What are the symptoms of hepatobiliary stones?

Stones can appear in many parts of the body, the most common ones are liver stones and gallstones. If the size is too large, surgery is the best treatment method. If the size is small, some physical methods can be used to solve it. Therefore, understanding the symptoms of liver and gallstones and identifying the condition in its early stages when the child is still relatively young is very helpful for treatment. So, what are the symptoms of gallstones?

Clinical manifestations of liver stones

Its clinical manifestations are often very atypical. Specifically, they can be summarized as follows:

1. During the interval between the disease courses, there may be no symptoms or only mild upper abdominal discomfort.

2. In the acute stage, symptoms of acute suppurative cholangitis or varying degrees of Charcot triad may appear. Specifically, they are manifested in the following aspects:

1. Upper abdominal pain: It can be manifested as typical biliary colic or persistent distending pain. Some patients do not have obvious pain, but have severe chills and fever, which occur periodically. This periodic intermittent attack is a characteristic clinical manifestation of intrahepatic bile duct stones.

2. There may be a long history of biliary disease or acute cholangitis accompanied by chills, fever, and jaundice;

3. Frequent pain and discomfort in the affected liver area and lower chest, often radiating to the back and shoulders;

4. When one side of the hepatic duct is obstructed, there may be no jaundice or very mild jaundice;

5. When combined with severe cholangitis, the systemic condition is more serious and the recovery after acute attack is slower;

6. During the examination, there is obvious tenderness and percussion pain in the liver area, and the liver is asymmetrically enlarged and tender;

7. The general condition is significantly affected, 90% of patients have hypoproteinemia, and 1/3 of patients have obvious anemia;

8. In the late stage, there will be symptoms of liver and spleen enlargement and portal hypertension.

Clinical manifestations of gallstones

1. Gallstones

The symptoms depend on the size and location of the stone, as well as the presence or absence of blockage and inflammation. Some patients with gallstones remain asymptomatic throughout their lives, which are called hidden stones. Larger gallstones can cause indigestion symptoms such as distension and discomfort in the middle or right upper abdomen, belching, and aversion to greasy food. Smaller stones may block the gallbladder duct after a full meal, greasy food, or when lying down at night, causing biliary colic and acute cholecystitis. Due to the contraction of the gallbladder, smaller stones may enter the common bile duct through the cystic duct and cause obstructive jaundice. Some stones may then be discharged into the duodenum through the bile duct, while some stones may remain in the bile duct and become secondary bile duct stones. Stones can also obstruct the cystic duct for a long time without causing infection, resulting in only gallbladder hydrops. At this time, a swollen gallbladder without obvious tenderness can be felt. When there is no infection, gallstones generally cause no special symptoms or only mild tenderness in the right upper abdomen. However, when there is an acute infection, tenderness and muscle tension in the middle and right upper abdomen may occur, and sometimes an enlarged and tender gallbladder can be felt.

2. Hepatobiliary stones

Hepatolithiasis refers to the formation of stones in the intrahepatic bile duct system, so it is also called intrahepatic bile duct stones. It often coexists with extrahepatic bile duct stones, but there are also simple intrahepatic bile duct stones, also known as true intrahepatic stones. In recent years, there have been more and more cases of intrahepatic bile duct stones, and most of the stones are classified as bilirubin stones. Hepatobiliary stones are mostly yellow-green lumpy or "mud-like" stones, mostly bilirubin calcium. Ascaris eggs can often be found in the center of the stones, so some people believe that hepatobiliary stones are caused by bile duct obstruction caused by ascaris and bacterial infection in the biliary tract.

Hepatobiliary stones are mostly found in the left lobe hepatic duct. The bile duct at the confluence of the upper and lower segments of the left external lobe of the liver is slightly enlarged, and stones mostly stay there. Hepatobiliary stones on the right side are mostly found in the bile duct of the right posterior lobe.

Clinical features are often manifested as:

(1) The patients are younger than those with gallstones, and some of them have congenital abnormalities of the intrahepatic bile duct. Patients often have a history of recurrent abdominal pain, chills, fever, and jaundice since childhood.

(2) Liver function is impaired, but gallbladder function may be normal. During the recurrent attack period, various liver function abnormalities may occur, and alkaline phosphatase may increase during the intermittent period. Long-term illness may lead to atrophy of liver lobe segments and liver fibrosis.

(3) Abdominal pain, jaundice, and fever are the main symptoms, but typical severe colic rarely occurs.

(4) Complications are numerous and severe. The more common ones include suppurative intrahepatic cholangitis, liver abscess, and bile duct bleeding.

(5) Cholecystography can show dilatation of the intrahepatic bile duct without dilatation of the extrahepatic bile duct, and small translucencies in the hepatic duct.