Picture, Symptoms, Types, Causes, Risks, Treatments

Written by WebMD Editorial Contributors

• What Are Gallstones?
• Gallstone Types
• Symptoms of Gallstones
• Causes of Gallstones
• Gallstone Risk Factors
• Gallstone Diagnosis
• Can Gallstones Go Away on Their Own?
• Gallstone Treatment
• Complications of Gallstones
• Preventing Gallstones
• More

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

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 don’t normally cause symptoms. Symptoms occur only when a gallstone gets stuck and blocks the flow of bile through your system.

If you have symptoms, they 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:

• Belly pain that lasts several hours or is severe
• Fever and chills
• Yellow skin or eyes

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.

You’re more likely to get gallstones if you:

• Have a family history of them
• Are a woman
• Are over age 40
• Are of Native American or Mexican descent
• Are obese
• Have a diet high in fat and cholesterol but low in fiber
• Don’t get much exercise
• Use birth control pills or hormone replacement therapy
• Are pregnant
• Have diabetes
• Have an intestinal disease like Crohn’s
• Have hemolytic anemia or cirrhosis of the liver
• Take medicine to lower your cholesterol
• Lose a lot of weight in a short time
• Are fasting

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 waves 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. This can help diagnose cholecystitis (inflammation of the gallbladder) from gallstones.

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, but that’s only done if treatment is planned as part of the procedure since it’s invasive.

Endoscopic ultrasound. This test combines ultrasound and endoscopy to look for gallstones that may be in places that are hard to see with other imaging, such as in the common bile duct as it passes through the pancreas.

If your gallstones aren’t causing symptoms, there’s usually no need for you to have surgery. You’ll only need it if a stone goes into, or blocks, one of your bile ducts. This causes what doctors call a “gallbladder attack.” It’s an intense, knife-like pain in your belly that can last several hours.

If you have sickle cell or another blood disorder, your doctor may consider doing a cholecystectomy as a precaution, even if you don’t have symptoms. 

You don’t need treatment if you don’t have 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. The surgeon works through tiny cuts (incisions). They pass a narrow tube called a laparoscope into your belly through a small cut. The tube contains a tiny light and a camera. The doctor will take out your gallbladder through another small cut using special devices. 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. You’ll need open surgery if you have a bleeding disorder. You may also need it if you have severe gallbladder disease, are very overweight, or are in your last trimester of pregnancy.

For both types of surgery,  you’ll get general anesthesia. This means you won’t be awake during the procedure.

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

Nonsurgical treatment: If you have another medical condition and your doctor thinks you shouldn’t have surgery, they might give you medication instead. Chenodiol (Chenodo l) 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.

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.

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.
• Although obesity is a risk factor, 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 avoid using hormonal birth control.

Top Picks

4 Things You Should Know About Gallstones

Do you have severe abdominal pain? You could have gallstones. Learn more about the signs and symptoms.

Tucked beneath your liver, the gallbladder is a seemingly inconsequential organ that stores bile from your liver. When this bile passes to your small intestine, it helps digest fatty foods. However, when gallstones occur, the pain can be debilitating.

1. What are gallstones and their symptoms?

Gallstones form when small bits of crystalized bile clump together. These stones can be as small as a grain of salt or as large as an egg. When they stay put in the gallbladder, these “silent” gallstones go unnoticed and do not require treatment. When they try to pass through the tiny bile duct to the small intestine, inflammation and severe pain set in. Lasting from a few minutes to a few hours, the pain can feel like indigestion or similar to a feeling of fullness.

Additional symptoms include:

• Severe abdominal pain, with no relief from pain relievers
• Pain that worsens after eating a meal, particularly foods high in fat
• Chest pain
• Excessive gas and heartburn
• Tenderness in the abdomen, especially on the upper right side
• Jaundice
• Nausea
• Pancreatitis

 “While pain can be a symptom of gallstones, it’s important to know that they often manifest as more of a vague discomfort rather than pain,” says Hector C. Ramos, MD, a hepatobiliary and pancreatic surgeon at Keck Medicine of USC. “They’re most often found when a primary care doctor does an ultrasound, because a patient comes in with what they believe to be indigestion or abdominal distress.”

2. Who is at risk for gallstones?

Gallstones have become increasingly common, and all age groups can be affected.

Factors that contribute to gallstones include:

• Obesity
• An increase in estrogen, from pregnancy or hormone therapy
• A diet high in fat and refined carbohydrates, and a decrease in fiber

A family history of gallstones, as well as multiple pregnancies, can increase risk. Likewise, there is a higher percentage in older people; about 25% of women age 60 or older will develop them.

3. How are gallstones treated?

An X-ray, CT scan or ultrasound will confirm whether you have gallstones. If you don’t have any symptoms, most likely you’ll simply live with them, until you do. After treating your gallstones, changing to a vegetarian diet or one that includes preventive factors, like polyunsaturated fat, monounsaturated fat, fiber and caffeine, is suggested.

“A vegetarian diet will prevent gallstones,” says Ramos. “However, if you have already been diagnosed with gallstones, it’s best not to change suddenly to a strict vegetarian diet. The rapid shift from the gallbladder being very active and frequently digesting fats to not being used at all can aggravate your condition and produce more gallstones. Crash-diet plans that cause a rapid loss of a great deal of weight can also produce or aggravate gallstones. If you’re considering weight management surgery, talk to your surgeon about the potential for gallstones.”

If your doctor decides to remove your gallbladder, a cholecystectomy might be suggested. For this procedure, a surgical incision is made, and then the gallbladder is removed by laparoscopic surgery. Most patients experience a quick recovery with little pain and discomfort.

“Not all gallstones need to be surgically removed,” Ramos says. “Sometimes, a physician will find gallstones, when doing a procedure for kidney stones, for example. If they aren’t causing you symptoms, the gallbladder may not need to be removed. But if you have persistent pain, surgery is the best option. Patients who are immunosuppressed are also advised to get surgery, as gallstones can lead to a potentially fatal infection.”

4. Are there complications with gallstones?

Even if you aren’t in pain from your gallstones, they may still present a health risk. Jaundice, where your skin itches and appears yellow, is one side effect. Another is acute cholecystitis, where the stone blocks the cystic duct, preventing the gallbladder from emptying bile into the bile duct. Nausea, vomiting and severe pain are usually present. In the most serious cases, patients may develop acute pancreatitis, also treated with surgery. Usually, patients return to normal lives, after having their gallbladder removed.

“The best way to prevent gallstones is to eat a moderate diet that is low in fat and simple carbohydrates, such as sugar and refined flour,” says Ramos. “Obesity is associated with gallstones, so do your best to keep your weight in a healthy range. The best prevention is a moderate, balanced diet that is low in fat. Get your carbohydrates from fresh, whole fruits and vegetables. You should also drink lots of water to keep your bile fluid.”

Topics

abdominal pain

Dr. Hector C. Ramos

gallbladder surgery

gallstones

Anne Fritz

Anne Fritz is a freelance health and lifestyle writer.

Cholelithiasis

Contents

Questions and Answers

What is gallstone disease?

Cholelithiasis, or cholelithiasis, is a disease characterized by the presence of stones (calculi) in the gallbladder and/or bile ducts. The disease can be asymptomatic, symptomatic and complicated.

Why do gallstones form?

The main cause of cholelithiasis is a metabolic disorder. At the same time, the composition of bile changes in such a way that its constituent substances precipitate, from which stones are formed. There are a lot of risk factors for cholelithiasis: heredity, liver disease, gout, urolithiasis, excessive consumption of fatty foods (“excess” cholesterol is excreted in bile), the influence of female sex hormones, etc.

How to diagnose cholelithiasis?

Today, the “gold standard” for the diagnosis of cholelithiasis and its complications is ultrasound. Sometimes, to obtain information about the condition of the bile ducts, you will be asked to undergo an MRI or endoscopic cholangiography

What to do if you find stones in the gallbladder?

If this is an “accidental finding” on ultrasound, you did not have symptoms of cholelithiasis – attacks of pain or discomfort in the upper abdomen after eating, any complications (for example, pancreatitis) – according to current clinical guidelines, diet and observation are sufficient. The risk of complications in such a situation is about 2% annually.

If you have had at least one attack of pain, the risk of complications of the disease increases significantly, in which case you need surgery

Make an appointment

Media

her – big or small?

For some reason, most people believe that small stones are much better than large ones.
In fact, the opposite is true , small stones can migrate into the common bile duct, causing complications such as choledocholithiasis, obstructive jaundice, cholangitis, acute pancreatitis, which are life-threatening conditions that require emergency treatment

Basic principles of diet
for cholelithiasis

9 0006 How to remove gallstones without surgery?

To date, other methods comparable in effectiveness with surgery, there are no ways to treat cholelithiasis

But what about the dissolution or crushing of stones?

Unfortunately, “dissolution” under the influence of ursodeoxycholic acid preparations (Ursofalk, Ursosan) is ineffective in most cases.
To improve efficiency, strict criteria for the use of this method have been developed: strictly cholesterol calculi (occur in no more than 25% of patients), size no more than 20 mm, passable bile ducts, preserved gallbladder function, absence of other diseases of the digestive system. However, even under these conditions, the effectiveness of the technique does not exceed 25%.

And even if successfully dissolved, stone recurrence rate reaches 45-60% [Zacco S. Overview of nonsurgical management of gallbladder stones. UpToDate, 2023]
Given the cost of drugs (and the patient is doomed to lifelong use of them), the use of this technique is rarely justified.

Stone crushing – extracorporeal shock wave lithotripsy, not currently used. Technically, stones can be crushed, but their fragments must somehow be removed from the gallbladder. There is only one way – through the common bile duct. And the migration of stones into the common bile duct, as you already know, leads to life-threatening complications. The risk of lithotripsy far exceeds the risk of the disease itself, which means that this type of treatment is not applicable, and is currently recognized as dangerous and ineffective.

My YouTube videos on this topic

Is it possible to remove stones from the gallbladder without removing the organ itself?

Possible. And even easier than removing the gallbladder. It just makes no sense…

This operation (cholecystolithotomy) was no longer performed worldwide in the 80s of the last century, with the exception of three situations:

with anatomical or pathological changes in the gallbladder zone, making its removal extremely risky. In such cases, percutaneous drainage of the gallbladder is used, and then stones are removed through the drainage channel using an endoscope.

2. An extremely pronounced acute inflammatory process in the area of ​​the gallbladder, making it impossible to differentiate anatomical structures in the area of ​​the hepatoduodenal ligament. In this case, indeed, part of the gallbladder can be left by removing the stones (subtotal cholecystectomy). And we ourselves write about this in national clinical guidelines (your obedient servant is one of the authors)

3. Someone really wants to make money on people’s health and the desire to leave their gallbladder. Here there have always been and there are a couple of people who want to.

Removing stones from the gallbladder is technically even easier than removing it, but it makes no sense. That is why this far from the most complicated operation is performed only in a few clinics in the world.
All the reasons for the recurrence of stones remain, plus a scar on the bladder is added, further impairing its ability to contract.
The result is obvious – a recurrence of cholelithiasis, with a worse course than before.

But the question is so common that I even recorded a separate video:

Surgery for cholelithiasis

Laparoscopic cholecystectomy is recognized worldwide as the best method for gallbladder removal . Other methods (surgery from a mini-access, traditional surgery from a large incision) are used by us extremely rarely in case of serious complications and technical difficulties, predicted both before the operation and during the intervention itself. All details will be explained in detail by your surgeon.
Laparoscopic cholecystectomy is performed through 3-4 small (5-15 mm) punctures in the anterior abdominal wall. The technique allows you to significantly reduce the intensity of postoperative pain, achieve a good cosmetic result and return to normal life as quickly as possible. The length of stay in the clinic most often does not exceed a day.

Now, with the latest generation of equipment in GMS Hospital , I have the opportunity to make this operation even less traumatic by performing it from three- and five-millimeter approaches. This technology is already called “ mini laparoscopy” and allows patients to comfortably go home as early as the next day after surgery.

Read more about the operation in the article
“Gallbladder removal: briefly about the main”

When to operate, how to operate,
recommendations for rehabilitation and nutrition

Here you can see how I perform the operation.
Video 18+

6 months after laparoscopic surgery with cosmetic intradermal sutures.
Arrows indicate postoperative scars

What complications can occur during gallbladder removal?

Any operation has a certain risk of complications. In the case of cholecystectomy, their list includes bleeding, damage to the bile ducts, complications from postoperative wounds, and a number of others.

At our clinic, patient safety is a top priority. The experience and qualifications of surgeons, the latest technologies and equipment provide a minimal risk of complications (<1%), most of which are “small”, that is, do not pose a threat to life and health.

More information about the possible consequences of gallbladder removal

Is it possible to live a full life after gallbladder removal?

Yes, of course. If you look at the diagram, you will see that the gallbladder is somewhat away from the “main route” of bile entry into the duodenum. During the operation, we turn off only the cystic duct, leaving the main ducts for the free flow of bile into the gastrointestinal tract. Only one thing changes – after the removal of the gallbladder, unconcentrated bile constantly enters the duodenum, regardless of food intake. That is why we recommend that you eat often and in small portions after the operation, “give bile a job” and limit fatty foods. Some time after the operation, the digestive system adapts to the new functioning conditions, and the bile ducts partially take over the reservoir function of the gallbladder. , any complications (for example, pancreatitis) – according to modern clinical recommendations, diet and observation are sufficient. The risk of complications in such a situation is about 2% annually.

If you have had at least one attack of pain, the risk of complications of the disease increases significantly, in which case surgery is needed

Reviews

What my patients write about cholecystectomy
and life after gallbladder removal

Recommendations

before and after gallbladder removal surgery

Before surgery:

• Avoid alcohol the day before surgery
• Avoid food and water the night before surgery

After surgery:

• You can drink a little water in the first hours after surgery
• If you feel pain, call a nurse who will administer pain medication in consultation with your doctor
• After discharge (usually the next day), take medication
• Prepare to limit activity for the first few days
• Avoid heavy lifting (more than 10 kg) for three months after surgery
• You can shower the next day after surgery
• Diet: you need to limit fat intake, eat often (4-5 times a day) in small portions
• Sports (running, swimming) can be resumed after 4-6 weeks. It is better to postpone weight training for 3 months.
• In most cases, you can return to work within a week after the operation, and you can return to routine household activities in two to three days.

How much does surgery cost

to remove the gallbladder?

Laparoscopic cholecystectomy

from 150,000

The cost depends on the complexity of the operation and its urgency