Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Pediatric Gallstones (Cholelithiasis) Clinical Presentation

  • Author: Melissa Kennedy, MD; Chief Editor: Carmen Cuffari, MD  more...
 
Updated: Nov 19, 2015
 

History

Although approximately 80% of adults with gallstones were historically believed to be asymptomatic, retrospective studies have found that only 33-40% of children are asymptomatic.

In symptomatic patients, pain, primarily in the right upper quadrant, is the most common presenting symptom and may be accompanied by nausea and vomiting.[6]

Gallstones should be considered in the workup of nonspecific, intermittent abdominal pain in children with risk factors. Risk factors include chronic hemolysis, obesity, ileal disease, a family history of childhood gallstones, parity, and parenteral nutrition.

Cholelithiasis should be considered in any symptomatic child with sickle cell or other hemolytic disease. Also, consider cholelithiasis in children with jaundice and low-grade elevations of transaminases. Older children may be able to localize their pain to the RUQ.

Next

Physical Examination

Perform a complete physical examination in children. Include auscultation, visualization, and, lastly, palpation of the abdomen in the examination. Pain in the RUQ is common. A Murphy sign (expiratory arrest with palpation in the RUQ) is thought to be pathognomonic. Also, note hepatomegaly and splenomegaly, because they may be a clue to venous congestion or a hemolytic process that may be a predisposing factor for cholelithiasis.

Obesity should also be noted on physical examination, because this can be a risk factor for the development of cholesterol gallstones.

Previous
 
 
Contributor Information and Disclosures
Author

Melissa Kennedy, MD Attending Physician, Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia

Melissa Kennedy, MD is a member of the following medical societies: American Academy of Pediatrics, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.

Coauthor(s)

Joshua R Friedman, MD, PhD Adjunct Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania

Joshua R Friedman, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Study of Liver Diseases, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Received salary from Johnson & Johnson for employment.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

B UK Li, MD Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin; Attending Gastroenterologist, Director, Cyclic Vomiting Program, Children’s Hospital of Wisconsin

B UK Li, MD is a member of the following medical societies: Alpha Omega Alpha, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.

Chief Editor

Carmen Cuffari, MD Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Royal College of Physicians and Surgeons of Canada

Disclosure: Received honoraria from Prometheus Laboratories for speaking and teaching; Received honoraria from Abbott Nutritionals for speaking and teaching.

Additional Contributors

Jorge H Vargas, MD Professor of Pediatrics and Clinical Professor of Pediatric Gastroenterology, University of California, Los Angeles, David Geffen School of Medicine; Consulting Physician, Department of Pediatrics, University of California at Los Angeles Health System

Jorge H Vargas, MD is a member of the following medical societies: American Liver Foundation, Latin American Society of Pediatric Gastroenterology, Hepatology & Nutrition, American Society for Gastrointestinal Endoscopy, American Society for Parenteral and Enteral Nutrition, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Alexandre F Migala, DO, Hildegardo Costa, MD, and Richard D Warren, MD, to the development and writing of the source article.

References
  1. Bellows CF, Berger DH, Crass RA. Management of gallstones. Am Fam Physician. 2005 Aug 15. 72(4):637-42. [Medline].

  2. Bonnard A, Seguier-Lipszyc E, Liguory C, et al. Laparoscopic approach as primary treatment of common bile duct stones in children. J Pediatr Surg. 2005 Sep. 40(9):1459-63. [Medline].

  3. Stringer MD, Soloway RD, Taylor DR, Riyad K, Toogood G. Calcium carbonate gallstones in children. J Pediatr Surg. 2007 Oct. 42(10):1677-82. [Medline].

  4. Stringer MD, Taylor DR, Soloway RD. Gallstone composition: are children different?. J Pediatr. 2003 Apr. 142(4):435-40. [Medline].

  5. Koivusalo A, Pakarinen M, Gylling H, Nissinen MJ. Relation of cholesterol metabolism to pediatric gallstone disease: a retrospective controlled study. BMC Gastroenterol. 2015 Jun 30. 15:74. [Medline].

  6. Svensson J, Makin E. Gallstone disease in children. Semin Pediatr Surg. 2012 Aug. 21(3):255-65. [Medline].

  7. Bonfrate L, Wang DQ, Garruti G, Portincasa P. Obesity and the risk and prognosis of gallstone disease and pancreatitis. Best Pract Res Clin Gastroenterol. 2014 Aug. 28 (4):623-35. [Medline].

  8. Prince JS, Senac MO Jr. Ceftriaxone-associated nephrolithiasis and biliary pseudolithiasis in a child. Pediatr Radiol. 2003 Sep. 33(9):648-51. [Medline].

  9. Nakken KE, Labori KJ, Rodningen OK, et al. ABCB4 sequence variations in young adults with cholesterol gallstone disease. Liver Int. 2009 May. 29(5):743-7. [Medline].

  10. Wesdorp I, Bosman D, de Graaff A, Aronson D, van der Blij F, Taminiau J. Clinical presentations and predisposing factors of cholelithiasis and sludge in children. J Pediatr Gastroenterol Nutr. 2000 Oct. 31(4):411-7. [Medline].

  11. Mehta S, Lopez ME, Chumpitazi BP, Mazziotti MV, Brandt ML, Fishman DS. Clinical characteristics and risk factors for symptomatic pediatric gallbladder disease. Pediatrics. 2012 Jan. 129(1):e82-8. [Medline].

  12. Kaechele V, Wabitsch M, Thiere D, et al. Prevalence of gallbladder stone disease in obese children and adolescents: influence of the degree of obesity, sex, and pubertal development. J Pediatr Gastroenterol Nutr. 2006 Jan. 42(1):66-70. [Medline].

  13. Alonso MH. Gall bladder abnormalities in children with sickle cell disease: management with laparoscopic cholecystectomy. J Pediatr. 2004 Nov. 145(5):580-1. [Medline].

  14. Currò G, Meo A, Ippolito D, Pusiol A, Cucinotta E. Asymptomatic cholelithiasis in children with sickle cell disease: early or delayed cholecystectomy?. Ann Surg. 2007 Jan. 245(1):126-9. [Medline]. [Full Text].

  15. Dalton SJ, Balupuri S, Guest J. Routine magnetic resonance cholangiopancreatography and intra-operative cholangiogram in the evaluation of common bile duct stones. Ann R Coll Surg Engl. 2005 Nov. 87(6):469-70. [Medline]. [Full Text].

  16. Rocca R, Castellino F, Daperno M, et al. Therapeutic ERCP in paediatric patients. Dig Liver Dis. 2005 May. 37(5):357-62. [Medline].

  17. Vrochides DV, Sorrells DL Jr, Kurkchubasche AG, Wesselhoeft CW Jr, Tracy TF Jr, Luks FI. Is there a role for routine preoperative endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis in children?. Arch Surg. 2005 Apr. 140(4):359-61. [Medline].

  18. Al-Salem AH, Issa H. Laparoscopic cholecystectomy in children with sickle cell anemia and the role of ERCP. Surg Laparosc Endosc Percutan Tech. 2012 Apr. 22(2):139-42. [Medline].

  19. Della Corte C, Falchetti D, Nebbia G, et al. Management of cholelithiasis in Italian children: a national multicenter study. World J Gastroenterol. 2008 Mar 7. 14(9):1383-8. [Medline]. [Full Text].

  20. Siddiqui S, Newbrough S, Alterman D, Anderson A, Kennedy A Jr. Efficacy of laparoscopic cholecystectomy in the pediatric population. J Pediatr Surg. 2008 Jan. 43(1):109-13; discussion 113. [Medline].

  21. St Peter SD, Keckler SJ, Nair A, et al. Laparoscopic cholecystectomy in the pediatric population. J Laparoendosc Adv Surg Tech A. 2008 Feb. 18(1):127-30. [Medline].

  22. Kinney CK, Erickson HC. Modeling the client's world: a way to holistic care. Issues Ment Health Nurs. 1990. 11(2):93-108. [Medline].

  23. Tannuri AC, Leal AJ, Velhote MC, Gonlçalves ME, Tannuri U. Management of gallstone disease in children: a new protocol based on the experience of a single center. J Pediatr Surg. 2012 Nov. 47(11):2033-8. [Medline].

  24. Leitzmann MF, Giovannucci EL, Rimm EB, et al. The relation of physical activity to risk for symptomatic gallstone disease in men. Ann Intern Med. 1998 Mar 15. 128(6):417-25. [Medline].

  25. Leitzmann MF, Rimm EB, Willett WC, et al. Recreational physical activity and the risk of cholecystectomy in women. N Engl J Med. 1999 Sep 9. 341(11):777-84. [Medline].

 
Previous
Next
 
Transverse view of the gallbladder reveals multiple stones, without gallbladder wall thickening, edema, or surrounding fluid accumulation.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.