What Is It?

Gallstones are rocklike nuisances that can form inside the gallbladder. The gallbladder is a pouch that collects bile as it flows from the liver to the intestine through the bile ducts. Bile is a fluid that is made, in part, to help with digestion. The salts in bile make it easier for you to digest fats. However, bile also contains some waste products including cholesterol and bilirubin (created when old red blood cells are destroyed). Gallstones form in the gallbladder when cholesterol or bilirubin particles begin to cluster together into a solid lump. The stone grows in size as the bile fluid washes over it, much like a pearl can form inside an oyster.

Most of the time, gallstones do not cause any symptoms or problems. Small gallstones can leave the gallbladder and pass out of the body through the intestines. However, gallstones can cause symptoms if they become caught in the narrow outlet of the gallbladder. After meals (especially meals high in fat), a muscle in the wall of the gallbladder squeezes to help empty bile into the intestines. If this muscle squeezes against a gallstone, or if a gallstone blocks the draining fluid, the gallbladder can ache with a strong, steady pain. More serious problems can develop if a gallstone gets into the drainage-duct system but does not make it all the way through to the intestines. In this case, the stone can cause a buildup of bile as well as infection in the gallbladder or liver or inflammation of the nearby pancreas.

Gallstones are very common. They occur in one out of five women by age 60, and they are half as common in men. Gallstones occur more commonly in older people and in people who are overweight or who lose weight suddenly. They also occur more frequently in women who have been exposed to higher amounts of the hormone estrogen over their lifetime by having multiple pregnancies, by taking birth-control pills, or by taking hormone replacement after menopause.

Eighty percent of people with gallstones have no symptoms and do not require treatment. When gallstones do cause symptoms, you might experience:

• Abdominal pain, usually high in the abdomen and more often on the right side — Pain from gallstones is usually a steady pain that lasts between 15 minutes and several hours each time it occurs.
• Sensitivity to high fat meals — Fats trigger the gallbladder to contract and can worsen your pain.
• Belching, gas, nausea or a general decrease in appetite.

Occasionally, gallstones cause more serious complications including pancreatitis or infections in the gallbladder or bile ducts. If this occurs, you may experience jaundice (a yellow color of the skin or whites of the eyes), fever or more severe abdominal pain.

Most gallstones do not show up on regular X-rays, but they are seen easily with an ultrasound. Gallstones are very common, but don’t cause symptoms in most people. Even if you are found to have gallstones on an ultrasound or computed tomography (CT) scan, it may be difficult for your doctor to know if the stones are causing symptoms. If your symptoms are typical for gallstones, though, your doctor probably will recommend treatment.

If a stone is blocking drainage of bile, an ultrasound might show widened bile ducts. Your doctor may also order blood tests to evaluate injury to the liver and pancreas.

Smaller gallstones sometimes float out of the gallbladder on their own and are eliminated from the body through the intestines. Gallstone attacks also can calm down on their own if the bothersome stones shift position within the gallbladder. However, the majority of people whose gallstones cause symptoms will require surgery to cure the problem and will continue to have symptoms until the gallbladder is removed. Even when gallstone attacks subside on their own, the symptoms will return within a year 50 percent of the time.

You are less likely to form gallstones if you avoid becoming overweight. If you are already overweight, try to avoid diets that cause you to lose weight very quickly, such as those providing fewer than 500 calories daily.

Certain medicines, such as birth-control pills and estrogen, can increase the likelihood of gallstones. Consider avoiding these medications if you already have other risk factors for gallstones. Groups at high risk for gallstones include American Indians, Hispanics, people with sickle cell anemia and women who have had multiple pregnancies.

Gallstones only require treatment if they are causing symptoms.

Nearly 90 percent of patients who want treatment for their gallstones undergo a type of surgery called laparoscopic cholecystectomy. In this procedure, a surgeon uses a small light and camera placed through a small incision into your abdomen. The camera, called a laparoscope, allows the surgeon to see what he or she is doing during the operation by watching a video screen. Using small instruments that are placed through other small incisions, the surgeon is able to remove fluid and stones from the gallbladder to deflate it. The gallbladder then can be removed and pulled out through one of the same small holes. People recover very quickly from laparoscopic surgery because the surgical wounds are very small.

Some patients have their gallbladder removed through a larger incision in a type of surgery called open cholecystectomy. In this surgery, a larger diagonal incision is made above the gallbladder and the surgeon removes the gallbladder using a direct view instead of a camera. This is a more practical surgery for people who have significant abdominal scarring from prior surgery or have a higher risk of complications during the surgery. For some patients who are very obese, an open cholecystectomy is technically easier. It is also important to know that in about 5 percent of cases, a surgeon may start a laparoscopic procedure, but choose to convert to an open cholecystectomy for technical reasons.

For stones that are caught in the common bile duct, an additional treatment might be required. Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure performed by a gastroenterology specialist or surgeon to view the opening of the bile duct where it empties into the intestine. Using miniature instruments attached to a camera at the end of flexible tube that is inserted into the intestine through the mouth, the gastroenterologist can tug a stone out of the bile duct, or can widen the lower part of the duct so that the stones can pass out into the intestine on their own.

For people who cannot tolerate surgery, an oral medication known as ursodeoxycholic acid (Actigall) may be used to help dissolve stones. This treatment usually requires at least six months before results are seen and is only effective in about half of patients. Once the medication is stopped, gallstones are likely to return in most patients. Two other ways to break up gallstones are to use shockwaves (lithotripsy) or to dissolve the stones with solvents injected directly into the gallbladder with a needle. However, surgery is the preferred treatment because stones are likely to form again if the gallbladder is not removed.

If you know that you have gallstones contact your doctor if you develop:

• An unexplained fever
• Severe or persistent pain in the right side of the abdomen, mid-abdomen or back
• Persistent vomiting
• Yellowing of your skin or eyes (jaundice)

Surgical treatment for gallstones is highly effective. In most patients symptoms go away completely and stay away. The gallbladder is not a necessary organ and most people do not notice any digestive changes after it is removed. In a few cases, abdominal pain or diarrhea develops after the gallbladder is removed, and additional treatment or changes in the diet are needed.

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.