The clinical features of gallstones depend on where these have lodged and upon which organ or tube is obstructed.
These can lead to obstruction of the cystic duct with the development of biliary colic. This leads to constant pain in the right upper quadrant of the abdomen lasting for several hours. If the gallbladder becomes inflamed (acute cholecystitis) there is pain that can last for several days before resolution of the inflammation. With superadded bacterial infection the gallbladder may become a bag of pus (empyema). If the gallbladder bursts peritonitis may develop (this is less common). Sometimes after the gallbladder is inflamed it remains blocked and accumulates mucus leading to a mucocoele.
The migration of gallstones from the gallbladder into the bile duct can lead to obstructive jaundice. This is a surgical emergency as an obstructed system may become infected (cholangitis) with fatal consequences. In the event of a stone blocking the common bile duct a procedure called an ERCP (endoscopic retrograde cholangio-pancreatography) may be necessary for stone extraction. See page on ERCP.
Occasionally a stone may migrate through the lower end of the common bile duct and into the duodenum. The passage of a stone through this area can trigger an attack of acute pancreatitis. Most gallstone pancreatitis will settle spontaneously but in a small proportion of patients the attack will be fatal on the first occasion.