Gallstones (Cholelithiasis)

What Are Gallstones?

Gallstones are pieces of solid material that form in your gallbladder, a small organ under your liver. If you have them, you might hear your doctor say you have cholelithiasis.

Your gallbladder stores and releases bile, a fluid made in your liver, to help in digestion. Bile also carries wastes like cholesterol and bilirubin, which your body makes when it breaks down red blood cells. These things can form gallstones.

Gallstones can range from the size of a grain of sand to that of a golf ball. You might not know that you have them until they block a bile duct, causing pain that needs treatment right away.

Gallstone Types

The two main kinds of gallstones are:

  • Cholesterol stones. These are usually yellow-green. They're the most common, making up 80% of gallstones.
  • Pigment stones. These are smaller and darker. They're made of bilirubin..

Gallstones

Signs and Symptoms of Gallstones

Symptoms may include:

  • Pain in your upper belly, often on the right, just under your ribs
  • Pain in your right shoulder or back
  • An upset stomach
  • Vomiting
  • Other digestive problems, including indigestion, heartburn, and gas

See your doctor or go to the hospital if you have signs of a serious infection or inflammation:

Causes of Gallstones

Doctors aren’t sure exactly what causes gallstones, but they might happen when:

  • There’s too much cholesterol in your bile. Your body needs bile for digestion. It usually dissolves cholesterol. But when it can’t do that, the extra cholesterol might form stones.
  • There’s too much bilirubin in your bile. Conditions like cirrhosis, infections, and blood disorders can cause your liver to make too much bilirubin.
  • Your gallbladder doesn’t empty all the way. This can make your bile very concentrated.

Gallstone Risk Factors

You're more likely to get gallstones if you:

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Gallstone Diagnosis

Your doctor will do a physical exam and might order tests including:

Blood tests. These check for signs of infection or blockage, and rule out other conditions.

Ultrasound. This makes images of the inside of your body.

CT scan. Specialized X-rays let your doctor see inside your body, including your gallbladder.

Magnetic resonance cholangiopancreatography (MRCP). This test uses a magnetic field and pulses of radio wave energy to make pictures of the inside of your body, including your liver and gallbladder.

Cholescintigraphy (HIDA scan). This test can check whether your gallbladder squeezes correctly. Your doctor injects a harmless radioactive material that makes its way to the organ. A technician can then watch its movement.

Endoscopic retrograde cholangiopancreatography (ERCP). Your doctor runs a tube called an endoscope through your mouth down to your small intestine. They inject a dye so they can see your bile ducts on a camera in the endoscope. They can often take out any gallstones that have moved into the ducts.

Endoscopic ultrasound. This test combines ultrasound and endoscopy to look for gallstones.

Gallstone Treatment

You don’t need treatment if you don’t have any symptoms. Some small gallstones can pass through your body on their own.

Most people with gallstones have their gallbladders taken out. You can still digest food without it. Your doctor will use one of two procedures.

Laparoscopic cholecystectomy. This is the most common surgery for gallstones. Your doctor passes a narrow tube called a laparoscope into your belly through a small cut. It holds instruments, a light, and a camera. They take out your gallbladder through another small cut. You’ll usually go home the same day.

Open cholecystectomy. Your doctor makes bigger cuts in your belly to remove your gallbladder. You’ll stay in the hospital for a few days afterward.

If gallstones are in your bile ducts, your doctor may use ERCP to find and remove them before or during surgery.

If you have another medical condition and your doctor thinks you shouldn't have surgery, they might give you medication instead. Chenodiol (Chenodol) and ursodiol (Actigall, Urso 250, Urso Forte) dissolve cholesterol stones. They can cause mild diarrhea.

You may have to take the medicine for years to totally dissolve the stones, and they may come back after you stop taking it.

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Complications of Gallstones

Gallstones can cause serious problems, including:

  • Gallbladder inflammation (acute cholecystitis). This happens when a stone blocks your gallbladder so it can’t empty. It causes constant pain and fever. Your gallbladder might burst, or rupture, if you don’t get treatment right away.
  • Blocked bile ducts. This can cause fever, chills, and yellowing of your skin and eyes (jaundice). If a stone blocks the duct to your pancreas, that organ may become inflamed (pancreatitis).
  • Infected bile ducts (acute cholangitis). A blocked duct is more likely to get infected. If the bacteria spread to your bloodstream, they can cause a dangerous condition called sepsis.
  • Gallbladder cancer. It’s rare, but gallstones raise your risk of this kind of cancer.

Preventing Gallstones

Some lifestyle changes might lower your risk of gallstones.

  • Eat a healthy diet that's high in fiber and good fats, like fish oil and olive oil. Avoid refined carbs, sugar, and unhealthy fats.
  • Get regular exercise. Aim for at least 30 minutes, 5 days a week.
  • Avoid diets that make you lose a lot of weight in a short time.
  • If you’re a woman at high risk of gallstones (for example, because of your family history or another health condition), talk to your doctor about whether you should use hormonal birth control.

WebMD Medical Reference Reviewed by Minesh Khatri, MD on January 14, 2020

Sources

SOURCES:

National Digestive Diseases Information Clearinghouse.

American College of Surgeons.

UpToDate: “Patient education: Gallstones (Beyond the Basics).”

Mayo Clinic: “Gallstones.”

National Institute of Diabetes and Digestive and Kidney Diseases: “Gallstones.”

Harvard Health Publishing: “Gallstones: Symptoms, diagnosis and treatment.”

Cleveland Clinic: “Gallstones.”

Merck Manual Consumer Version: “Gallstones.”

NHS inform: “Gallstones.”

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