You wake at 1 a.m. with a deep, steady ache under your right ribs after a rich dinner. It hurts to breathe in. You feel a bit sick, and nothing you do settles it. Is this just indigestion-or the start of a gallstone problem? Here’s how to tell, what to do tonight, and what to ask your GP in Australia this week.
TL;DR: Is your tummy-ache likely gallstones?
Short on time? Start here.
- Pain location and feel: Gallstone pain (biliary colic) usually sits in the upper right or upper middle belly, feels deep and steady (not crampy), and can spread to the right shoulder blade or back. It often follows a fatty meal and builds over 15-60 minutes.
- Duration: Typical attacks last 30 minutes to 3 hours, then settle. If pain lasts beyond 6 hours or you develop fever or jaundice (yellow eyes), that’s not a simple attack-seek urgent care.
- Clues it’s gallbladder, not stomach: Pain isn’t eased by burping, antacids, or passing gas; it can worsen when you take a deep breath. Nausea is common. Bowel movements don’t change it.
- First-line test: A right upper quadrant ultrasound is the best starting test; your GP can order this in Australia. Bloods may show liver enzyme changes if a stone has moved.
- What to do now: If symptoms fit and you’re otherwise well, use simple pain relief you can safely take, avoid high-fat foods, and book a GP visit within 24-48 hours. Red flags (fever, jaundice, severe ongoing pain, repeated vomiting, pregnancy with severe pain, age >60 with diabetes) need urgent care today.
Step-by-step: Self-checks, the right tests, and when to seek help
Use this simple flow to make sense of that belly pain and plan your next move.
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Map the pain
- Point with one finger: Is it under your right ribs or the upper middle (just below the breastbone)? That’s classic gallbladder territory. Right lower belly is more appendix; left upper is less likely gallbladder.
- Does it spread to your right shoulder blade or the middle of your back? That spread supports gallstones.
- Deep breath test: Take a slow, deep breath. If it sharply worsens right under the ribs and you wince or stop breathing in, that’s a “Murphy-like” sign-often seen in gallbladder problems.
- Clock it: Note the time it started. Biliary colic builds, plateaus, then fades. If you’re still in strong pain at hour 6, escalate care.
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Scan for triggers and context
- Meals: Did it start 30-120 minutes after a rich, fried, or creamy meal? That’s a telltale trigger.
- Life stage and meds: Pregnancy, recent weight loss (especially rapid), oestrogen-containing contraception or therapy, and some weight-loss injections (GLP-1 type) can tilt the odds toward gallstones.
- Risk profile: Age over 40, female sex, higher body weight, diabetes, family history, and certain ethnic backgrounds (including some Aboriginal and Torres Strait Islander communities) carry higher risk.
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Check for danger signs
- Fever, shivers, or feeling very unwell
- Yellow eyes/skin (jaundice), dark urine, pale stools, or unexplained itch
- Pain that won’t let up for 6+ hours
- Repeated vomiting, dehydration, or severe pain that’s worse lying flat and radiates straight through to the back (think pancreas)
- Special cases needing a lower threshold for urgent care: pregnancy, older age, diabetes, immune problems
If any of these are present, don’t wait it out-use urgent care or emergency services.
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Try safe symptom relief (if you’re otherwise well)
- Use simple pain relief you tolerate (e.g., paracetamol; an anti-inflammatory if you can take it and your doctor has said it’s safe). Avoid codeine-based products if possible-they can tighten the bile ducts and worsen pain for some people.
- Small sips of water; avoid alcohol and very fatty foods. A gentle heat pack may help.
- Avoid “self-tests” like chugging olive oil or apple juice cleanses-no evidence they help, and they can trigger a bad attack.
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Book the right tests
- Ultrasound is the first choice: It’s quick, safe, and picks up most gallstones and bile duct dilation. In Australia, your GP can refer you; many scans are bulk-billed.
- Blood tests: Liver enzymes (ALT, AST), cholestatic markers (ALP, GGT), and bilirubin can hint at a stone in the duct. Amylase/lipase helps spot pancreatitis.
- If the ultrasound is unclear but your story screams gallbladder, your GP may repeat the scan, arrange a HIDA scan (cholescintigraphy), or consider MRCP to look at the bile ducts. These choices follow RACGP and NICE recommendations.
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Plan the fix
- For recurring symptomatic stones, laparoscopic gallbladder removal is the standard cure recommended by major guidelines (NICE 2023, ACG 2021). Many people go home same-day.
- If surgery isn’t an option, some may try ursodeoxycholic acid to dissolve small cholesterol stones, but recurrence is common and it’s slow-best discussed with your specialist.
- Diet can lower the chance of attacks (lean proteins, more fibre, less saturated fat) but won’t remove stones.
What not to do: Don’t ignore fever or jaundice, don’t fast for long if you’re diabetic, don’t self-start old antibiotics, and don’t push through severe pain because it “might pass.”
Australia-specific tip: Your GP is the first stop for ultrasound and bloods. If you’re very uncomfortable tonight but stable, after-hours GP clinics and urgent care centres can assess and organise imaging. Go straight to emergency if red flags are present.
What it feels like (and what it isn’t): examples, checklists, and a quick decision guide
Stories are easier to recognise than lists. See which one matches you.
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Classic biliary colic (gallstones): After fish and chips, a dull, rising ache under the right ribs builds over 30-45 minutes, peaks, and holds steady for an hour or two. You pace, feel nauseous, and can’t get comfy. Breathing in hurts under the right ribs. Then it fades, leaving you tired but okay.
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Acute cholecystitis (inflamed gallbladder): Like biliary colic, but the pain doesn’t let up and you feel feverish or shivery. Pressing under the right ribs is sharp, and you guard the area. This needs urgent assessment.
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Stone in the common bile duct (choledocholithiasis/cholangitis): Pain similar to biliary colic, plus jaundice (yellow eyes), dark urine, sometimes fever. When infection sets in (cholangitis), you feel very unwell. This is an emergency.
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Gallstone pancreatitis: Severe upper belly pain straight through to the back, worse lying flat, often with vomiting. You feel wiped out and can’t get comfortable. Go to emergency.
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Not gallstones-common lookalikes:
- Reflux/ulcer: Burning in the upper middle belly, sour taste, better with antacids; doesn’t usually spread to the right shoulder blade.
- Kidney stone: Flank pain that comes and goes in waves, can shoot to the groin; often urinary symptoms.
- Appendicitis: Starts vague around the belly button, then drops to the right lower belly with tenderness and fever.
- Heart issue (especially in older adults or people with risk factors): Upper belly or chest pressure with breathlessness, sweating, or arm/jaw pain. Don’t ignore this-get urgent care.
- Stomach bug: Crampy pain with diarrhoea and vomiting, often in family clusters; tends to improve over 24-72 hours.
Checklist: Does this sound like gallstones? Tick the boxes that fit right now:
- Upper right or upper middle belly pain that’s steady (not waves)
- Starts 30-120 minutes after a rich or fatty meal
- Radiates to the right shoulder blade or back
- Worse when taking a deep breath
- Nausea without much bloating or burping relief
- Lasts 30 minutes to 3 hours, then eases off
- Previous, similar night-time attacks
If you checked 4 or more, your story fits gallstones symptoms pretty well-book an ultrasound via your GP. Any red flag lifts this from “maybe” to “assess now.”
Quick decision guide (plain language):
- If you have fever, jaundice, relentless pain >6 hours, or you feel very unwell → go to urgent care/emergency.
- If the pain matches the checklist, eases within 3 hours, and you feel okay between attacks → see your GP within 24-48 hours for ultrasound and bloods.
- If your pain isn’t typical and you’re unsure → get checked; your GP can sort gallbladder from stomach, kidney, or heart causes.
Special groups worth a separate note:
- Pregnancy: Gallbladder attacks are more common. Ultrasound is safe. Many cases are managed conservatively; surgery is often done in the second trimester if needed. Don’t sit on persistent pain or vomiting-get seen.
- Diabetes or older age: Seek earlier care. Infections can progress faster and feel “quieter.”
- Rapid weight loss: Crash diets and post-bariatric surgery weight loss raise stone risk; keep your team in the loop if pain starts.
- Aboriginal and Torres Strait Islander peoples: Some communities see more gallbladder disease-seek care early if symptoms fit.
Evidence notes: The patterns above match guidance from RACGP clinical reviews, NICE (UK) gallstone disease guideline (updated 2023), and the American College of Gastroenterology (2021). Ultrasound is the first-line test; HIDA is useful when ultrasound is equivocal for cholecystitis. Bloods help spot complications like bile duct stones or pancreatitis.
FAQ and next steps
Common follow-up questions people ask once gallstones are on the radar.
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Can gallstones cause bloating or diarrhoea? During attacks, nausea is common; some people get loose, pale, or greasy stools if bile flow is blocked. If your stools are persistently pale or greasy, see your GP-this can signal a duct problem.
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Will stones show on CT? Often not. CT can miss cholesterol stones. Ultrasound is better for the gallbladder. MRCP is excellent for bile ducts when needed.
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Can I “pass” a gallstone? Stones don’t pass from the gallbladder into the gut on their own; they can slip into the common bile duct. A small stone may pass into the bowel, causing brief jaundice or pancreatitis on the way. That’s why even small stones aren’t “safe.”
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Are smaller stones safer? No. Smaller stones are actually more likely to migrate into the duct and irritate the pancreas. This is one reason guidelines often recommend surgery after clear symptomatic attacks.
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Do I need surgery after one attack? Many people who have one attack will have another within months. NICE and ACG suggest offering laparoscopic cholecystectomy for symptomatic gallstones to prevent complications, especially if attacks are severe or recurrent. Your surgeon will weigh your risks and preferences.
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Is there a diet that “dissolves” stones? No proven diet dissolves stones. A lighter, lower-fat plan may reduce attacks while you’re waiting for surgery. Steady weight loss beats crash diets.
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Do home “gallbladder cleanses” work? No credible evidence, and they can trigger severe pain or pancreatitis. Major guidelines advise against them.
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Could this be heart-related instead? Upper abdominal pain can be cardiac-especially in older adults or those with risk factors. If pain comes with breathlessness, sweating, or spreads to the jaw/arm, get urgent help.
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What if my ultrasound is normal but the pain matches? Two options: repeat imaging during or soon after an attack, or consider a HIDA scan to check gallbladder function. Your GP may also look for other causes (ulcer, reflux, pancreas).
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What if I’ve had my gallbladder removed and get similar pain? Rarely, a stone remains in the duct, or the sphincter muscle at the duct opening can spasm. Get checked-bloods and imaging can sort it out.
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Are GLP-1 weight-loss injections a problem? These medicines are linked with a small increase in gallbladder events, especially with rapid weight loss. Don’t stop on your own-raise symptoms with your prescriber.
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Can kids get gallstones? It’s uncommon but happens, especially with certain blood conditions or obesity. Paediatric assessment is important.
Next steps and troubleshooting by scenario
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It fits biliary colic and I’m okay now: Book your GP within 24-48 hours. Ask for an abdominal ultrasound (gallbladder and bile ducts) and bloods (LFTs, bilirubin, lipase). Keep meals low in saturated fat until you have a plan.
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It’s my first attack and it was brutal: Still see your GP promptly. Strong early attacks tend to recur, and early surgical referral can save repeat ER visits.
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Pregnant and in pain: Don’t wait. Get assessed. Ultrasound is safe; hydration and pain control are key. If attacks recur, surgeons may operate in the second trimester when safer.
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Diabetic or immunosuppressed: Lower your threshold for urgent care. Infections are more serious and may look subtle.
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On holiday or far from home: Prioritise an urgent-care assessment for persistent or severe pain. Keep notes on timing, triggers, and any fever/jaundice to speed triage.
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Ultrasound negative, pain classic: Ask about repeat ultrasound during symptoms, a HIDA scan, or MRCP if labs suggest duct involvement. Consider reflux/ulcer testing if the pattern doesn’t fully fit.
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Waiting for surgery: Stick with modest-fat meals, avoid known triggers, and keep rescue pain relief on hand as advised by your doctor. Sudden fever or jaundice while waiting means urgent reassessment.
How sure can you be at home? You can’t diagnose conclusively without imaging, but the pattern is powerful. A steady, right-upper-quadrant ache after fatty food that lasts up to a few hours and recurs at night is very suggestive. The moment fever, jaundice, or unrelenting pain enters the picture, the conversation changes from “maybe gallstones” to “must be checked now.”
Credibility snapshot (no links): This guide reflects patterns and recommendations from the Royal Australian College of General Practitioners, NICE (UK) Gallstone Disease guideline (latest update 2023), the American College of Gastroenterology guideline on gallstone disease (2021), and standard emergency care pathways used across Australia. The Australian Institute of Health and Welfare reports gallbladder and biliary disease as a common reason for hospitalisation; most people do well with timely imaging and, when needed, laparoscopic surgery.