Many gallstones are “silent,” i.e., present in asymptomatic pts. Symptoms occur when stones trigger inflammation or cause obstruction of the cystic or common bile ducts (CBDs). Major symptoms: (1) biliary colic—a severe steady ache in the RUQ or epigastrium that begins suddenly; often occurs 30-90 min after meals, lasts for several hours, and occasionally radiates to the right scapula or back; (2) nausea, vomiting. Physical examination may be normal or show epigastric or RUQ tenderness.