Biliary pain is the most common symptom of gallstone disease. Patients typically describe acute, severe pain in the upper-right or upper-mid region of the abdomen, often radiating to the right shoulder or between the shoulder blades. Biliary pain may last for minutes to hours and may occur after eating or be constant (Mayo Clinic 2017; Shaffer 2018; Zakko 2018; Tanaja 2018; Fogel 2016).
Biliary pain that lasts longer than 24 hours points to the possibility of complications of gallstone disease. Certain symptom patterns can help predict the location of the stone and which complication is likely (Fogel 2016):
- Symptoms of acute cholecystitis include nausea, fever, and intense tenderness in the upper-right abdomen (Zakko 2018; Shaffer 2018).
- Symptoms of acute cholangitis, an infection of the bile duct, often include a classic group of signs and symptoms known as Charcot's triad—persistent abdominal pain, fever, and jaundice (Rumsey 2017; Zimmer 2015).
- Symptoms of acute pancreatitis due to gallstone obstruction of the pancreatic duct include pain in the upper-middle abdomen that may radiate to the mid-back. Gallstone pancreatitis may be accompanied by peritonitis (Shaffer 2018), a painful and potentially life-threatening condition in which the lining of the inner abdominal wall becomes inflamed (Mayo Clinic 2015; Banks 2010; Hazem 2009).
Chronic cholecystitis causes tenderness and a dull pain in the upper right abdomen that radiates to the middle of the back. It can also cause digestive symptoms such as gas, bloating, nausea, and occasional vomiting. These symptoms are usually worse after eating fatty foods and often occur in the evening. People with chronic cholecystitis sometimes have acute flare-ups of intense biliary pain (Jones, Ferguson 2018).