Biliary colic is felt in the right upper quadrant but epigastric and left abdominal pain are common, and some patients experience praecordial pain. The pain may radiate around the costal margin into the back or may be referred to the region of the scapula.
The pain is severe and steady. It usually begins abruptly and subsides gradually, lasting from a few minutes to several hours and often occurring postprandially. In a severe attack the patient may curl up in bed, changing position frequently in order to be more comfortable. There may be nausea and often a bout of vomiting signifies the end of an attack. The frequency of attacks is very variable ranging from almost continuous to many years apart.
There is no fever but the patient may be mildly tachycardic because of fright from the intensity of the pain.
Often, there is local tenderness due to gallbladder distension and this may preclude deep palpation.
An attack which does not settle within 24 hours more likely suggests acute cholecystitis.
Other symptoms associated with gallstone disease may be present, including intolerance of fatty foods, dyspepsia, and flatulence.
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