Gallstones: Pain With Fever or Jaundice

Key takeaways

Most people with gallstones have no symptoms at all, and those silent stones need no treatment. Seeing stones on an ultrasound report does not mean surgery is required.
But when the pain comes with a FEVER — even a slight one — with shivering, or with yellow skin and eyes, the level of urgency changes completely: that points towards infection or a blocked bile duct, and means going now.
The typical attack: in the upper right of the abdomen or the upper middle, lasting from half an hour to several hours, usually after a fatty meal and often in the evening or during the night, and it may spread through to the back or under the right shoulder blade.
There is no way to dissolve gallstones at home. The “stone-dissolving” and “stone-flushing” products sold online take away exactly the time during which a complication is developing.
The pain stopping does not mean it is over: an attack eases when the stone shifts, not when the stones are gone. Once you have had one attack another is very likely, so you still need to be seen.

Two things first. One: most gallstones cause no symptoms and need no treatment. Two: when an attack of pain comes with a fever, with shivering or with yellow skin, the level of urgency changes completely, and you must go now.

Recognising an attack of gallstone pain

A stone sitting quietly in the gallbladder causes no pain. Pain appears when a stone blocks the bile duct: pain in the upper right of the abdomen, or in the upper middle just below the breastbone, lasting at least half an hour and sometimes several hours. The attack usually arrives AFTER a meal — most often a fatty one — usually in the evening or during the night, and it may spread through to the back or under the right shoulder blade.

Nausea and vomiting often come with it.
The attack usually eases by itself when the stone shifts and the bile duct opens again — the pain easing does not prove the stone has passed.
Once you have had one attack, another is very likely; treat the first one as advance notice.
How bad the pain is says nothing about how dangerous things are. What changes the danger is a fever, jaundice, and a bile duct that stays blocked.
If you already know you have stones and this attack is lasting longer than all the previous ones, be seen — do not wait for it to ease by itself as before.

Silent stones, and why they still need watching

According to NIDDK, most people with gallstones have no symptoms; stones that do not block a bile duct do not affect how the gallbladder, liver and pancreas work, so they need no treatment. But the same material adds something: many people have no symptoms at all until a complication has already developed.

What it is easily mistaken for

Kidney or ureteric stones: pain coming in waves in the flank, then spreading down to the groin, and the urine may be pink.
Acute pancreatitis: CONTINUOUS pain above the navel boring through to the back, easier when sitting bent forward — and gallstones are one of the leading causes of acute pancreatitis.
Stomach pain and reflux: also related to meals, but rarely spreading up to the shoulder.
Appendicitis: pain starting around the navel, then settling into the lower right abdomen and steadily increasing.

What to do straight away

Write down the TIME the pain started, where it is, whether it spreads to the back or the right shoulder blade, and what the most recent meal was.
Take the temperature, note the time you took it, and take it again after each attack. A slight fever counts; do not wait for a high one.
Go into natural light and look at the whites of the eyes and the skin for yellowing; watch for dark tea-coloured urine and pale stools — those three together point towards a blocked bile duct.
During an attack, do not eat anything more, especially nothing fatty.
Gather the old abdominal ultrasound report, any liver blood test results, and a list of current medicines — including contraceptives and hormone treatment.
Do not drive yourself while in pain or just after taking a painkiller.

What must NOT be done

Do NOT trust “stone-dissolving” or “stone-flushing” products sold online: there is no way to dissolve gallstones at home, and even the stone-dissolving medicines a doctor prescribes are measured in years.
Do NOT take a painkiller and sleep through the night when the pain comes with a fever or with jaundice. The medicine masks the sensation of pain but cannot open a bile duct that is blocked.
Do NOT use antibiotics left over in the house or belonging to someone else. According to the US CDC, do not take antibiotics prescribed for someone else and do not save antibiotics for later.
Do NOT apply heat, warming plasters, coin-rubbing or cupping to the right upper abdomen.
Do NOT fast or force rapid weight loss to “flush the stones out”. According to NIDDK, losing weight too quickly raises the chance of forming stones, and in someone with silent stones it also makes symptoms more likely to appear.
Do NOT cancel the appointment just because the attack of pain has passed.

When you must go to hospital

GO TO EMERGENCY CARE or call 115 (the emergency number in Vietnam) NOW if you are in, or have just come through, an attack of pain and ANY of these is present: pain that does not ease and goes on and on; A FEVER — even a slight one — or shivering; continuous vomiting, unable to keep fluids down; yellow skin or yellow whites of the eyes; dark tea-coloured urine together with pale stools; severe pain boring through to the back that only eases when sitting bent forward; a rigid abdomen that nobody may touch; confusion, lethargy, cold clammy skin, a fast heartbeat. According to NIDDK, these signs may be a sign of infection or severe inflammation in the gallbladder, liver or pancreas, and a blocked bile duct that is not dealt with can lead to death. Keep your threshold for waiting far lower if the patient is elderly, pregnant, has diabetes or liver disease, or is taking medicines that suppress the immune system. — BE SEEN THE SAME DAY, do not wait until tomorrow, if the pain has eased but this is the first time, or this attack lasted longer than every previous one. — BE SEEN WITHIN THE NEXT ONE TO THREE DAYS if an ultrasound found stones by chance and you have never had an attack of pain.

Gallstones with a complication are hospital work: diagnosis needs an abdominal ultrasound and blood tests. Y Te Xanh helps with two other things: listening to you describe the attack over a video call so the two of you can decide whether to go now, and sending a doctor to the house to take the history, examine the patient, and order tests at home if more information is needed.

But not every test belongs at home: anything that must be run immediately, or that needs specialised equipment, gives more reliable results when the sample is taken at a medical facility. If any sign in the box above is present, go in first and call afterwards. After gallbladder surgery, a nurse comes to the house or the hotel to change dressings, remove stitches and monitor the wound.

The clinical content above follows publicly available material from NIDDK (the US National Institute of Diabetes and Digestive and Kidney Diseases), because CDC has no public guidance page for gallstones. What is cited from the US CDC is just two things: the risk from obesity, and not taking somebody else's antibiotics.

This article passes on the recommendations of public health authorities and does not replace being examined. Citing CDC here does not imply that CDC endorses Y Te Xanh or our services.

Need personalised advice for your loved one? Call our hotline 094 368 81 15 (24/7) — calling to ask a question or to book costs nothing. GreenCare has doctors who come to examine, nurses who carry out doctor's orders (injections, infusions, dressing changes), remote consultation by video call, and a review of the medicines you are taking; an in-depth remote consultation, or any one after the first, is a paid service. For children we take examination and acute care only — not long-term care at home, and not newborns or expectant mothers. We confirm we have staff in your area and provide transparent pricing before we begin.

Sources

NIDDK — Gallstones
CDC — Antibiotic Prescribing and Use

Frequently asked questions

If I have gallstones, do I have to have surgery?

Not everyone does. According to NIDDK, stones that cause no symptoms are silent gallstones and need no treatment; of the people diagnosed with gallstones, around a quarter need treatment, usually surgery. The deciding question is not “are there stones” but “have the stones caused symptoms or a complication yet”. People who have already had an attack of pain are usually operated on soon after the stones are found; if you have never had an attack, the doctor will explain exactly how you should be monitored.

How is gallstone pain different from stomach pain?

Both are related to meals, which is why they are so often confused. The most notable differences are where the pain travels and how long an attack lasts: gallstone pain is usually in the upper right of the abdomen or the upper middle, lasts from half an hour to several hours and then eases, and may spread through to the back or under the right shoulder blade; stomach pain rarely spreads up to the shoulder. But nobody tells them apart reliably by how it feels — it takes an examination and an ultrasound. And if there is a fever or jaundice as well, stop trying to tell them apart and go now.

What should I eat to dissolve gallstones?

No food dissolves gallstones. Diet helps in two other places: during an attack, avoid fatty meals, because that kind of meal is what often sets an attack off; and over the longer term, according to NIDDK, a diet high in calories and refined carbohydrates and low in fibre is one of the factors that makes stones more likely to form. A specific menu is a question for a doctor or a dietitian, particularly if you have other conditions. What must be avoided is switching to fasting or rapid weight loss — that raises the chance of forming stones.

The pain has gone — do I still need to be seen?

You do. An attack eases by itself when the stone shifts and the bile duct opens again, not when the stones are gone — according to NIDDK, if a bile duct stays blocked for more than a few hours it can lead to complications, and once you have had one attack another is very likely. Be seen so you know where the stones are and whether the liver and pancreas have been affected, and then decide what to do with your doctor. If the pain comes back with a fever or jaundice, go now rather than waiting for the appointment.

Who is more likely to get gallstones?

According to the US CDC, obesity raises the risk of gallbladder disease and gallstones. NIDDK names several further groups as more likely: women, especially during pregnancy or when using contraceptives and hormone therapy; older adults; people with a relative who has had gallstones; people with cirrhosis, conditions that break down a lot of red blood cells, or bowel conditions affecting absorption; people with high triglycerides, metabolic syndrome, diabetes or insulin resistance; and people who have just lost weight very rapidly, including after weight-loss surgery. Being in any of those groups does not mean you have stones — it is simply a reason to be seen sooner when an attack of pain happens.

What should I know if I am about to have weight-loss surgery or start a very low calorie diet?

This is a situation NIDDK addresses specifically. When you go without eating for a long period or lose weight quickly, the liver puts extra cholesterol into the bile and the gallbladder empties less well, so the chance of forming stones goes up; repeatedly losing and regaining weight does the same. NIDDK advises avoiding rapid weight-loss regimens and aiming instead for gradual loss that can be sustained. If you are about to have weight-loss surgery or start a very low calorie diet, tell your doctor beforehand so you can be advised on how to lower the risk of gallstones — that is a conversation to have in advance, not something to handle at home.