Choledocholithiasis denotes the presence of calculi within the extra- or intrahepatic bile ducts. Symptoms arise when a stone obstructs flow, triggers inflammation, or provokes infection. The presentation ranges from silent imaging findings to life-threatening sepsis.

1. Biliary colic
   Epigastric or right-upper-quadrant pain begins 30–60 min post-prandially, peaks for ≥30 min, and radiates to the inter-scapular region or right shoulder. Movement does not relieve the discomfort, and analgesics are often required.
2. Nausea and vomiting
   Gastric stasis and vagal reflexes produce repeated retching that may transiently lessen pain.
3. Fluctuating jaundice
   Intermittent elevation of conjugated bilirubin produces scleral icterus, dark urine, and clay-coloured stools that wax and wane as stones impact or disimpact.
4. Cholangitis
   Complete obstruction plus bacterial contamination yields Charcot triad: spiking fever with rigors, constant RUQ pain, and deepening jaundice. Suppurative forms add hypotension and mental confusion (Reynolds pentad), indicating pus under pressure.
5. Acute pancreatitis
   Impaction at the ampulla obstructs both bile and pancreatic flow, leading to epigastric pain radiating to the back, intractable vomiting, and elevated serum amylase/lipase.
6. Tender hepatomegaly
   The liver edge is smooth, hot and exquisitely tender; inspiratory arrest on palpation (Murphy sign) is frequent when concomitant acute cholecystitis is present.
7. Laboratory cholestasis
   Serum alkaline phosphatase and γ-glutamyl transferase rise early; total bilirubin climbs steadily as obstruction persists.