Intrahepatic biliary calculi (hepatolithiasis) are stones that form within the liver’s intrahepatic bile ducts. Most small or segmental stones are silent; symptoms appear when stones obstruct flow, provoke cholangitis, or lead to secondary biliary cirrhosis.

1. Right-upper-quadrant pain
   Dull or colicky ache under the ribs, often recurrent and triggered by fatty meals; may radiate to the back or right shoulder.
2. Cholangitis attacks
   Intermittent fever with chills, shaking rigors, and raised right-sided tenderness (Charcot triad) when stones block a segmental duct and become infected.
3. Jaundice
   Fluctuating yellowing of sclera and skin, dark urine, and pale stools occur as stones impact major intra-hepatic radicals or cause stricture.
4. Pruritus
   Intense itching accompanies fluctuating hyper-bilirubinaemia, even if jaundice is not overt.
5. Hepatomegaly & palpable mass
   Chronic obstruction produces lobar hypertrophy; the liver edge feels firm and nodular, sometimes with an audible bruit over dilated ducts.
6. Systemic features
   Low-grade fever, night sweats, fatigue and weight loss reflect recurrent infection and biliary cirrhosis.
7. Complication warnings
   Persistent high fever, hypotension, confusion (Reynold pentad) or upper-GI bleeding from portal hypertension signal acute suppurative cholangitis or advanced secondary cirrhosis.

Because findings overlap with gallbladder stones or tumours, any combination of recurrent RUQ pain, fluctuating jaundice and fever warrants imaging to map stones and strictures.