Pediatric Gallstones (Cholelithiasis) Clinical Presentation

Updated: Mar 30, 2021
  • Author: Melissa Kennedy, MD; Chief Editor: Carmen Cuffari, MD  more...
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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.