis of Cholecystitis
• Failure to diagnose Cholecystitis
• Hidden causes of Cholecystitis (possibly wrongly diagnosed)
• Undiagnosed: Cholecystitis
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Cholecystitis: Deaths
Read more about Deaths and Cholecystitis.
Diagnostic Tests for Cholecystitis
Test for Cholecystitis in your own home
Click for Tests
• X-rays - to find gallstones
• Ultrasound - to find gallstones
• See tests for gallstones
• more tests...»
Cholecystitis: Complications
Read more about complications of Cholecystitis.
Causes of Cholecystitis
• Gallstones
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See full list of 18 causes of Cholecystitis
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• Cholecystitis as a symptom
• Medical news summaries relating to Causes of Cholecystitis
Disease Topics Related To Cholecystitis
Research the causes of these diseases that are similar to, or related to, Cholecystitis:
• Cystic duct stones
• Acute cholecystitis
• Chronic cholecystitis
• Emphysematous cholecystitis
• Acalculous cholecystitis
• Calculous cholecystitis
• Stones in the cystic duct
• more related diseases...»
The list of signs and symptoms mentioned in various sources for Cholecystitis includes the 21
symptoms listed below:
• Fever
• Nausea
• Vomiting
• Flatulence
• Jaundice
• Itching skin
• Pale stool
• Thickening of gallbladder
• Shrinking of gallbladder
• Gallbladder inflammation
• Severe pain in upper right side of abdomen
• Back pain
• Indigestion
• Yellow skin
• Yellow membranes
• Yellow whites of the eyes
• more information...»
Research symptoms & diagnosis of Cholecystitis:
• Overview -- Cholecystitis
• Diagnostic Tests for Cholecystitis
• Home Diagnostic Testing
• Complications -- Cholecystitis
• Doctors & Specialists
• Misdiagnosis and Alternative Diagnoses
• Hidden Causes of Cholecystitis
• Other Causes -- causes of these or similar symptoms
Read information about complications of Cholecystitis.
Cholecystitis Symptoms: Book Excerpts
• Signs and symptoms - Cholelithiasis, cholecystitis, and related disorders
Diagnostic Testing
Diagnostic testing of medical conditions related to Cholecystitis:
• more tests...»
Research More About Cholecystitis
Do I have Cholecystitis?
• Cholecystitis: Introduction
• Cholecystitis: Diagnostic Testing to confirm diagnosis
• Alternative diagnoses and misdiagnosis for Cholecystitis
• Treatments for Cholecystitis
• More about Cholecystitis
Cholecystitis: Medical Mistakes
• Women's Health Mistakes:
○ Womens Health -- Health Mistakes
○ Contraception -- Health Mistakes
○ Fertility -- Health Mistakes
• more mistakes...»
Cholecystitis: Undiagnosed Conditions
Diseases that may be commonly undiagnosed in related medical areas:
• Women's Reproductive Health: diseases that are commonly undiagnosed:
○ Overactive Bladder Syndrome -- Undiagnosed
○ PCOS -- Undiagnosed
○ Chlamydia -- Undiagnosed
○ Pelvic Inflammatory Disease -- Undiagnosed
○ Cervical Cancer -- Undiagnosed
○ Breast Cancer -- Undiagnosed
○ Ovarian Cancer -- Undiagnosed
○ Von Willebrand Disease -- Undiagnosed
○ more ...»
• more undiagnosed conditions...»
Cholecystitis: Rare Types
Rare types of medical conditions and diseases in related medical categories:
• Women's Reproductive Health -- rare types of diseases:
○ Overactive Bladder Syndrome -- Rare Types
○ PCOS -- Rare Types
○ Chlamydia -- Rare Types
○ Pelvic Inflammatory Disease -- Rare Types
○ Cervical Cancer -- Rare Types
○ Breast Cancer -- Rare Types
○ Ovarian Cancer -- Rare Types
○ Von Willebrand Disease -- Rare Types
○ more ...»
• more rare diseases...»
Cholecystitis: Related Disease Topics
More general medical disease topics related to Cholecystitis include:
• Biliary disorder
• Gall bladder conditions
• Symptoms: Cholecystitis
• Causes: Cholecystitis
• Treatments: Cholecystitis
List of causes of Cholecystitis
Following is a list of causes or underlying conditions (see also Misdiagnosis of underlying
causes of Cholecystitis) that could possibly cause Cholecystitis includes:
• Gallstones
• Bile duct blockage
• Opisthorchiasis - cholecystitis
• Triosephosphate isomerase 1 - cholecystitis
• Bacteriodes
• Klebsiella
• Secondary infection from gut organisms
• Inspissation of bile
• Impacted stone
• E-coli
• Typhoid fever - cholecystitis
• Sjogren's Syndrome - cholecystitis
• Bile stasis
• Cholelithiasis
• Hyperlipoproteinemia type 3 - cholecystitis
• Familial hyperlipoproteinemia - cholecystitis
• Edwardsiella tarda infection - cholecystitis
• Ischemia
More causes: see full list of causes for Cholecystitis
Cholecystitis Causes: Book Excerpts
• Differential Diagnosis - Abdominal Masses
• Differential Diagnosis - Abdominal Masses
• Medical causes - Abdominal mass
• Differential Overview - Abdominal/Pelvic Mass
• Causes - Cholelithiasis, cholecystitis, and related disorders
• Principal Causes of Abdominal Masses - Abdominal Masses
Cholecystitis: Related Medical Conditions

To research the causes of Cholecystitis, consider researching the causes of these these diseases
that may be similar, or associated with Cholecystitis:
• Cystic duct stones
• Chronic cholecystitis
• Emphysematous cholecystitis
• Acalculous cholecystitis
• Calculous cholecystitis
• Stones in the cystic duct
• Obstruction of the cystic duct
• Biliary pain
• Acalculous biliary colic
Cholecystitis: Causes and Types

Causes of Broader Categories of Cholecystitis: Review the causal information about the
various more general categories of medical conditions:
• Biliary disorder
• Gall bladder conditions
• more types...»
Cholecystitis as a complication of other conditions:

Other conditions that might have Cholecystitis as a complication may, potentially, be an
underlying cause of Cholecystitis. Our database lists the following as having Cholecystitis as a
complication of that condition:
• Edwardsiella tarda infection
• Opisthorchiasis
• Sjogren's Syndrome
• Typhoid fever
Cholecystitis as a symptom:
Conditions listing Cholecystitis as a symptom may also be potential underlying causes of
Cholecystitis. Our database lists the following as having Cholecystitis as a symptom of that
condition:
• Familial hyperlipoproteinemia
• Hyperlipoproteinemia type 3
• Triosephosphate isomerase 1
Medical news summaries relating to Cholecystitis:

The following medical news items are relevant to causes of Cholecystitis:
• Use of estrogen by women with hysterectomies may increase the risk of
gallbladder disease
• More news »
Related information on causes of Cholecystitis:

As with all medical conditions, there may be many causal factors. Further relevant information
on causes of Cholecystitis may be found in:
• Risk factors for Cholecystitis
• Hidden causes of Cholecystitis
Causes of Cholecystitis: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without
registration, for more information about the causes of Cholecystitis.
Abdominal Masses: Differential Diagnosis
(In a Page: Signs and Symptoms)
• Constipation/inability to pass stool
–Most commonly due to dehydration and/or low dietary fiber intake
–Hirschsprung's disease (congenital aganglionic megacolon)
–Medications: Narcotics, opiates, or anticholinergic medications
–Ogilvie's syndrome (colonic pseudo-obstruction)
• Ascites
–May be due to malignancy, nephrotic syndrome, liver disease, or congestive
heart failure
 Large or small bowel obstruction
 Soft tissue mass
–Tumor (e.g., ovarian, uterine, bowel, liver)
–Uterine fibroids
–Lipoma: Soft, fleshy, mobile, and contained in the subcutaneous tissue of the
abdominal wall
–Hernia: Bowel sounds may be audible over the mass; incarceration causes pain;
strangulation leads to bowel death
–Pyloric stenosis: Seen primarily in infants; palpable pyloric olive-shaped mass
–Pregnancy
–Massive lymphadenopathy (e.g., lymphoma)
–Organomegaly (e.g., hepatomegaly, splenomegaly)
–Infection: Intra-abdominal or tubo-ovarian abscess
–Abdominal aortic aneurysm: Associated with pulsatile mass and hypotension
• Cyst
–Mesenteric cysts: Fluid collections in the mesentery; typically benign
–Hydatid cyst: Caused by larval form of Echinococcus granulosus; typically
found in the liver in patients with history of travel to tropical areas
–Dermoid cyst: May be massive due to delayed presentation
• Palpable gallbladder (Courvoisier's sign): Associated with common bile duct
obstruction and a distended gallbladder
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Abdominal Masses: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
• Wilms tumor
–More common in younger children
• Neuroblastoma
–More common in younger children
• Leukemia/lymphoma
–Involvement of retroperitoneal nodes, liver, or spleen
• Hepatic tumors
–Hepatoblastoma, hepatocellular carcinoma, angiosarcoma,
rhabdomyosarcoma of the liver, metastatic disease
• Germ cell tumors
–Ovarian, teratoma
• Soft tissue sarcoma
–Rhabdomyosarcoma
• Rare malignancies in children
–Carcinoid tumors, adrenocortical carcinoma, pancreatoblastoma,
malignant rhabdoid tumor
• Cystic masses
–Ovary, renal, mesenteric
• Benign tumors
–Adenomas (especially of liver), hamartomas, pheochromocytoma
• Vascular lesions (e.g., hemangioma)
• Renal etiologies
–Distended, nonemptying bladder, bladder outlet obstruction
–Congenital mesoblastic nephroma
–Severe hydronephrosis
• Gynecologic
–Ovarian torsion, endometriosis, pelvic inflammatory disease
• Gastrointestinal
–Constipation/stool impaction, intestinal obstruction (e.g.,
Hirschsprung), GI duplication, incarcerated hernia
• Pancreatic pseudocyst
• Infectious
–Abscess, hepatitis, virus (EBV, CMV) causing splenomegaly or
hepatomegaly
• Structures normally palpable in small children are liver edge, spleen tip
(especially with viral illness), aorta, sigmoid colon, and spine
Source: In A Page: Pediatric Signs and Symptoms, 2007
Abdominal mass: Medical causes
(Handbook of Signs & Symptoms (Third Edition))
❑ Abdominal aortic aneurysm. Abdominal aortic aneurysm may persist for years, producing only
a pulsating periumbilical mass with a systolic bruit over the aorta. However, it may become life-
threatening if the aneurysm expands and its walls weaken. In such cases, the patient initially
reports constant upper abdominal pain or, less commonly, low back or dull abdominal pain. If
the aneurysm ruptures, he’ll report severe abdominal and back pain. After rupture, the aneurysm
no longer pulsates.
Associated signs and symptoms of rupture include mottled skin below the waist, absent femoral
and pedal pulses, lower blood pressure in the legs than in the arms, mild to moderate tenderness
with guarding, and abdominal rigidity. Signs of shock — such as tachycardia and cool, clammy
skin — appear with significant blood loss.
❑ Cholecystitis.Deep palpation below the liver border may reveal a smooth, firm, sausage-shaped
mass. However, with acute inflammation, the gallbladder is usually too tender to be palpated.
Cholecystitis can cause severe right upper quadrant pain that may radiate to the right shoulder,
chest, or back; abdominal rigidity and tenderness; fever; pallor; diaphoresis; anorexia; nausea;
and vomiting. Recurrent attacks usually occur 1 to 6 hours after meals. Murphy’s sign
(inspiratory arrest elicited when the examiner palpates the right upper quadrant as the patient
takes a deep breath) is common.
❑ Colon cancer.A right lower quadrant mass may occur with cancer of the right colon, which
may also cause occult bleeding with anemia and abdominal aching, pressure, or dull cramps.
Associated findings include weakness, fatigue, exertional dyspnea, vertigo, and signs and
symptoms of intestinal obstruction, such as obstipation and vomiting.
Occasionally, cancer of the left colon also causes a palpable mass. It usually produces rectal
bleeding, intermittent abdominal fullness or cramping, and rectal pressure. The patient may also
report fremitus and pelvic discomfort. Later, he develops obstipation, diarrhea, or pencil-shaped,
grossly bloody, or mucus-streaked stools. Typically, defecation relieves pain.
❑ Crohn’s disease. With Crohn’s disease, tender, sausage-shaped masses are usually palpable in
the right lower quadrant and, at times, in the left lower quadrant. Attacks of colicky right lower
quadrant pain and diarrhea are common. Associated signs and symptoms include fever, anorexia,
weight loss, hyperactive bowel sounds, nausea, abdominal tenderness with guarding, and
perirectal, skin, or vaginal fistulas.
❑ Diverticulitis. Most common in the sigmoid colon, diverticulitis may produce a left lower
quadrant mass that’s usually tender, firm, and fixed. It also produces intermittent abdominal pain
that’s relieved by defecation or passage of flatus. Other findings may include alternating
constipation and diarrhea, nausea, a low-grade fever, and a distended and tympanic abdomen.
❑ Gastric cancer.Advanced gastric cancer may produce an epigastric mass. Early findings
include chronic dyspepsia and epigastric discomfort, whereas late findings include weight loss, a
feeling of fullness after eating, fatigue and, occasionally, coffee-ground vomitus or melena.
❑ Hepatomegaly. Hepatomegaly produces a firm, blunt, irregular mass in the epigastric region or
below the right costal margin. Associated signs and symptoms vary with the causative disorder
but commonly include ascites, right upper quadrant pain and tenderness, anorexia, nausea,
vomiting, leg edema, jaundice, palmar erythema, spider angiomas, gynecomastia, testicular
atrophy and, possibly, splenomegaly.
❑ Hernia. The soft and typically tender bulge is usually an effect of prolonged, increased intra-
abdominal pressure on weakened areas of the abdominal wall. An umbilical hernia is typically
located around the umbilicus and an inguinal hernia in either the right or left groin. An incisional
hernia can occur anywhere along a previous incision. Hernia may be the only sign until
strangulation occurs.
❑ Hydronephrosis. Enlarging one or both kidneys, hydronephrosis produces a smooth, boggy
mass in one or both flanks. Other findings vary with the degree of hydronephrosis. The patient
may have severe colicky renal pain or dull flank pain that radiates to the groin, vulva, or testes.
Hematuria, pyuria, dysuria, alternating oliguria and polyuria, nocturia, accelerated hypertension,
nausea, and vomiting may also occur.
❑ Ovarian cyst. A large ovarian cyst may produce a smooth, rounded, fluctuant mass, resembling
a distended bladder, in the suprapubic region. Large or multiple cysts may also cause mild pelvic
discomfort, low back pain, menstrual irregularities, and hirsutism. A twisted or ruptured cyst
may cause abdominal tenderness, distention, and rigidity.
❑ Splenomegaly. The lymphomas, leukemias, hemolytic anemias, and inflammatory diseases are
among the many disorders that may cause splenomegaly. Typically, the smooth edge of the
enlarged spleen is palpable in the left upper quadrant. Associated signs and symptoms vary with
the causative disorder but usually include a feeling of abdominal fullness, left upper quadrant
abdominal pain and tenderness, splenic friction rub, splenic bruits, and a low-grade fever.
❑ Uterine leiomyomas (fibroids). If large enough, these common, benign uterine tumors produce
a round, multinodular mass in the suprapubic region. The patient’s chief complaint is usually
menorrhagia; she may also experience a feeling of heaviness in the abdomen, and pressure on
surrounding organs may cause back pain, constipation, and urinary frequency or urgency. Edema
and varicosities of the lower extremities may develop. Rapid fibroid growth in perimenopausal
or postmenopausal women needs further evaluation.
Source: Handbook of Signs & Symptoms (Third Edition), 2006
(Professional Guide to Signs & Symptoms (Fifth Edition))
Abdominal aortic aneurysm
An abdominal aortic aneurysm may persist for years, producing only a pulsating periumbilical
mass with a systolic bruit over the aorta. However, it may become life-threatening if the
aneurysm expands and its walls weaken. In such cases, the patient initially reports constant upper
abdominal pain or, less often, low back or dull abdominal pain. If the aneurysm ruptures, he’ll
report severe abdominal and back pain. And after rupture, the aneurysm no longer pulsates.
with guarding, and abdominal rigidity. Signs of shock—such as tachycardia and cool, clammy
skin—appear with significant blood loss.
Bladder distention
A smooth, rounded, fluctuant suprapubic mass is characteristic. In extreme distention, the mass
may extend to the umbilicus. Severe suprapubic pain and urinary frequency and urgency may
also occur.
Cholecystitis
Deep palpation below the liver border may reveal a smooth, firm, sausage-shaped mass.
However, in acute inflammation, the gallbladder is usually too tender to be palpated.
Cholecystitis can cause severe right-upper-quadrant pain that may radiate to the right shoulder,
chest, or back; abdominal rigidity and tenderness; fever; pallor; diaphoresis; anorexia; nausea;
and vomiting. Recurrent attacks usually occur 1 to 6 hours after meals. Murphy’s sign
Cholelithiasis
A stone-filled gallbladder usually produces a painless right-upper-quadrant mass that’s smooth
and sausage-shaped. However, passage of a stone through the bile or cystic duct may cause
severe right-upper-quadrant pain that radiates to the epigastrium, back, or shoulder blades.
Accompanying signs and symptoms include anorexia, nausea, vomiting, chills, diaphoresis,
restlessness, and low-grade fever. Jaundice may occur with obstruction of the common bile duct.
The patient may also experience intolerance of fatty foods and frequent indigestion.
Colon cancer
A right-lower-quadrant mass may occur in cancer of the right colon, which may also cause occult
bleeding with anemia and abdominal aching, pressure, or dull cramps. Associated findings
include weakness, fatigue, exertional dyspnea, vertigo, and signs and symptoms of intestinal
obstruction, such as obstipation and vomiting.
Occasionally, cancer of the left colon also causes a palpable mass. Usually though, it produces
rectal bleeding, intermittent abdominal fullness or cramping, and rectal pressure. The patient
may also report fremitus and pelvic discomfort. Later, he develops obstipation, diarrhea, or
pencil-shaped, grossly bloody, or mucus-streaked stools. Typically, defecation relieves pain.
Crohn’s disease
In Crohn’s disease, tender, sausage-shaped masses are usually palpable in the right lower
quadrant and, at times, in the left lower quadrant. Attacks of colicky right-lower-quadrant pain
and diarrhea are common. Associated signs and symptoms include fever, anorexia, weight loss,
hyperactive bowel sounds, nausea, abdominal tenderness with guarding, and perirectal, skin, or
vaginal fistulas.
Diverticulitis
Most common in the sigmoid colon, diverticulitis may produce a left-lower-quadrant mass that’s
usually tender, firm, and fixed. It also produces intermittent abdominal pain that’s relieved by
defecation or passage of flatus. Other findings may include alternating constipation and diarrhea,
nausea, low-grade fever, and a distended and tympanic abdomen.
Gallbladder cancer
Gallbladder cancer may produce a moderately tender, irregular mass in the right upper quadrant.
Accompanying it is chronic, progressively severe epigastric or right-upper-quadrant pain that
may radiate to the right shoulder. Associated signs and symptoms include nausea, vomiting,
anorexia, weight loss, jaundice, and possibly hepatosplenomegaly.
Gastric cancer
Advanced gastric cancer may produce an epigastric mass. Early findings include chronic
dyspepsia and epigastric discomfort, whereas late findings include weight loss, a feeling of
fullness after eating, fatigue, and occasionally coffee-ground vomitus or melena.
Hepatic cancer
Hepatic cancer produces a tender, nodular mass in the right upper quadrant or right epigastric
area accompanied by severe pain that’s aggravated by jolting. Other effects include weight loss,
weakness, anorexia, nausea, fever, dependent edema, and occasionally jaundice and ascites. A
large tumor can also cause a bruit or hum.
Hepatomegaly
Hepatomegaly produces a firm, blunt, irregular mass in the epigastric region or below the right
costal margin. Associated signs and symptoms vary with the causative disorder but commonly
include ascites, right-upper-quadrant pain and tenderness, anorexia, nausea, vomiting, leg edema,
jaundice, palmar erythema, spider angiomas, gynecomastia, testicular atrophy, and possibly
splenomegaly.
Hydronephrosis
By enlarging one or both kidneys, hydronephrosis produces a smooth, boggy mass in one or both
flanks. Other findings vary with the degree of hydronephrosis. The patient may have severe
colicky renal pain or dull flank pain that radiates to the groin, vulva, or testes. Hematuria, pyuria,
dysuria, alternating oliguria and polyuria, nocturia, accelerated hypertension, nausea, and
vomiting may also occur.
Ovarian cyst
A large ovarian cyst may produce a smooth, rounded, fluctuant mass, resembling a distended
bladder, in the suprapubic region. Large or multiple cysts may also cause mild pelvic discomfort,
low back pain, menstrual irregularities, and hirsutism. A twisted or ruptured cyst may cause
abdominal tenderness, distention, and rigidity.
Pancreatic abscess
Occasionally, pancreatic abscess may produce a palpable epigastric mass accompanied by
epigastric pain and tenderness. The patient’s temperature usually rises abruptly but may climb
steadily. Nausea, vomiting, diarrhea, tachycardia, and hypotension may also occur.
Pancreatic pseudocysts
After pancreatitis, pseudocysts may form on the pancreas, causing a palpable nodular mass in the
epigastric area. Other findings include nausea, vomiting, diarrhea, abdominal pain and
tenderness, low-grade fever, and tachycardia.
Renal cell carcinoma
Usually occurring in only one kidney, renal cell carcinoma produces a smooth, firm, nontender
mass near the affected kidney. Accompanying it are dull, constant abdominal or flank pain and
hematuria. Other signs and symptoms include elevated blood pressure, fever, and urine retention.
Weight loss, nausea, vomiting, and leg edema occur in late stages.
Splenomegaly
Lymphomas, leukemias, hemolytic anemias, and inflammatory diseases are among the many
disorders that may cause splenomegaly. Typically, the smooth edge of the enlarged spleen is
palpable in the left upper quadrant. Associated signs and symptoms vary with the causative
disorder but often include a feeling of abdominal fullness, left-upper-quadrant abdominal pain
and tenderness, splenic friction rub, splenic bruits, and low-grade fever.
Uterine leiomyomas (fibroids)
If large enough, these common, benign uterine tumors produce a round, multinodular mass in the
suprapubic region. The patient’s chief complaint is usually menorrhagia; she may also
experience a feeling of heaviness in the abdomen, and pressure on surrounding organs may cause
back pain, constipation, and urinary frequency or urgency. Edema and varicosities of the lower
extremities may develop. Rapid fibroid growth in perimenopausal or postmenopausal women
needs further evaluation.
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Abdominal/Pelvic Mass: Differential Overview
(Field Guide to Bedside Diagnosis)
Abdominal Mass
❑ Liver enlargement
❑ Spleen enlargement
❑ Fecal mass
❑ Diverticulitis
❑ Colon cancer
❑ Gallbladder enlargement
❑ Pancreatic pseudocyst
❑ Crohn disease
❑ Abdominal aortic aneurysm
❑ Renal enlargement
Pelvic Mass
❑ Distended bladder
❑ Pregnant uterus
❑ Salpingitis
❑ Ovarian cyst
❑ Uterine fibromyoma
❑ Ovarian cancer
❑ Endometrial cancer
❑ Ectopic pregnancy
❑ Malignant deposit
Source: Field Guide to Bedside Diagnosis, 2007
Cholelithiasis, cholecystitis, and related disorders: Causes
(Handbook of Diseases)
The origin and frequency of gallbladder and biliary tract disease vary with the particular
disorder.
Cholelithiasis
The presence of stones or calculi (gallstones) in the gallbladder results from changes in bile
components. Gallstones are made of cholesterol, calcium bilirubinate, or a mixture of cholesterol
and bilirubin pigment. They arise during periods of sluggishness in the gallbladder resulting from
pregnancy, use of oral contraceptives, diabetes mellitus, Crohn’s disease, cirrhosis of the liver,
pancreatitis, obesity, and rapid weight loss.
Cholelithiasis is the fifth leading cause of hospitalization among adults and accounts for 90% of
all gallbladder and duct diseases. The prognosis is usually good with treatment unless infection
occurs, in which case the prognosis depends on the infection’s severity and response to
antibiotics.
Cholecystitis
Cholecystitis, an acute or chronic inflammation of the gallbladder, is usually associated with a
gallstone impacted in the cystic duct; the inflammation develops behind the obstruction.
Cholecystitis accounts for 10% to 25% of all patients requiring gallbladder surgery.
The acute form is most common during middle age; the chronic form, among elderly people. The
prognosis is good with treatment.
Biliary cirrhosis
Primary biliary cirrhosis is a chronic, progressive disease of the liver characterized by
autoimmune destruction of the intrahepatic bile ducts and cholestasis. This condition usually
leads to obstructive jaundice and pruritus and involves the portal and periportal spaces of the
liver. It affects women between the ages of 40 and 60 nine times more often than men. The
prognosis is poor without liver transplantation.
Cholangitis
An infection of the bile duct, cholangitis is commonly associated with choledocholithiasis and
may follow percutaneous transhepatic cholangiography. Predisposing factors include bacterial or
metabolic alteration of bile acids. Widespread inflammation may cause fibrosis and stenosis of
the common bile duct. The prognosis for this rare condition is poor without stenting or surgery.
Choledocholithiasis
One out of every 10 patients with gallstones develops choledocholithiasis, or gallstones in the
common bile duct (sometimes called common duct stones). This occurs when stones passed out
of the gallbladder lodge in the hepatic and common bile ducts and obstruct the flow of bile into
the duodenum. The prognosis is good unless infection occurs.
Cholesterolosis
Cholesterol polyps or cholesterol crystal deposits in the gallbladder’s submucosa may result from
bile secretions containing high concentrations of cholesterol and insufficient bile salts. The
polyps may be localized or may speckle the entire gallbladder. Cholesterolosis, the most
common pseudotumor, isn’t related to widespread inflammation of the mucosa or lining of the
gallbladder. The prognosis is good with surgery.
Gallstone ileus
Gallstone ileus results from a gallstone lodging in the terminal ileum. It’s more common in
elderly people. The prognosis is good with surgery.
Postcholecystectomy syndrome
Postcholecystectomy syndrome commonly results from retained or recurrent common bile duct
stones, spasm of the sphincter of Oddi, functional bowel disorder, technical errors, or mistaken
diagnoses. It occurs in 1% to 5% of all patients whose gallbladders have been surgically removed
and may produce right upper quadrant abdominal pain, biliary colic, fatty food intolerance,
dyspepsia, and indigestion. The prognosis is good with selected radiologic procedures,
endoscopic procedures, or surgery.
Complications
Each disorder produces its own set of complications. Cholelithiasis may lead to any of the
disorders associated with gallstone formation: cholangitis, cholecystitis, choledocholithiasis, or
gallstone ileus.
Cholecystitis can progress to gallbladder complications, such as empyema, hydrops or mucocele,
or gangrene. Gangrene may lead to perforation, resulting in peritonitis, fistula formation,
pancreatitis, limy bile, and porcelain gallbladder. Other complications include chronic
cholecystitis and cholangitis.
Choledocholithiasis may lead to cholangitis, obstructive jaundice, pancreatitis, and secondary
biliary cirrhosis. Cholangitis, especially in the suppurative form, may progress to septic shock
and death. Gallstone ileus may cause bowel obstruction, which can lead to intestinal perforation,
peritonitis, septicemia, secondary infection, and septic shock.
Source: Handbook of Diseases, 2003
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Abdominal aortic aneurysm
An abdominal aortic aneurysm may persist for years, producing only a pulsating periumbilical
mass with a systolic bruit over the aorta. However, it may become life-threatening if the
aneurysm expands and its walls weaken. In such cases, the patient initially reports constant upper
abdominal pain or, less often, low back or dull abdominal pain. If the aneurysm ruptures, he’ll
report severe abdominal and back pain. After rupture, the aneurysm no longer pulsates.
with guarding, and abdominal rigidity. Signs of shock — such as tachycardia and cool, clammy
skin — appear with significant blood loss.
Bladder distention
A smooth, rounded, fluctuant suprapubic mass is characteristic of bladder distention. With
extreme distention, the mass may extend to the umbilicus. Severe suprapubic pain and urinary
frequency and urgency may also occur.
Cholecystitis
With cholecystitis, deep palpation below the liver border may reveal a smooth, firm, sausage-
shaped mass. However, with acute inflammation, the gallbladder is usually too tender to be
palpated. Cholecystitis can cause severe right-upper-quadrant pain that may radiate to the right
shoulder, chest, or back; abdominal rigidity and tenderness; fever; pallor; diaphoresis; anorexia;
nausea; and vomiting. Recurrent attacks usually occur 1 to 6 hours after meals. Murphy’s sign
Cholelithiasis
With cholelithiasis, a stone-filled gallbladder usually produces a painless right-upper-quadrant
mass that’s smooth and sausage-shaped. However, passage of a stone through the bile or cystic
duct may cause severe right-upper-quadrant pain that radiates to the epigastrium, back, or
shoulder blades. Accompanying signs and symptoms include anorexia, nausea, vomiting, chills,
diaphoresis, restlessness, and low-grade fever. Jaundice may occur with obstruction of the
common bile duct. The patient may also experience intolerance to fatty foods and frequent
indigestion.
Colon cancer
A right-lower-quadrant mass may occur with cancer of the right colon, which may also cause
occult bleeding with anemia and abdominal aching, pressure, or dull cramps. Associated findings
include weakness, fatigue, exertional dyspnea, vertigo, and signs and symptoms of intestinal
obstruction, such as obstipation and vomiting.
Occasionally, cancer of the left colon also causes a palpable mass. Usually though, it produces
rectal bleeding, intermittent abdominal fullness or cramping, and rectal pressure. The patient
may also report fremitus and pelvic discomfort. Later, he develops obstipation, diarrhea, or
pencil-shaped, grossly bloody, or mucus-streaked stools. Typically, defecation relieves pain.
Crohn’s disease
With Crohn’s disease, tender, sausage-shaped masses are usually palpable in the right lower
quadrant and, at times, in the left lower quadrant. Attacks of colicky right-lower-quadrant pain
and diarrhea are common. Associated signs and symptoms include fever, anorexia, weight loss,
hyperactive bowel sounds, nausea, abdominal tenderness with guarding, and perirectal, skin, or
vaginal fistulas.
Diverticulitis
Most common in the sigmoid colon, diverticulitis may produce a left-lower-
quadrant mass that’s usually tender, firm, and fixed. It also produces intermittent abdominal pain
that’s relieved by defecation or passage of flatus. Other findings may include alternating
constipation and diarrhea, nausea, low-grade fever, and a distended and tympanic abdomen.
Gallbladder cancer
Gallbladder cancer may produce a moderately tender, irregular mass in the right upper quadrant.
Accompanying it is chronic, progressively severe epigastric or right-upper-quadrant pain that
may radiate to the right shoulder. Associated signs and symptoms include nausea, vomiting,
anorexia, weight loss, jaundice and, at times, hepatosplenomegaly.
Gastric cancer
Advanced gastric cancer may produce an epigastric mass. Early findings include chronic
dyspepsia and epigastric discomfort, whereas late findings include weight loss, a feeling of
fullness, fatigue and, occasionally, coffee-ground vomitus or melena.
Hepatic cancer
Hepatic cancer produces a tender, nodular mass in the right upper quadrant or right epigastric
area accompanied by severe pain that’s aggravated by jolting. Other effects include weight loss,
weakness, anorexia, nausea, fever, dependent edema and, occasionally, jaundice and ascites. A
large tumor can also cause a bruit or hum.
Hepatomegaly
Hepatomegaly produces a firm, blunt, irregular mass in the epigastric region or below the right
costal margin. Associated signs and symptoms vary with the causative disorder but commonly
include ascites, right-upper-quadrant pain and tenderness, anorexia, nausea, vomiting, leg edema,
jaundice, palmar erythema, spider angiomas, gynecomastia, testicular atrophy and, possibly,
splenomegaly.
Hydronephrosis
Enlarging one or both kidneys, hydronephrosis produces a smooth, boggy mass in one or both
flanks. Other findings vary with the degree of hydronephrosis. The patient may have severe
colicky renal pain or dull flank pain that radiates to the groin, vulva, or testes. Hematuria, pyuria,
dysuria, alternating oliguria and polyuria, nocturia, accelerated hypertension, nausea, and
vomiting may also occur.
Ovarian cyst
A large ovarian cyst may produce a smooth, rounded, fluctuant mass, resembling a distended
bladder, in the suprapubic region. Large or multiple cysts may also cause mild pelvic discomfort,
low back pain, menstrual irregularities, and hirsutism. A twisted or ruptured cyst may cause
abdominal tenderness, distention, and rigidity.
Pancreatic abscess
Occasionally, pancreatic abscess may produce a palpable epigastric mass accompanied by
epigastric pain and tenderness. The patient’s temperature usually rises abruptly but may climb
steadily. Nausea, vomiting, diarrhea, tachycardia, and hypotension may also occur.
Renal cell cancer
Usually occurring in only one kidney, renal cell carcinoma produces a smooth, firm, nontender
mass near the affected kidney. Accompanying it are dull, constant abdominal or flank pain and
hematuria. Other signs and symptoms include elevated blood pressure, fever, and urine retention.
Weight loss, nausea, vomiting, and leg edema occur in late stages.
Splenomegaly
The lymphomas, leukemias, hemolytic anemias, and inflammatory diseases are among the many
disorders that may cause splenomegaly. Typically, the smooth edge of the enlarged spleen is
palpable in the left upper quadrant. Associated signs and symptoms vary with the causative
disorder but commonly include a feeling of abdominal fullness, left-upper-quadrant abdominal
pain and tenderness, splenic friction rub, splenic bruits, and low-grade fever.
Uterine leiomyomas (fibroids)
If large enough, a uterine leiomyoma (common, benign uterine tumor) can produce a round,
multinodular mass in the suprapubic region. The patient’s chief complaint is usually
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Abdominal Masses: Principal Causes of Abdominal Masses
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
1. Rightupper quadrant
1. Liver
1. Hepatomegaly
2. Hepatic cyst
3. Primary hepatic neoplasms
2. Gallbladder
1. Cholecystitis
2. Hydrops of the gallbladder
3. Biliary tree
1. Choledochal cyst
4. Intestine
1. Pyloric stenosis
2. Duodenal hematoma
3. Duplication
2. Left upper quadrant
1. Spleen
1. Splenomegaly
2. Splenic cyst
3. Neoplasm
3. Epigastric
1. Stomach
1. Bezoar
2. Duplication
2. Pancreas
1. Pancreatic cyst
2. Pancreatic pseudocyst
3. Neoplasm
4. Right/left mid-abdomen
1. Kidney
1. Unilateral
1. Hydronephrosis
2. Multicystic dysplastic kidney
3. Renal vein thrombosis
4. Congenital mesoblastic nephroma
5. Wilms tumor
6. Renal cyst
7. Ectopic kidney
8. Horseshoe kidney
9. Renal or perinephric abscess
2. Bilateral
1. Hydronephrosis
2. Multicystic dysplastic kidney
3. Renal vein thrombosis
4. Polycystic kidney disease
5. Beckwith-Wiedemann syndrome
2. Adrenal
1. Neonatal adrenal hematoma
2. Neuroblastoma
5. Periumbilical
1. Intestine
1. Mesenteric cyst
2. Volvulus
3. Duplication
4. Neoplasm
6. Right lower quadrant
1. Intestine
1. Abscess
2. Intussusception
3. Lymphoma
2. Ovary
1. Cyst
2. Torsion
3. Neoplasm
7. Left lower quadrant
1. Intestine
1. Constipation
2. Ovary (see right lower quadrant)
8. Hypogastrium
1. Bladder
1. Distension/obstruction
2. Uterus
1. Pregnancy
2. Hydrometrocolpos
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
(Nursing: Interpreting Signs and Symptoms)
Abdominal aortic aneurysm.An abdominal aortic aneurysm may exist for years, producing
only a pulsating periumbilical mass with a systolic bruit over the aorta. It may become life-
threatening if the aneurysm expands and its walls weaken. In such cases, the patient initially
reports constant upper abdominal pain or, less commonly, low back or dull abdominal pain. If
the aneurysm ruptures, he'll report severe abdominal and back pain. After rupture, the aneurysm
no longer pulsates.
with guarding, and abdominal rigidity. Signs of shock—such as altered mental status,
tachycardia, and cool, clammy skin—appear with significant blood loss.
Cholecystitis.Deep palpation below the liver border may reveal a smooth, firm, sausage-shaped
mass. With acute inflammation, the gallbladder is usually too tender to be palpated. Cholecystitis
can cause severe right upper quadrant pain that may radiate to the right shoulder, chest, or back;
abdominal rigidity and tenderness; fever; pallor; diaphoresis; anorexia; nausea; and vomiting.
Recurrent attacks usually occur 1 to 6 hours after meals. Murphy's sign (inspiratory arrest
elicited when the examiner palpates the right upper quadrant as the patient takes a deep breath) is
common.
Colon cancer.A right lower quadrant mass may occur with cancer of the right colon, which may
also cause occult bleeding with anemia and abdominal aching, pressure, or dull cramps.
Associated findings include weakness, fatigue, exertional dyspnea, vertigo, and signs and
symptoms of intestinal obstruction, such as obstipation and vomiting.
Occasionally, cancer of the left colon also causes a palpable mass. It usually produces rectal
bleeding, intermittent abdominal fullness or cramping, and rectal pressure. The patient may also
report fremitus and pelvic discomfort. Later, he develops obstipation, diarrhea, or pencil-shaped,
grossly bloody, or mucus-streaked stools. Typically, defecation relieves pain.
Crohn's disease.With Crohn's disease, tender, sausage-shaped masses are usually palpable in the
right lower quadrant and, at times, in the left lower quadrant. Attacks of colicky right lower
quadrant pain and diarrhea are common. Associated signs and symptoms include fever, anorexia,
weight loss, hyperactive bowel sounds, nausea, abdominal tenderness with guarding, and
perirectal, skin, or vaginal fistulas.
Diverticulitis.Most common in the sigmoid colon, diverticulitis may produce a left lower
quadrant mass that's usually tender, firm, and fixed. It also produces intermittent abdominal pain
that's relieved by defecation or passage of flatus. Other findings may include alternating
constipation and diarrhea, nausea, a low-grade fever, and a distended and tympanic abdomen.
Gastric cancer.Advanced gastric cancer may produce an epigastric mass. Early findings include
chronic dyspepsia and epigastric discomfort, whereas late findings include weight loss, a feeling
of fullness after eating, fatigue and, occasionally, coffee-ground vomitus or melena.
Hepatomegaly.Hepatomegaly produces a firm, blunt, irregular mass in the epigastric region or
below the right costal margin. Associated signs and symptoms vary with the causative disorder
but commonly include ascites, right upper quadrant pain and tenderness, anorexia, nausea,
vomiting, leg edema, jaundice, palmar erythema, spider angiomas, gynecomastia, testicular
atrophy and, possibly, splenomegaly.
Hernia.The soft and typically tender bulge is usually an effect of prolonged, increased intra-
abdominal pressure on weakened areas of the abdominal wall. An umbilical hernia is typically
located around the umbilicus and an inguinal hernia in either the right or left groin. An incisional
hernia can occur anywhere along a previous incision. Hernia may be the only sign until
strangulation occurs.
Hydronephrosis.Enlarging one or both kidneys, hydronephrosis produces a smooth, boggy mass
in one or both flanks. Other findings vary with the degree of hydronephrosis. The patient may
have severe colicky renal pain or dull flank pain that radiates to the groin, vulva, or testes.
Hematuria, pyuria, dysuria, alternating oliguria and polyuria, nocturia, accelerated hypertension,
nausea, and vomiting may also occur.
Ovarian cyst.A large ovarian cyst may produce a smooth, rounded, fluctuant mass, resembling a
distended bladder, in the suprapubic region. Large or multiple cysts may also cause mild pelvic
discomfort, low back pain, menstrual irregularities, and hirsutism. A twisted or ruptured cyst
may cause abdominal tenderness, distention, and rigidity.
Splenomegaly.With splenomegaly,the smooth edge of the enlarged spleen is palpable in the left
upper quadrant. Associated signs and symptoms vary with the causative disorder but usually
include a feeling of abdominal fullness, left upper quadrant abdominal pain and tenderness,
splenic friction rub, splenic bruits, and a low-grade fever.
Uterine leiomyomas (fibroids).If large enough, these common, benign uterine tumors produce a
round, multinodular mass in the suprapubic region. The patient's chief complaint is usually
Source: Nursing: Interpreting Signs and Symptoms, 2007
Risks factors for Cholecystitis: medical news summaries:
The following medical news items are relevant to risk factors for Cholecystitis:
• Aortic disease warning
• Use of estrogen by women with hysterectomies may increase the risk of gallbladder
disease
• More news »
About risk factors:
Risk factors for Cholecystitis are factors that do not seem to be a direct cause of the disease, but
seem to be associated in some way. Having a risk factor for Cholecystitis makes the chances of
getting a condition higher but does not always lead to Cholecystitis. Also, the absence of any risk
factors or having a protective factor does not necessarily guard you against getting Cholecystitis.
For general information and a list of risk factors, see the risk center.
Symptoms of Ovarian Cancer
Most women will survive ovarian cancer if it is detected at an early stage. But
most cases are detected late. Can women rely on their bodies to tell...

Stress Reduction

The list of signs and symptoms mentioned in various sources for Cholecystitis includes the 21
• Fever
• Nausea
• Vomiting
• Flatulence
• Jaundice
• Itching skin
• Pale stool
• Thickening of gallbladder
• Shrinking of gallbladder
• Gallbladder inflammation
• Severe pain in upper right side of abdomen
• Back pain
• Indigestion
• Yellow skin
• Yellow membranes
• Yellow whites of the eyes
Research symptoms & diagnosis of Cholecystitis:
• Overview -- Cholecystitis
• Diagnostic Tests for Cholecystitis
• Complications -- Cholecystitis
• Doctors & Specialists
Read information about complications of Cholecystitis.
Cholecystitis Symptoms: Book Excerpts
Diagnostic Testing
Diagnostic testing of medical conditions related to Cholecystitis:
• more tests...»
Do I have Cholecystitis?
• Cholecystitis: Diagnostic Testing to confirm diagnosis
• Alternative diagnoses and misdiagnosis for Cholecystitis
• Treatments for Cholecystitis
• More about Cholecystitis
Cholecystitis: Medical Mistakes
• Women's Health Mistakes:
○ Womens Health -- Health Mistakes
○ Contraception -- Health Mistakes
○ Fertility -- Health Mistakes
• more mistakes...»
Cholecystitis: Undiagnosed Conditions
Diseases that may be commonly undiagnosed in related medical areas:
• Women's Reproductive Health: diseases that are commonly undiagnosed:
○ Overactive Bladder Syndrome -- Undiagnosed
○ PCOS -- Undiagnosed
○ Chlamydia -- Undiagnosed
○ Pelvic Inflammatory Disease -- Undiagnosed
○ Cervical Cancer -- Undiagnosed
○ Breast Cancer -- Undiagnosed
○ Ovarian Cancer -- Undiagnosed
○ Von Willebrand Disease -- Undiagnosed
○ more ...»
• more undiagnosed conditions...»
Home Diagnostic Testing
Home medical tests related to Cholecystitis:
• Bladder & Urinary Health: Home Testing:
○ Home Bladder Testing
○ Home Urinary Tract Infection Tests
○ Home Cystitis Tests
○ Home Kidney Tests
○ Home Urine Protein Tests (Kidney Function)
○ Home Prostate Cancer Tests
• Menopause: Related Home Testing:
○ Home Menopause Tests
○ Home FSH Hormone Tests
○ Home Osteoporosis Testing
• Vaginal Health: Home Testing:
○ Home Vaginal Infection Tests
○ Home Vaginal PH Tests
○ Home Yeast Infection Tests
○ Home Candida Kits
○ Home Urinary Tract Infection (UTI) Test Kits
○ Home Bladder Test Kits
• Breast Cancer: Related Home Tests:
○ Home Breast Cancer Test Kits
○ Home Breast Lump Detection
• Kidney Health: Home Testing:
○ Home Kidney Testing
○ Home Microalbumin Tests (Kidney)
○ Home Urine Protein Tests (Kidney)
○ Home Urinary Tract Infection Test Kits
• more home tests...»
Wrongly Diagnosed with Cholecystitis?
The list of other diseases or medical conditions that may be on the differential diagnosis list of
alternative diagnoses for Cholecystitis includes:
• Acute Appendicitis
• Alcoholic liver disease
• Appendicitis/acute appendicitis/chronic appendicitis
• Diabetic Diarrhea
• Diverticular disease and diverticulitis
• more diagnoses...»
See the full list of 12 alternative diagnoses for Cholecystitis
Cholecystitis: Research Doctors & Specialists
• Pregnancy & Fertility Health Specialists:
○ Maternal & Fetal Medicine
○ Obstetrics & Gynecology
○ Reproductive Endocrinology & Infertility
○ Neonatal-Perinatal Medicine
• Womens Health Specialists:
○ Gynecological Oncology
• Urinary & Bladder Specialists (Urology):
○ Urology (Urinary Specialists)
○ Urological Surgery (Urinary Surgeons)
○ Kidney Doctors (Nephrologists) -- State Directory
• Kidney Health Specialists (Nephrology):
○ Nephrology (Kidney Health)
○ Pediatric Nephrology (Child Kidney Health)
○ Urology (Urinary/Bladder)
○ Kidney Doctors (Nephrologists) -- Local Directory
Cholelithiasis: Introduction
Cholelithiasis: Is the presence of gallstones in the gallbladder. More detailed information about
the symptoms, causes, and treatments of Cholelithiasis is available below.
Symptoms of Cholelithiasis
Click to Check
• Many are asymptomatic
• Others can cause cholecystitis (inflammation of the gallbladder)
• Biliary colic (when a stone temporarily lodges in the bile duct)
• Cholangitis
• Or pancreatitis
Read more about symptoms of Cholelithiasis
Treatments for Cholelithiasis
• Supportive measures
• Pain relief
• Fluids
• Surgery
• more treatments...»
Read more about treatments for Cholelithiasis
Wrongly Diagnosed with Cholelithiasis?
• Misdiagnosis of Cholelithiasis
• Hidden causes of Cholelithiasis (possibly wrongly diagnosed)
Videos for Cholelithiasis
Stress Reduction
Your Health and Your Insurance
Health insurance is important to everyone, especially people with chronic

conditions like Crohn's disease and ulcerative colitis. Tune in to...

Cholelithiasis: Related Patient Stories
• Gallbladder removal and GERD
• Is my illness Gallbladder disease?
• The Gall stone story....hmmm saga?
• After Gallbladder removal
• Gallbladder removal or not? HELP
• multiple gall stones
• To anyone who has had their gallbladder out
• Gallbladder help
• gall stones, stomach pain, lump left side under ribcage...
• Gallbladder????
• help now after my thread on gallbladder i'm getting this.
Cholelithiasis: Complications
Read more about complications of Cholelithiasis.
Causes of Cholelithiasis
• Sickle cell disease
• Somatostatinoma
• Clofibrate
• Erythropoietic protoporphyria
• Hypercalcaemia
• more causes...»
See full list of 12 causes of Cholelithiasis
Read more about causes of Cholelithiasis.
More information about causes of Cholelithiasis:
• Cholelithiasis as a complication caused by other conditions
• Cholelithiasis as a symptom
Disease Topics Related To Cholelithiasis
Research the causes of these diseases that are similar to, or related to, Cholelithiasis:
• Cholesterol stones
• Pseudolithiasis
• Pigment gallstones
• Haemolytic anemia
• Erythropoietic protoporphyria
• Sickle cell anemia
• Biliary colic
• more related diseases...»
Medical Textbooks Online about Cholelithiasis
Medical Books Excerpts
• Cholelithiasis and related disorders
• "Professional Guide to Diseases (Eighth Edition)" (2005)
• [ read ]
• Cholelithiasis, cholecystitis, and related disorders
• "Handbook of Diseases" (2003)
• [ read ]
• Cholelithiasis
• "The 5-Minute Pediatric Consult" (2008)
• [ read ]
• Colic
• [ read ]
Book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
Latest Treatments for Cholelithiasis

• Laparotomy
• ERCP
• Transhepatic cholangiography
• Invasive radiological drainage
• IV fluids
The list of signs and symptoms mentioned in various sources for Cholelithiasis includes the 5
• Cholangitis
• Or pancreatitis
Research symptoms & diagnosis of Cholelithiasis:
• Overview -- Cholelithiasis
• Diagnostic Tests for Cholelithiasis
• Complications -- Cholelithiasis
• Hidden Causes of Cholelithiasis
Cholelithiasis: Complications
Read information about complications of Cholelithiasis.
Cholelithiasis Symptoms: Book Excerpts
• Signs and symptoms - Cholelithiasis and related disorders
• Cholelithiasis - signs & symptoms - Cholelithiasis
Research More About Cholelithiasis
Do I have Cholelithiasis?
• Cholelithiasis: Introduction
• Cholelithiasis: Diagnostic Testing to confirm diagnosis
• Alternative diagnoses and misdiagnosis for Cholelithiasis
• Treatments for Cholelithiasis
• More about Cholelithiasis
Wrongly Diagnosed with Cholelithiasis?
The list of other diseases or medical conditions that may be on the differential diagnosis list of
alternative diagnoses for Cholelithiasis includes:
• Acute pancreatitis
• Peptic ulcer disease
• Appendicitis
• Acute hepatitis (type of Hepatitis)
• more diagnoses...»
See the full list of 12 alternative diagnoses for Cholelithiasis
More about symptoms of Cholelithiasis:
More information about symptoms of Cholelithiasis and related conditions:
• Other diseases with similar symptoms and common misdiagnoses
• Tests to determine if these are the symptoms of Cholelithiasis
• Symptoms that may be caused by complications of Cholelithiasis
• Underlying causes of Cholelithiasis
• Risk factors for Cholelithiasis
Medical Books Online about Cholelithiasis
Medical Books Excerpts Excerpts of published medical book chapters related to Cholelithiasis
are available from published medical books for more detailed information about Cholelithiasis.
Medical Books Excerpts
• Cholelithiasis and related disorders
• "Professional Guide to Diseases (Eighth Edition)" (2005)
• [ read ]
• Cholelithiasis, cholecystitis, and related disorders
• "Handbook of Diseases" (2003)
• [ read ]
• Cholelithiasis
• [ read ]
• Colic
• [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All
rights reserved.
Related videos for Cholelithiasis


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Patient Surveys for Cholelithiasis
• Patient Profile Survey
Take Survey View Results
• Survey about the symptoms of your Cholelithiasis
Take Survey View Results
Symptoms of Cholelithiasis: Online Medical Books
registration, for more information about the symptoms of Cholelithiasis.
Cholelithiasis and related disorders: Signs and symptoms

(Professional Guide to Diseases (Eighth Edition))
Although gallbladder disease may produce no symptoms, acute cholelithiasis, acute cholecystitis,
choledocholithiasis, and cholesterolosis produce the symptoms of a classic gallbladder attack.
Attacks usually follow meals rich in fats or may occur at night, suddenly awakening the patient.
They begin with acute abdominal pain in the right upper quadrant that may radiate to the back,
between the shoulders, or to the front of the chest; the pain may be so severe that the patient
seeks emergency department care. Other features may include recurring fat intolerance, biliary
colic, belching, flatulence, indigestion, diaphoresis, nausea, vomiting, chills, low-grade fever,
jaundice (if a stone obstructs the common bile duct), and clay-colored stools (with
choledocholithiasis).
Clinical features of cholangitis include a rise in eosinophils, jaundice, abdominal pain, high
fever, and chills; biliary cirrhosis may produce jaundice, related itching, weakness, fatigue, slight
weight loss, and abdominal pain. Gallstone ileus produces signs and symptoms of small-bowel
obstruction — nausea, vomiting, abdominal distention, and absent bowel sounds if the bowel is
completely obstructed. Its most telling symptom is intermittent recurrence of colicky pain over
several days.
Source: Professional Guide to Diseases (Eighth Edition), 2005
Cholelithiasis, cholecystitis, and related disorders: Signs and symptoms
Although gallbladder disease may produce no symptoms, acute cholelithiasis, acute cholecystitis,
choledocholithiasis, and cholesterolosis all produce the symptoms of a classic gallbladder attack.
Such attacks commonly follow meals rich in fats or may occur at night, suddenly awakening the
patient.
A gallbladder attack may begin with acute abdominal pain in the right upper quadrant that may
radiate to the back, between the shoulders, or to the front of the chest. The pain may be so severe
that the patient seeks emergency care.
Other signs and symptoms include recurring fat intolerance, biliary colic, belching, flatulence,
indigestion, diaphoresis, nausea, vomiting, chills, low-grade fever, jaundice (if a stone obstructs
the common bile duct), and clay-colored stool (with choledocholithiasis).
Signs and symptoms of cholangitis include a rise in eosinophils, jaundice, abdominal pain, high
fever, and chills. Biliary cirrhosis may produce jaundice, related itching, weakness, fatigue,
slight weight loss, and abdominal pain. Gallstone ileus produces signs and symptoms of small-
bowel obstruction —nausea, vomiting, abdominal distention, and absent bowel sounds if the
bowel is completely obstructed. Its most telling sign is intermittent recurrence of colicky pain
over several days.
Cholelithiasis: Cholelithiasis - signs & symptoms
(The 5-Minute Pediatric Consult)
• Silent gallstones present coincidentally in infancy and preschool-age children.
• Classic symptoms of right upper quadrant (RUQ) pain (Murphy sign) and vomiting exist
only in older children and adolescents.
• Younger children present with nonspecific symptoms, including obstructive jaundice.
• Fever is unusual in all age groups and often indicates the development of rare
complications in children:
○ Cholecystitis
○ Choledocholithiasis
○ Cholangitis
○ Gallbladder perforation:
 Pancreatitis develops in 8% of patients with gallstones and is the most
common complication.
 Pancreatitis is more common in obese adolescents who have undergone
rapid weight reduction, as reported in the adult population.
Source: The 5-Minute Pediatric Consult, 2008
Cholelithiasis as a Cause of Symptoms or Medical
Conditions
When considering symptoms of Cholelithiasis, it is also important to consider Cholelithiasis as a
possible cause of other medical conditions. The Disease Database lists the following medical
conditions that Cholelithiasis may cause:
• Abdominal mass
• Abdominal pain
• Alkaline phosphatase liver isoenzyme levels raised (plasma or serum)
• Bile duct stricture
• Cholestasis, extrahepatic
• Ileus
• Nausea and vomiting
• Pancreatitis, acute
• Peritonitis
• Shoulder pain
- (Source - Diseases Database)
Cholelithiasis as a symptom:
For a more detailed analysis of Cholelithiasis as a symptom, including causes, drug side effect
causes, and drug interaction causes, please see our Symptom Center information for
Cholelithiasis.
Medical articles and books on symptoms:
These general reference articles may be of interest in relation to medical signs and symptoms of
disease in general:
• Research Alternative Diagnoses for Cholelithiasis
• More about Cholelithiasis
• Online Diagnosis
• Self Diagnosis Pitfalls
• Pitfalls of Online Diagnosis
• Symptoms of the Silent Killer Diseases
• Lesser known silent killer diseases
• Books on signs and symptoms
Full list of premium articles on symptoms and diagnosis
About signs and symptoms of Cholelithiasis:
The symptom information on this page attempts to provide a list of some possible signs and
symptoms of Cholelithiasis. This signs and symptoms information for Cholelithiasis has been
gathered from various sources, may not be fully accurate, and may not be the full list of
Cholelithiasis signs or Cholelithiasis symptoms. Furthermore, signs and symptoms of
Cholelithiasis may vary on an individual basis for each patient. Only your doctor can provide
adequate diagnosis of any signs or symptoms and whether they are indeed Cholelithiasis
symptoms.
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registration, for more information about diagnostis of Cholelithiasis.
Cholelithiasis and related disorders: Diagnosis

(Professional Guide to Diseases (Eighth Edition))
Echography and X-rays detect gallstones. Other tests may include the following:
❑ Abdominal computed tomography scan or ultrasound reflects stones in the gallbladder.
❑ Percutaneous transhepatic cholangiography, done under fluoroscopic control, distinguishes
between gallbladder or bile duct disease and cancer of the pancreatic head in patients with
jaundice.
❑ Endoscopic retrograde cholangiopancreatography visualizes the biliary tree after insertion of
an endoscope down the esophagus into the duodenum, cannulation of the common bile and
pancreatic ducts, and injection of contrast medium.
❑ HIDA scan of the gallbladder detects obstruction of the cystic duct.
❑ Oral cholecystography shows stones in the gallbladder and biliary duct obstruction.
An elevated icteric index and total bilirubin, urine bilirubin, and alkaline phosphatase levels
support the diagnosis. The white blood cell count is slightly elevated during a cholecystitis
attack. Differential diagnosis is essential because gallbladder disease can mimic other diseases
(myocardial infarction, angina, pancreatitis, pancreatic head cancer, pneumonia, peptic ulcer,
hiatal hernia, esophagitis, and gastritis). Serum amylase levels distinguish gallbladder disease
from pancreatitis. With suspected heart disease, serial cardiac enzyme tests and
electrocardiography should precede gallbladder and upper GI diagnostic tests.
Source: Professional Guide to Diseases (Eighth Edition), 2005
Cholelithiasis, cholecystitis, and related disorders: Diagnosis
Ultrasonography and X-rays detect gallstones. Specific procedures include the following:
❑ Ultrasonography reflects stones in the gallbladder with 96% accuracy.
❑ Percutaneous transhepatic cholangiography allows imaging under fluoroscopic control to help
distinguish between gallbladder or bile duct disease and cancer of the pancreatic head in patients
with jaundice.
❑ Endoscopic retrograde cholangiopancreatography visualizes the biliary tree after insertion of
an endoscope down the esophagus into the duodenum, cannulation of the common bile and
pancreatic ducts, and injection of contrast medium.
❑ Hepatobiliary iminodiacetic acid analogue scan of the gallbladder helps detect obstruction of
the cystic duct.
❑ Computed tomography scan, although not routinely used, helps distinguish between
obstructive and nonobstructive jaundice.
❑ Plain abdominal X-rays identify calcified but not cholesterol stones with 15% accuracy.
❑ Oral cholecystography shows stones in the gallbladder and biliary duct obstruction.
Elevated icteric index and elevated total bilirubin, urine bilirubin, and alkaline phosphatase
levels support the diagnosis. White blood cell count is slightly elevated during a cholecystitis
attack.
Differential diagnosis is essential because gallbladder disease can mimic other diseases
(myocardial infarction, angina, pancreatitis, pancreatic head cancer, pneumonia, peptic ulcer,
hiatal hernia, esophagitis, and gastritis). Serum amylase levels help distinguish gallbladder
disease from pancreatitis. With suspected heart disease, cardiac enzyme testsand an
electrocardiogram should precede gallbladder and upper GI diagnostic tests.
Stress Reduction


The list of medical symptoms mentioned in various sources for Cholelithiasis may include:
• Cholangitis
• Or pancreatitis
Symptoms of Cholelithiasis »
Note that Cholelithiasis symptoms usually refers to various medical symptoms known to a
patient, but the phrase Cholelithiasis signs may often refer to those signs that are only noticable
by a doctor.
More Symptoms of Cholelithiasis:
More detailed symptom information may be found on the symptoms of Cholelithiasis article. In
addition to the above medical information, to get a full picture of the possible signs or symptoms
of this condition and also possibly the signs and symptoms of its related medical conditions, it
may be necessary to examine symptoms that may be caused by:
• Complications of Cholelithiasis
• Hidden causes of Cholelithiasis
• Associated conditions for Cholelithiasis
• Risk factors for Cholelithiasis
• Related symptoms
Medical articles on signs and symptoms:
These general reference articles may be related to medical signs and symptoms of disease in
general:
• Books on signs and symptoms
• Books on medical diagnosis
• Symptoms of the Silent Killer Diseases
• Symptoms and Medical Malpractice
What are the signs of Cholelithiasis?
The phrase "signs of Cholelithiasis" should, strictly speaking, refer only to those signs and
symptoms of Cholelithiasis that are not readily apparent to the patient. The word "symptoms of
Cholelithiasis" is the more general meaning; see symptoms of Cholelithiasis.
The signs and symptom information on this page attempts to provide a list of some possible signs
and symptoms of Cholelithiasis. This medical information about signs and symptoms for
Cholelithiasis has been gathered from various sources, may not be fully accurate, and may not be
the full list of Cholelithiasis signs or Cholelithiasis symptoms. Furthermore, signs and symptoms
of Cholelithiasis may vary on an individual basis for each patient. Only your doctor can provide
adequate diagnosis of any signs or symptoms and whether they are indeed Cholelithiasis
symptoms.
Complications list for Cholelithiasis:
The list of complications that have been mentioned in various sources for Cholelithiasis includes:
Complications and sequelae of Cholelithiasis from the Diseases Database include:
• Abdominal pain
• Ileus
• Bile duct stricture
• Peritonitis
• Shoulder pain
• Nausea and vomiting
• Alkaline phosphatase liver isoenzyme levels raised (plasma or serum)
• Pancreatitis, acute
• Cholestasis, extrahepatic
• Abdominal mass
Source: Diseases Database

See also the symptoms of Cholelithiasis and Cholelithiasis: Introduction.
Cholelithiasis Symptoms: Book Excerpts
• Signs and symptoms - Cholelithiasis and related disorders
• Cholelithiasis - signs & symptoms - Cholelithiasis
Cholelithiasis as a symptom:
For a more detailed analysis of Cholelithiasis as a symptom, including causes, drug side effect
causes, and drug interaction causes, please see our Symptom Center information for
Cholelithiasis.
About complications:
Complications of Cholelithiasis are secondary conditions, symptoms, or other disorders that are
caused by Cholelithiasis. In many cases the distinction between symptoms of Cholelithiasis and
complications of Cholelithiasis is unclear or arbitrary.

List of Risk Factors For Gallstones

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List of Risk Factors For Gallstones

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List of Risk Factors for Gallstones

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Cholelithiasis is the presence of one or more calculi (gallstones) in the

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Cholecystitis is inflammation of the gallbladder, usually resulting from a

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Source: Diseases Database

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