These symptoms frequently are not cured by cholecystectomy. The best definition of biliary colic is pain that is relatively severe in the epigastrium or right upper quadrant that lasts 1-5 hours, often awakening the patient at night with radiation to shoulder or back. Only if the distended gallbladder touched the peritoneum did the patient experience right upper quadrant pain. Associated symptoms of nausea, vomiting, or referred pain were present in distention of the CBD but not of the gallbladder. Once the peritoneum is irritated, pain localizes into the right upper quadrant.
Small stones are more likely to be symptomatic than large stones.
Vital signs and physical examination findings in cholelithiasis are completely normal. Fever, tachycardia, and hypotension should alert the physician to more serious infections, including cholangitis and cholecystitis. Abdominal pain and right upper quadrant pain may indicate that gallstones have become symptomatic and further evaluation is necessary. Alcohol use Alcoholism severe enough to cause cirrhosis may increase risk of pigmented stones. Moderate use of alcohol may decrease risk of cholesterol stones.