Gallstones Causing Jaundice: Mechanism, Types, and Clinical Presentation

Gallstones cause jaundice when a stone obstructs the common bile duct (choledocholithiasis), blocking bilirubin excretion.

Pathophysiology

Bile (bilirubin, cholesterol, bile salts) flows: liver → hepatic ducts → common hepatic duct → cystic duct (gallbladder) → common bile duct → duodenum. Obstruction → conjugated bilirubin backs up into blood → yellow skin/sclera, dark urine, pale stools, pruritus.

Gallstone Types

• Cholesterol Stones (80%): Supersaturation of cholesterol in bile + nucleation + gallbladder stasis.
• Pigment Stones (20%): Black (hemolysis, cirrhosis) or brown (biliary infection/stasis) – calcium bilirubinate.

Risk Factors (5 F's + More)

Female, Forty, Fertile, Fair, Fat; rapid weight loss, TPN, Crohn's disease, ileal resection, certain drugs (ceftriaxone, octreotide).

Clinical Presentation

• Biliary colic: RUQ pain postprandial, 30 min–hours.
• Acute cholecystitis: Persistent pain + fever, Murphy's sign.
• Cholangitis: Charcot's triad (pain, fever, jaundice) → Reynolds' pentad (+ hypotension, altered mental status).
• Gallstone pancreatitis: Epigastric pain radiating to back.

Diagnosis & Treatment

• Ultrasound (stones, duct dilation), LFTs (↑ ALP, GGT, bilirubin).
• ERCP for stone extraction ± cholecystectomy.