Gallstones

Overview

Gallstones are solid, pebble-like deposits that form inside the gallbladder, a small pouch under the liver that stores bile to help digest fat. They range in size from a grain of sand to a golf ball, and a person may have one large stone, many small ones, or a mix. Most gallstones are made mainly of cholesterol; others form from bile pigments.

Many people have gallstones and never know it, because the stones sit quietly and cause no symptoms. Problems begin when a stone blocks the flow of bile, for example by lodging in the neck of the gallbladder or a bile duct. This can trigger intense pain and, if not relieved, serious complications such as inflammation, infection, or jaundice. Symptomatic gallstones are one of the most common reasons for abdominal surgery.

Common Causes

Gallstones form when bile contains too much cholesterol or pigment, or when the gallbladder does not empty well, allowing deposits to crystallize and harden. Factors that increase the chance of forming gallstones include:

• High cholesterol in bile, the most common type of stone.
• Being female, with hormones such as estrogen playing a role; pregnancy and some birth control or hormone therapy add risk.
• Excess body weight or obesity.
• Rapid weight loss, including after bariatric surgery or crash diets.
• Older age and a family history of gallstones.
• Certain conditions, such as diabetes, cirrhosis, and some blood disorders that raise bile pigment.
• A diet high in fat and refined carbohydrates and low in fiber.

These factors raise the likelihood of stones forming but do not guarantee that they will cause symptoms.

Associated Symptoms

When gallstones cause trouble, the hallmark is a biliary attack, a sudden steady pain that often follows a fatty meal. Symptoms may include:

• Sudden, intense pain in the upper-right or upper-middle abdomen
• Pain spreading to the right shoulder or between the shoulder blades
• Nausea and vomiting
• Pain that lasts from minutes to a few hours
• Bloating, indigestion, or intolerance of fatty foods

Warning signs of a complication include fever and chills, yellowing of the skin or eyes (jaundice), dark urine, pale stools, and pain that lasts more than a few hours. These suggest a blocked duct, infection, or pancreatitis and need urgent care.

Diagnosis & Evaluation

Gallstones are often found during tests for abdominal pain or incidentally on a scan done for another reason. Evaluation may include:

• Abdominal ultrasound, the main test, which reliably shows stones in the gallbladder.
• Blood tests to check for infection, inflammation, liver function, and pancreas involvement.
• CT or MRI (including MRCP) to look at the bile ducts when a blockage is suspected.
• HIDA scan to assess how well the gallbladder is working.

Treatment & Management

Gallstones that cause no symptoms usually need no treatment and are simply monitored. When stones cause pain or complications, treatment options include:

• Gallbladder removal (cholecystectomy): The standard treatment for symptomatic gallstones, usually done with minimally invasive (laparoscopic) surgery. People live normally without a gallbladder.
• Procedures to remove ductal stones, such as ERCP, when a stone is stuck in a bile duct.
• Medication to dissolve cholesterol stones, used occasionally for people who cannot have surgery, though it is slow and stones may return.
• Pain control and treatment of infection during an acute attack.

Removing the gallbladder cures the problem because the source of the stones is gone, and most people recover quickly.

Self-Care & Prevention

• Aim for a steady, healthy weight and avoid crash dieting and rapid weight loss
• Eat a balanced diet rich in fiber, fruits, and vegetables, and limit refined carbohydrates and saturated fat
• Stay physically active
• Do not skip meals for long periods, which can affect gallbladder emptying

When to See a Doctor

See a doctor if you have repeated bouts of upper-right belly pain, especially after eating. Seek urgent or emergency care for:

• Severe abdominal pain that lasts more than a few hours
• Fever and chills with belly pain
• Yellowing of the skin or eyes (jaundice)
• Dark urine and pale stools
• Persistent vomiting

These can signal a blocked bile duct, gallbladder infection, or inflammation of the pancreas, which need prompt 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 Gastroenterology. Gallstones.