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 (RUQ), 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.

Physical Examination

Perform a complete physical examination in children. Include auscultation, visualization, and, lastly, palpation of the abdomen in the examination. Pain in the right upper quadrant (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 as it can be a risk factor for the development of cholesterol gallstones.

Differential Diagnoses

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Stringer MD, Soloway RD, Taylor DR, Riyad K, Toogood G. Calcium carbonate gallstones in children. J Pediatr Surg. 2007 Oct. 42(10):1677-82. [QxMD MEDLINE Link].
Stringer MD, Taylor DR, Soloway RD. Gallstone composition: are children different?. J Pediatr. 2003 Apr. 142(4):435-40. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Svensson J, Makin E. Gallstone disease in children. Semin Pediatr Surg. 2012 Aug. 21(3):255-65. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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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. [QxMD MEDLINE Link].
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Media Gallery

Pediatric Gallstones (Cholelithiasis). Transverse view of the gallbladder reveals multiple stones, without gallbladder wall thickening, edema, or surrounding fluid accumulation.

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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 Director and Head of Disease Biology, Janssen Research and Development

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. for: Abbott Nutritional, Abbvie, speakers' bureau.

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.

Sections Pediatric Gallstones (Cholelithiasis)
Overview
Presentation
DDx
Workup
Treatment
Medication
References

Pediatric Gallstones (Cholelithiasis) Clinical Presentation

History

Physical Examination

References

Tables

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