What Are Gallstones?

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Gallstones, also called cholelithiasis, are hardened deposits that form within the gallbladder. The gallbladder is a small organ located beneath the liver that stores bile, a fluid produced by the liver that helps digest fats.

 

Gallstones vary greatly in size and number. Most gallstones cause no symptoms and do not require treatment.

 

Problems usually develop when a gallstone moves from the gallbladder and temporarily or persistently blocks one of the bile ducts. Sometimes tumors can mimick their symptoms. 

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Types of Gallstones

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Cholesterol Stones

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Cholesterol stones are the most common type of gallstone in the United States. They develop when the composition of bile favors crystallization of cholesterol.

Factors that increase the likelihood of cholesterol stones include:

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• Increasing age

• Female sex

• Pregnancy

• Family history of gallstones

• Overweight or obesity

• Rapid weight loss (increased cholesterol into bile and reduced emptying)

• Bariatric surgery

• Diabetes or metabolic syndrome

• Certain medications

• Conditions that interfere with normal gallbladder emptying

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Pigment Stones

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Pigment stones contain increased amounts of bilirubin.

 

They are more likely to occur in people with conditions that increase bilirubin production or alter the biliary system, including:

• Chronic hemolytic disorders, in which red blood cells are broken down excessively

• Certain liver diseases

• Biliary tract infections

• Some disorders affecting the bile ducts

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What Are the Symptoms?

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Biliary Colic — A "Gallbladder Attack" = Symptoms commonly occur when a gallstone temporarily blocks the cystic duct, preventing the gallbladder from emptying normally.

 

The pain typically:

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• Occurs in the right upper abdomen or upper middle abdomen

• Becomes steady and can be severe

• May travel to the right shoulder or back

• Often begins after eating, particularly after a large or fatty meal

• May be accompanied by nausea or vomiting

• Usually lasts from approximately 30 minutes to several hours

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Complications of Gallstones

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Acute Cholecystitis

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Acute cholecystitis is inflammation of the gallbladder, usually caused when a gallstone becomes persistently lodged in the cystic duct.

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Unlike uncomplicated biliary colic, the pain typically does not resolve after several hours.

 

Symptoms may include:

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• Persistent right upper abdominal pain

• Significant tenderness over the gallbladder

• Fever

• Nausea or vomiting

• Elevated white blood cell count

 

Treatment commonly requires hospitalization, pain control, IV fluids when necessary, and surgical removal of the gallbladder.

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Acute Cholangitis

 

If a blocked bile duct becomes infected, it turns into this potentially life-threatening condition.

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Choledocholithiasis

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Choledocholithiasis means that a gallstone has entered the common bile duct, which carries bile from the liver and gallbladder toward the small intestine.

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• Upper abdominal pain

• Jaundice

• Dark urine

• Pale or clay-colored stools

• Elevated bilirubin and liver enzymes

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Gallstone Pancreatitis

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The common bile duct and pancreatic duct empty near one another in the small intestine. A gallstone that becomes lodged near this opening can interfere with pancreatic drainage and cause acute pancreatitis.

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• Severe upper abdominal pain

• Pain extending into the back

• Nausea and vomiting

• Significant abdominal tenderness

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How Are Gallstones Diagnosed?

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-Your healthcare provider will consider your symptoms, medical history, physical examination, laboratory testing, and imaging.

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-Abdominal ultrasound

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-Blood Tests

• Complete blood count (CBC)

• Bilirubin

• Alkaline phosphatase

• AST and ALT

• Lipase

• Other metabolic testing

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-HIDA Scan - evaluates the movement of bile through the liver, gallbladder, and bile ducts. It may be particularly useful when acute cholecystitis is suspected but ultrasound does not provide a definite answer.

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-Magnetic resonance cholangiopancreatography (MRCP) - a specialized MRI technique that provides detailed images of the bile ducts.

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-Endoscopic retrograde cholangiopancreatography (ERCP) uses an endoscope passed through the mouth into the small intestine to access the bile ducts.

Because ERCP is invasive, it is generally not used simply to look for ordinary gallbladder stones. It is particularly useful when a common bile duct stone needs to be removed.

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How Are Gallstones Treated?

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Gallstones Without Symptoms - no treatment generally required

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Symptomatic Gallstones - typically laparoscopic surgical removal of the gallbladder. May be performed outpatient for uncomplicated cases. Avoid eating large or fatty meals, which cause the gallbladder to contract and provoke symptoms.

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Can You Live Without a Gallbladder?

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Yes. The liver continues producing bile after the gallbladder is removed. Instead of being stored in the gallbladder and released after meals, bile flows more continuously from the liver into the small intestine. Most people can eat normally and live normally without a gallbladder. 

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Can Gallstones Be Dissolved With Medication?

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In some instances circumstances, medications like ursodiol, can be used to very gradually dissolve certain small cholesterol stones.

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Can Diet Prevent Gallbladder Attacks?

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Eating a large or fatty meal causes the gallbladder to contract, which may provoke symptoms in someone who already has symptomatic gallstones.