Biliary tract diseases encompass a spectrum of disorders affecting the gallbladder, cystic duct, and extra- or intra-hepatic bile ducts. Symptoms arise from obstruction, inflammation, infection, or neoplastic change, and often overlap among entities such as cholelithiasis, cholecystitis, cholangitis, and cholangiocarcinoma. Recognition of characteristic patterns guides timely imaging and intervention.
- Biliary colic
Paroxysmal, post-prandial pain located in the epigastrium or right upper quadrant, radiating to the inter-scapular region or right shoulder, peaking over ≥30 min and resolving spontaneously within 6 h. - Nausea and vomiting
Vagal stimulation and gastric compression produce repeated retching that may transiently relieve pain. - Fluctuating or progressive jaundice
Conjugated hyper-bilirubinaemia manifests as scleral icterus, dark urine, and clay-coloured stools; levels oscillate with stone impaction or steadily rise with malignant stricture. - Fever and rigors
High spiking temperature with chills signals bacterial infection (cholecystitis, cholangitis) or central tumour necrosis. - Tender hepatomegaly and Murphy sign
A smooth, hot liver edge that arrests inspiration on palpation indicates acute cholecystitis; diffuse tenderness accompanies acute cholangitis. - Pruritus
Cutaneous deposition of bile salts produces intense itching, often preceding visible jaundice. - Systemic features
Fatigue, early satiety, and unintentional weight loss suggest chronic cholestasis or malignancy. - Acute complications
Persistent hypotension, confusion, or unrelenting pain heralds septic shock (Reynolds pentad), acute pancreatitis, or perforation.
| Symptom / Sign | Typical Presentation |
|---|---|
| Biliary colic | Post-prandial RUQ/epigastric pain ≥30 min |
| Nausea/vomiting | Repeated, may relieve pain |
| Jaundice | Fluctuating (stones) or progressive (tumour) |
| Fever/rigors | High spiking, chills |
| Tender hepatomegaly | Hot edge, positive Murphy sign |
| Pruritus | Intense, precedes icterus |
| Systemic | Fatigue, weight loss, early satiety |
| Alarm signs | Hypotension, confusion, unrelenting pain |