Cholelithiasis (Gallstones)

Overview

Cholelithiasis is the medical term for gallstones, which are hard deposits that form inside the gallbladder. The gallbladder is a small pear-shaped organ under the liver that stores bile, a fluid that helps digest fats. When the chemicals in bile fall out of balance, they can crystallize and clump together into stones that range from tiny grains to several centimeters across.

Many gallstones cause no problems and are found by chance. They become a concern when a stone moves and blocks a bile duct, causing a sudden, intense pain called biliary colic or leading to inflammation and infection. Most cholesterol-rich stones can be managed effectively, and surgery to remove the gallbladder is a common and generally safe solution.

Symptoms

Stones that stay quietly in the gallbladder are often called silent and cause no symptoms. When a stone blocks the flow of bile, symptoms can come on suddenly.

• Sudden, intense pain in the upper-right or center of the abdomen
• Pain that spreads to the right shoulder blade or back
• Nausea and vomiting
• Pain that often follows fatty meals and can last minutes to hours
• Bloating, belching, or indigestion in some people

Warning signs of a complication such as infection or duct blockage include fever and chills, yellowing of the skin or eyes (jaundice), dark urine, and pain lasting more than a few hours. These need urgent care.

Causes

Gallstones form when substances in bile become too concentrated and harden.

• Cholesterol stones: The most common type, forming when bile contains more cholesterol than it can dissolve.
• Pigment stones: Dark stones that form when bile has too much bilirubin, often linked to certain blood disorders, liver disease, or biliary infections.

An incompletely emptying gallbladder also lets bile sit and concentrate, encouraging stones to grow.

Risk Factors

• Being female, especially during the reproductive years and with pregnancy
• Being older (risk rises with age)
• Excess body weight or rapid weight loss
• A diet high in fat and cholesterol and low in fiber
• Diabetes and certain blood disorders
• A family history of gallstones
• Some medications, including certain hormone therapies

Diagnosis

Doctors diagnose gallstones using symptoms and imaging.

• Abdominal ultrasound: The main test, which reliably shows stones in the gallbladder.
• Blood tests: Check for signs of infection, inflammation, or blocked bile flow affecting the liver and pancreas.
• CT scan or MRCP: Detailed imaging used when a stone is suspected in the bile ducts or to look for complications.
• HIDA scan: Assesses how well the gallbladder empties.

Treatment

Silent gallstones often need no treatment beyond watching for symptoms. When stones cause pain or complications, treatment is usually advised.

• Gallbladder removal (cholecystectomy): The standard treatment for symptomatic stones, most often done with small keyhole (laparoscopic) incisions. People can digest normally without a gallbladder.
• Endoscopic removal: A procedure called ERCP can remove stones stuck in the common bile duct.
• Medications: Bile acid pills can slowly dissolve some cholesterol stones but are used only in select cases and stones may return.

Treating complications such as gallbladder inflammation or infection may require antibiotics and prompt surgery.

Prevention

• Maintain a steady, healthy weight and avoid crash diets or rapid weight loss
• Eat regular meals and include fiber, fruits, and vegetables
• Limit refined carbohydrates and unhealthy fats
• Stay physically active
• Manage diabetes and cholesterol with your care team

When to See a Doctor

See a doctor if you have repeated bouts of upper-abdominal pain after meals. Seek emergency care right away if you have:

• Abdominal pain lasting more than a few hours
• Fever and chills with abdominal pain (possible infection)
• Yellowing of the skin or eyes (jaundice)
• Dark urine and pale stools

These can signal a blocked duct, gallbladder infection, or inflammation of the pancreas, which need urgent treatment.

Related Topics

Frequently Asked Questions

References

1. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Gallstones.
2. Mayo Clinic. Gallstones — Symptoms and causes.
3. MedlinePlus, U.S. National Library of Medicine. Gallstones.
4. American College of Surgeons. Cholecystectomy.