Definition & Facts for Gallstones

In this section:

• What are gallstones?
• Do gallstones have another name?
• What is the biliary tract?
• How common are gallstones?
• Who is more likely to develop gallstones?
• What are the complications of gallstones?

What are gallstones?

Gallstones are hard, pebble-like pieces of material, usually made of cholesterol or bilirubin, that form in your gallbladder. Gallstones can range in size from a grain of sand to a golf ball. The gallbladder can make one large gallstone, hundreds of tiny stones, or both small and large stones.

When gallstones block the bile ducts of your biliary tract, the gallstones can cause sudden pain in your upper right abdomen. This pain is called a gallbladder attack, or biliary colic. If your symptoms continue and they’re left untreated, gallstones can cause serious complications.

However, most gallstones don’t cause blockages and are painless, also called “silent” gallstones. Silent gallstones usually don’t need medical treatment.

Types of gallstones

The two main types of gallstones are

• cholesterol stones
• pigment stones

Cholesterol stones are usually yellow-green in color and are made of mostly hardened cholesterol. In some countries, cholesterol stones make up about 75 percent of gallstones.¹

Pigment stones are dark in color and are made of bilirubin. Some people have a mix of both kinds of stones.

Gallstones can range in size from a grain of sand to a golf ball.

Do gallstones have another name?

Cholelithiasis is the name doctors sometimes call gallstones.

What is the biliary tract?

Your biliary tract, which is made up of your gallbladder and bile ducts, helps with digestion by releasing bile.

The gallbladder is a small, pear-shaped organ that stores bile and is located in your upper right abdomen, below your liver.

The bile ducts of your biliary tract include the hepatic ducts, common bile duct, and cystic duct. Bile ducts also carry waste and digestive juices from the liver and pancreas to the duodenum.

Your liver produces bile, which is mostly made of cholesterol, bile salts, and bilirubin. Your gallbladder stores the bile until it’s needed. When you eat, your body signals your gallbladder to empty bile into your duodenum to mix with food. The bile ducts carry the bile from your gallbladder to the duodenum.

Your biliary tract, which is made up of your gallbladder and bile ducts, helps with digestion by releasing bile.

How common are gallstones?

Gallstones are very common, affecting 10 to 15 percent of the U.S. population, which is almost 25 million people. About a quarter of the nearly 1 million people diagnosed with gallstones each year will need to be treated, usually with surgery.²

Who is more likely to develop gallstones?

Certain groups of people have a higher risk of developing gallstones than others.³

• Women are more likely to develop gallstones than men. Women who have extra estrogen in their body due to pregnancy, hormone replacement therapy, or birth control pills may be more likely to produce gallstones.
• Older people are more likely to develop gallstones. As you age, the chance that you’ll develop gallstones becomes higher.
• People with a family history of gallstones have a higher risk.
• American Indians have genes that raise the amount of cholesterol in their bile, and have the highest rate of gallstones in the United States.
• Mexican Americans are also at higher risk of developing gallstones.

American Indians have genetic factors that make them more likely to develop gallstones.

People with certain health conditions

You are more likely to develop gallstones if you have one of the following health conditions:

• cirrhosis, a condition in which your liver slowly breaks down and stops working due to chronic, or long-lasting, injury
• infections in the bile ducts, which can also be a complication of gallstones
• hemolytic anemias, conditions in which red blood cells are continuously broken down, such as sickle cell anemia
• some intestinal diseases that affect normal absorption of nutrients, such as Crohn’s disease
• high triglyceride levels
• low HDL cholesterol
• metabolic syndrome, which can also raise the risk of gallstone complications
• diabetes and insulin resistance

People with diet- and weight-related health concerns

You are more likely to develop gallstones if you

• have obesity, especially if you are a woman
• have had fast weight loss, like from weight-loss surgery
• have been on a diet high in calories and refined carbohydrates and low in fiber

Learn more about dieting and gallstones.

What are the complications of gallstones?

Complications of gallstones can include

• inflammation of the gallbladder
• severe damage to or infection of the gallbladder, bile ducts, or liver
• gallstone pancreatitis, which is inflammation of the pancreas due to a gallstone blockage

Many people do not have symptoms of gallstones until they have complications.

If left untreated, gallstones can be deadly. Treatment for gallstones usually involves gallstone surgery.

References

Gallstones – NHS

Gallstones are small stones, usually made of cholesterol, that form in the gallbladder. In most cases, they do not cause any symptoms and do not need to be treated.

Symptoms of gallstones

Gallstones often have no symptoms.

But if a gallstone becomes trapped in an opening (duct) inside the gallbladder, it can trigger a sudden, intense pain in your tummy that usually lasts between 1 and 5 hours.

This type of abdominal pain is known as biliary colic.

Some people with gallstones can also develop complications, such as inflammation of the gallbladder (cholecystitis).

This can cause:

• persistent pain
• yellowing of the skin and eyes (jaundice)
• a high temperature

When gallstones cause symptoms or complications, it’s known as gallstone disease or cholelithiasis.

The gallbladder

The gallbladder is a small pouch-like organ found underneath the liver. Its main purpose is to store and concentrate bile.

Bile is a liquid produced by the liver to help digest fats. It’s passed from the liver into the gallbladder through a series of channels known as bile ducts.

The bile is stored in the gallbladder and, over time, becomes more concentrated, which makes it better at digesting fats.

The gallbladder releases bile into the digestive system when it’s needed.

Causes of gallstones

Gallstones are thought to develop because of an imbalance in the chemical make-up of bile inside the gallbladder.

In most cases the levels of cholesterol in bile become too high and the excess cholesterol forms into stones.

Gallstones are very common. It’s estimated more than 1 in every 10 adults in the UK has gallstones, although only a minority of people develop symptoms.

You’re more at risk of developing gallstones if you’re:

• overweight or obese
• female (particularly if you have had children)
• 40 or over (the risk increases as you get older)

Treating gallstones

Treatment is usually only necessary if gallstones are causing:

• symptoms, such as tummy pain
• complications, such as jaundice or acute pancreatitis

In these cases, keyhole surgery to remove the gallbladder may be recommended.  

This procedure, known as a laparoscopic cholecystectomy, is relatively simple to perform and has a low risk of complications.

It’s possible to lead a normal life without a gallbladder.

Your liver will still produce bile to digest food, but the bile will drip continuously into the small intestine, rather than build up in the gallbladder.

Outlook

Gallstone disease is usually easily treated with surgery. 

Very severe cases can be life threatening, particularly in people who are already in poor health.

But deaths from gallstone disease are rare in the UK.

Video: gallstones

In this video, a doctor explains what gallstones are, the symptoms and the treatment options.

Media last reviewed: 1 May 2021
Media review due: 1 May 2024

Community content from HealthUnlocked

Page last reviewed: 19 November 2021
Next review due: 19 November 2024

Is it possible to dissolve stones in the gallbladder and how to do it correctly?

There is now a significant increase in interest in the dissolution of gallstones. According to scientific studies, the indications for the treatment of gallstone disease without surgery using the dissolution of stones are rather limited, and there are also a large number of contraindications. To find out the medical view of what are the possibilities for dissolving gallstones, we recommend that you read this article.

General information

Gallstone disease (GSD) – a disease accompanied by the formation of stones (calculi) in the gallbladder and biliary tract, with a hereditary predisposition, according to statistics, occurs in 10-15% of the population. It can proceed both asymptomatically and with an abundance of various complaints and complications. In recent years, the number of cases of gallstone disease among younger people has increased, however, this disease is more common in women.

The possibility of dissolution of gallstones is influenced by many factors – their variety and composition, size, location, as well as the absence or presence of exacerbations of cholelithiasis and other factors. Let’s look at everything in order.

Types of stones in the gallbladder and bile ducts

Depending on the composition and method of formation, there are two main types of gallbladder stones – cholesterol and pigment.

Cholesterol stones

Cholesterol stones form predominantly in the gallbladder and consist mainly of cholesterol, the proportion of which usually exceeds 60%. In addition to cholesterol, they may contain protein compounds (mucins), bilirubin compounds with calcium and calcium salts, as well as small amounts of other substances. “Pure” 100% cholesterol stones make up approximately 10-15% of all cholesterol stones. Stones containing less than 60% cholesterol are called mixed.

One of the main reasons for the formation of cholesterol stones is an increased saturation of bile with cholesterol, in addition, the formation of such stones can contribute to a delay in the emptying of the gallbladder.

Pigment stones

Pigment stones account for 10-25% of all gallstones in patients in European countries, but among the population of Asian countries, their incidence is much higher. Like cholesterol, pigment stones are more common in women. They are usually small, fragile, black or dark brown in color and are formed mainly on the basis of bilirubin compounds.

Black pigment stones consist of a black polymer formed from bilirubin and calcium, as well as other compounds of calcium, copper and a large number of complex proteins (mucins). These stones do not contain cholesterol and do not have a distinct crystal structure.

Black pigment stones are more common in patients with cirrhosis of the liver, in chronic hemolytic conditions (hereditary spherocytic or sickle cell anemia in patients with vascular prostheses, artificial heart valves, etc.). Their formation is facilitated by a supersaturation of bile with indirect, water-insoluble bilirubin and a change in the acidity of bile (pH).

Brown pigment stones consist mainly of calcium salts of indirect bilirubin with the inclusion of varying amounts of cholesterol and proteins.

The formation of brown pigment stones is associated with the presence of infection (cholecystitis, ascending cholangitis), and microscopic examination reveals the structural elements of bacteria in them. Such stones are formed already in the bile ducts under the action of enzymes produced by bacteria.

Pigment stones can form both in the gallbladder and in the ducts, and in the ducts they are detected more often than stones of other composition. In recent decades, there has been a decrease in the frequency of detection of pigment stones, which many researchers attribute to a decrease in the incidence of infectious and inflammatory diseases of the biliary tract.

Which gallstones can be dissolved and with what?

Now let’s look at the situations in which drug dissolution of stones is possible. To dissolve stones, preparations of ursodeoxycholic and chenodosoxyzolic acids are used. Preference is given to the former due to its higher efficiency and lower frequency of side effects.

Can be dissolved :

1. Radiolucent (not distinguishable on radiographs) cholesterol stones with preserved contractile activity of the gallbladder.
2. Radiopositive (lighter on radiographs) stones less than 88 HU on CT scan.
3. Solitary cholesterol stones, no larger than 10 mm.
4. Multiple small cholesterol stones, 5 mm or less, not exceeding 50% of the total gallbladder volume.

What will help you succeed?

Remember that the decision on the possibility of dissolution of stones in the cavity of the gallbladder is made only by a specialist. A gastroenterologist and surgeon can help make an informed decision to assess the possibility of such medical treatment and evaluate all the associated risks.

All attempts at dissolution, which are made without a doctor’s recommendation, may result in the removal of the gallbladder on an emergency basis – along with this, the risks of complications during and after the operation increase.

It is also important to know that the volume of the operation during an emergency operation often expands and may no longer require video laparoscopic intervention from a mini-access, but the traditional removal of the gallbladder using large incisions of the anterior abdominal wall, which is accompanied by significant trauma and more frequent postoperative complications – hernias, infections, etc.

Instrumental examinations for the diagnosis of cholelithiasis

When a doctor decides to prescribe drugs to dissolve stones, it is of great importance to analyze the patient’s complaints, medical history data and the results of examination and instrumental examinations.

The leading position in the diagnosis of cholelithiasis is rightfully occupied by ultrasound using modern ultrasonic devices . The sensitivity and specificity of high-resolution ultrasonography for the detection of gallstones exceed 95%. It is possible to identify stones up to 2 mm in diameter.

In time, ultrasound determines the size of the gallbladder, the degree of thickening of its wall, reveals kinks and constrictions of the bladder, intracavitary structures – stones, polyps, gallstones, etc. It is possible to conduct stress tests to study the functional activity (contractility) of the gallbladder.

Using ultrasound, it is possible to determine the expansion of intra- and extrahepatic ducts, the presence of stones in them (in 50-60% of cases). If an ultrasound scan reveals an expansion of the common bile duct (more than 6-7 mm), the probability of the presence of stones in the common bile duct reaches 75%. It is also important to assess the condition of the pancreas and liver.

It should be noted that the information content of ultrasound is significantly reduced in the presence of a large amount of gas in the intestine and severe obesity.

In order to clarify the density characteristics of stones , to assess the signs of their calcification, if necessary, it is possible to conduct an X-ray survey, computed and magnetic resonance imaging of the abdominal organs.

Other research methods – endoultrasound, magnetic resonance cholangiography are performed strictly according to the indications and doctor’s prescription.

When should gallstones not be dissolved?

1. In case of previous biliary colic.

   How does biliary colic manifest itself?

   These are sudden onset and usually recurring attacks of intense pain. Such attacks can be provoked by the use of sweets, smoked, fried foods or alcohol, physical activity, taking certain medications (antibiotics, NSAIDs).

   Colic is characterized by the following pattern:

   • The attack occurs suddenly, can last for hours, less often – more than 24 hours.
   • Pain is acute, intense, paroxysmal, usually localized in the right hypochondrium, epigastric region, projection of the lower third of the sternum.
   • Pain may radiate to the back, jaw, neck or interscapular space.
   • An attack may be accompanied by:
   • nausea,
   • vomiting without relief
   • infrequently – an increase in body temperature.

   It is important to remember that an attack of pain lasting more than 6 hours may indicate the development of acute cholecystitis and requires a doctor’s consultation to resolve the issue of emergency hospitalization .

2. In the presence of radio-positive (calcified, “dark” on radiographs) stones, with a density of more than 88 HU according to computed tomography.
3. When a non-functioning gallbladder (“disabled”) is detected N.B.! Extremely high risks of complications with the development of obstructive jaundice, peritonitis.
4. When stones occupy more than 30% of the gallbladder cavity.
5. With a long history of the disease. N.B.! Stones that appeared many years ago often contain a large amount of calcium salts, and drugs with a dissolving effect can cause acute surgical complications.
6. Calcified stones.
7. Previous episode of acute cholecystitis treated with medication. N.B! The described gallbladder requires a planned removal.
8. Infectious and inflammatory diseases of the biliary tract.
9. “Injected” stone in the neck of the gallbladder.
10. Fixed, immovable stones – especially in the neck of the gallbladder N.B! High risks of bedsores or pathological anastomosis between the gallbladder and internal organs or the anterior abdominal wall.

Why is it dangerous to use traditional medicine?

The use of traditional medicine to dissolve stones is not recommended, primarily because there is no evidence base for their effectiveness, there are no recommendations on their safety, and possible side effects and contraindications are not described.

In addition, there are cases of complications after the use of traditional medicine, when patients had to be urgently hospitalized in a hospital. For example, situations with toxic hepatitis during treatment with various dietary supplements, when markers of liver damage increased to very high values ​​and were accompanied by jaundice. There have also been cases of blockage of the common bile duct by small stones as a result of an increase in the contractile activity of the gallbladder while taking herbs and nutritional supplements.

Therefore, we recommend dissolving stones only according to indications, under the supervision of a gastroenterologist and drugs with efficacy proven by clinical studies.

If you live in St. Petersburg, you can get a consultation from our center’s gastroenterologists about the presence of indications and the absence of contraindications for drug dissolution of stones.

It is also possible to undergo dissolution of stones under the supervision of a doctor using the comprehensive program “Rescue of the gallbladder with stones” . The program is based on the experience of our specialists, is carried out in several stages and includes all the necessary examinations and doctor’s consultations.

Gallstone disease

Gallstone disease is the presence of stones in the gallbladder and bile ducts. Stones are hard formations of various sizes made of cholesterol or bilirubin.

The disease may develop for a long time without symptoms. As a result, stones clog the bile ducts and cause biliary colic, inflammation of the gallbladder, jaundice, pancreatitis (inflammation of the pancreas).

This disease is widespread throughout the world and most often occurs in older women.

The treatment of gallstone disease consists in the removal of stones from the gallbladder or ducts.

If stones do not cause symptoms, removal is not indicated.

Synonyms Russian

Stones in the gallbladder and ducts, cholelithiasis, choledocholithiasis, cholelithiasis.

Synonyms English

Gallstones, Cholelithiasis, Choledoholitheasis, Gallstone in the bile duct, Bile duct stone.

Symptoms

Gallstones may not cause any symptoms for decades. If they clog the bile ducts, causing tension in the gallbladder wall, this manifests itself:

• sharp stabbing pain in the right upper abdomen, in the center of the abdomen;
• pain between shoulder blades;
• Pain in the right shoulder.

As a rule, a pain attack lasts 30-90 minutes. It can pass with increased sweating, nausea, vomiting. In the absence of episodes of acute pain, patients usually do not complain.

Complicated course of the disease is sometimes accompanied by jaundice.

General information about the disease

Cholelithiasis is the presence of one or more stones in the gallbladder and bile ducts.

The gallbladder is a small, pear-shaped, sac-shaped organ located on the right side of the abdomen, below the liver. It is a “reservoir” for bile produced by the liver. It passes into the cystic bile duct, which flows into the common bile duct.

The disease may develop unnoticed for a long time without causing any symptoms. It is widespread throughout the world and is most common in older women and obese people.

Stones usually form in the gallbladder. This occurs when cholesterol (a fat-like substance) or bilirubin (a breakdown product of hemoglobin) is present in bile in high concentrations. In this case, other components of bile cannot dissolve these substances. From bile supersaturated with them, a precipitate can form – microscopic crystals that settle on the mucous membrane of the gallbladder. Over time, the crystals enlarge and merge, gradually forming small stones. Gallstones can be composed of various substances:

• cholesterol stones are the most common type of stones; consist mainly of cholesterol and have a yellow color;
• pigment stones are less common and are small hard black stones or soft fatty brown stones; They are made up of the breakdown products of bilirubin.

The appearance of stones in the gallbladder or ducts can be caused by the following reasons.

• Hypersaturation of bile with cholesterol due to…

• Excessive excretion of cholesterol in the bile (eg, diabetes mellitus, high blood pressure, hyperlipidemia, obesity, when taking certain drugs).
• Reducing the production of bile salts, which make up the dry residue of bile and regulate the production of its other components, including cholesterol.

• Deficiency of lecithin, which breaks down into bile acids. This may be due to genetic disorders.
• Hypersaturation of bile with bilirubin. It leads to an increased formation of hemoglobin caused by sickle cell anemia (a hereditary disease that disrupts the structure of hemoglobin), cirrhosis of the liver (cicatricial degeneration of liver tissue).
• Violation of the motility of the gallbladder and, as a result, its incomplete emptying and stagnation of bile, as in pregnancy, fasting, sudden weight loss, spinal cord injuries.
• Certain parasites (eg liver fluke).

Cholelithiasis has the following complications.

• Inflammation of the gallbladder (cholecystitis), which can cause severe pain in the right upper abdomen and fever.
• Blockage (obstruction) of the common bile duct. This threatens with jaundice or inflammation of the bile ducts (cholangitis).
• Obstruction of the pancreatic duct – a tube through which the juice that helps digest food from the pancreas through the common bile duct enters the duodenum. A blocked duct can cause pancreatitis, an inflammation of the pancreas.
• Cancer of the gallbladder. Gallstone disease increases the risk of developing gallbladder cancer.

Who is at risk?

• Women.
• People over 60 years of age.
• Overweight or obese persons.
• Pregnant women and women who have given birth several times.
• People who eat a diet high in fat and low in fiber.
• Dramatically lost weight.
• Persons with a hereditary predisposition to develop the disease.
• Patients with diabetes mellitus.
• Those with elevated cholesterol levels.
• Persons taking certain drugs (containing estrogens, etc.)
• Suffering from high blood pressure, liver cirrhosis.

Diagnosis

Gallstone disease is suspected after the patient complains of acute pain in the right upper abdomen. To determine the presence of stones allows ultrasound of the abdominal cavity. Often, stones are discovered by accident when performing research for other purposes. A number of calcium-impregnated stones can be seen on x-ray.

Laboratory research methods

• Complete blood count (without leukocyte formula and ESR). The level of leukocytes can be increased with cholecystitis, with inflammation of the pancreas.
• Amylase and lipase in the blood are enzymes secreted by the pancreas. Their concentration is increased when the pancreatic duct is blocked.
• Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are liver enzymes that increase when the common bile duct is blocked.
• Total alkaline phosphatase (AP).
• Bilirubin total. An increase in its level is also characteristic of obstruction of the common bile duct.

Other research methods

• Ultrasound of the abdominal cavity. This widely used test allows the detection of gallstones with a high degree of accuracy.
• Computed tomography (CT) and magnetic resonance imaging (MRI) of the abdomen. They are an alternative to ultrasound.

• Endoscopic retrograde cholangiopancreatography (ERCP) – examination of the bile ducts and pancreatic duct by introducing a radiopaque substance through a special probe.

Treatment

Most people with gallstones do not need treatment: stones that do not cause symptoms should not be removed, and in some cases the disease is asymptomatic for life. However, gallstones must be removed for diabetes.

Treatment of cholelithiasis depends on the symptoms of the disease and may include:

• surgery to remove the gallbladder (cholecystectomy), which is carried out with frequent relapses and complications of the disease; removal of the gallbladder does not affect the vital functions of a person;

• taking medications to dissolve gallstones.

To prevent complications of gallstone disease, the patient may be given a diet high in fiber and low in saturated fat.