How do gallstones form in the body. What are the risk factors for developing gallstones. Can you get gallstones without a gallbladder. What are the symptoms of gallstone formation. How are gallstones diagnosed and treated.

Understanding Gallstones: What Are They and How Do They Form?

Gallstones are small, hard deposits that form in the gallbladder or biliary tract. These stones can vary in size and number, potentially causing complications if left untreated. But what exactly are gallstones made of?

Gallstones primarily consist of cholesterol and bile salts. They develop due to imbalances in bile composition, which can lead to the accumulation of these substances over time. While the exact cause of gallstone formation is still not fully understood by researchers, several factors contribute to their development.

The Role of the Gallbladder in Stone Formation

The gallbladder, a small organ located on the right side of the abdomen just below the liver, plays a crucial role in the digestive process. Its primary function is to store and concentrate bile, a digestive liquid produced by the liver. When gallstones form in the gallbladder, the condition is known as cholelithiasis.

How do gallstones typically form in the gallbladder? The process often begins when there’s an imbalance in the bile components. This imbalance can lead to the crystallization of cholesterol or bilirubin, which gradually accumulate to form stones. Factors such as inadequate gallbladder emptying or infrequent emptying can also contribute to stone formation.

Gallstones Beyond the Gallbladder

Interestingly, gallstones can form outside the gallbladder as well. Areas such as the liver, pancreas, and surrounding bile ducts are potential sites for stone formation. When stones develop in the common bile duct, the condition is referred to as choledocholithiasis.

Can you get gallstones without a gallbladder? Surprisingly, the answer is yes. Even after gallbladder removal (cholecystectomy), stones can still form in the biliary system. In these cases, stones may develop anywhere along the bile duct system, potentially causing complications similar to those experienced with an intact gallbladder.

Risk Factors for Gallstone Formation: Who’s at Higher Risk?

Understanding the risk factors for gallstone formation is crucial for prevention and early detection. While some risk factors are beyond our control, others can be modified through lifestyle changes.

Non-Modifiable Risk Factors

• Age: The risk of developing gallstones increases with age
• Gender: Women are more likely to develop gallstones than men
• Family history: Genetic factors can increase susceptibility
• Ethnicity: Some ethnic groups have a higher predisposition

Modifiable Risk Factors

• Obesity: Excess weight increases the risk of gallstone formation
• Rapid weight loss: Crash diets or surgical weight loss procedures can trigger stone formation
• Sedentary lifestyle: Lack of physical activity is associated with higher risk
• Diet: High-fat, high-cholesterol diets may contribute to stone formation
• Certain medications: Some drugs can increase the likelihood of developing gallstones

Are there specific dietary factors that increase the risk of gallstones? A diet high in refined carbohydrates and saturated fats, coupled with low fiber intake, has been associated with an increased risk of gallstone formation. Conversely, a diet rich in fruits, vegetables, whole grains, and lean proteins may help reduce the risk.

Recognizing the Symptoms: When to Suspect Gallstones

Identifying the symptoms of gallstones is crucial for timely diagnosis and treatment. While up to 80% of people with gallstones may not experience any symptoms, those who do can face significant discomfort and potential complications.

Common Symptoms of Gallstones

• Sudden, intense pain in the upper right abdomen
• Pain that radiates to the back or right shoulder
• Nausea and vomiting
• Fever and chills (if infection is present)
• Jaundice (yellowing of the skin and eyes)

Do gallstone symptoms differ in people without a gallbladder? While the symptoms can be similar, individuals without a gallbladder might experience pain more diffusely in the abdominal area. They may also be more prone to digestive issues such as diarrhea or indigestion due to the continuous flow of bile into the intestines.

When to Seek Medical Attention

If you experience severe abdominal pain, especially if accompanied by fever or jaundice, it’s crucial to seek immediate medical attention. These symptoms could indicate a serious complication such as a blocked bile duct or infection.

Diagnostic Approaches: How Are Gallstones Detected?

Accurate diagnosis of gallstones is essential for appropriate treatment. Healthcare providers employ various diagnostic tools and techniques to identify and characterize gallstones.

Imaging Studies

• Ultrasound: The most common and non-invasive method for detecting gallstones
• CT scan: Provides detailed images of the gallbladder and surrounding structures
• MRI: Offers high-resolution images and can detect smaller stones
• ERCP (Endoscopic Retrograde Cholangiopancreatography): Combines X-rays with endoscopy to visualize the bile ducts

Blood Tests

Blood tests can help assess liver function and detect signs of infection or inflammation associated with gallstones. Elevated liver enzymes or bilirubin levels may indicate a blockage in the bile ducts.

How accurate are these diagnostic methods? While ultrasound is highly accurate for detecting gallstones in the gallbladder (sensitivity of 95-98%), its accuracy may be lower for stones in the bile ducts. In such cases, additional imaging studies like MRCP (Magnetic Resonance Cholangiopancreatography) or ERCP may be necessary for a definitive diagnosis.

Treatment Options: Managing Gallstones Effectively

The treatment approach for gallstones depends on various factors, including the severity of symptoms, the location of the stones, and the patient’s overall health. Let’s explore the main treatment options available:

Watchful Waiting

For asymptomatic gallstones, a watchful waiting approach may be recommended. This involves regular monitoring without active treatment, as many people with gallstones never develop symptoms.

Medication

In some cases, medications may be prescribed to dissolve small gallstones. Ursodeoxycholic acid (Ursodiol) is the most commonly used drug for this purpose. However, this treatment is generally only effective for small cholesterol stones and may take months or years to work.

Surgical Interventions

• Cholecystectomy: Surgical removal of the gallbladder, often performed laparoscopically
• ERCP with stone removal: Used for stones in the bile ducts
• Lithotripsy: A technique that uses shock waves to break up gallstones (rarely used)

What is the most effective treatment for gallstones? For symptomatic gallstones, cholecystectomy (gallbladder removal) is generally considered the gold standard treatment. It provides a permanent solution and prevents future stone formation in the gallbladder. However, it’s important to note that stones can still form in the bile ducts even after gallbladder removal.

Living Without a Gallbladder: What to Expect

Many people wonder about life after gallbladder removal. While the body can function without a gallbladder, some adjustments may be necessary.

Dietary Considerations

After gallbladder removal, some individuals may need to make dietary modifications to manage symptoms and maintain digestive health. These may include:

• Eating smaller, more frequent meals
• Reducing fat intake, especially saturated and trans fats
• Increasing fiber consumption
• Staying hydrated

Potential Complications

While most people adapt well to life without a gallbladder, some may experience complications or ongoing symptoms. These can include:

• Diarrhea or loose stools
• Difficulty digesting fatty foods
• Abdominal pain or discomfort
• Rarely, bile duct injury or bile leakage

Can gallstones still form after gallbladder removal? Yes, it’s possible for stones to form in the bile ducts even without a gallbladder. While this is less common, it’s important to be aware of the possibility and monitor for any symptoms.

Prevention Strategies: Reducing Your Risk of Gallstones

While not all risk factors for gallstones are modifiable, there are several steps you can take to reduce your chances of developing them:

Lifestyle Modifications

• Maintain a healthy weight: Obesity increases the risk of gallstones
• Exercise regularly: Physical activity can help prevent stone formation
• Stay hydrated: Adequate water intake supports proper bile flow
• Avoid rapid weight loss: Gradual, sustainable weight loss is preferable

Dietary Approaches

• Eat a balanced diet rich in fruits, vegetables, and whole grains
• Limit saturated fats and refined carbohydrates
• Include healthy fats from sources like olive oil, nuts, and fatty fish
• Consider including coffee in your diet, as some studies suggest it may reduce the risk of gallstones

Are there specific foods that can help prevent gallstones? While no single food can guarantee prevention, a diet rich in fiber, fruits, vegetables, and lean proteins has been associated with a lower risk of gallstone formation. Some studies also suggest that moderate alcohol consumption and regular coffee intake may have protective effects, although more research is needed in these areas.

The Future of Gallstone Management: Emerging Treatments and Research

As medical science advances, new approaches to gallstone prevention and treatment are being explored. These emerging strategies offer hope for more effective and less invasive management of gallstones in the future.

Novel Pharmaceutical Approaches

Researchers are investigating new medications that could more effectively dissolve gallstones or prevent their formation. Some promising areas of study include:

• Bile acid analogues: New compounds that may be more effective than current medications in dissolving stones
• Cholesterol absorption inhibitors: Drugs that could reduce cholesterol concentration in bile
• Targeted therapies: Medications designed to address specific mechanisms of stone formation

Minimally Invasive Techniques

Advancements in medical technology are paving the way for less invasive treatment options:

• Improved lithotripsy techniques: More precise and effective ways to break up stones without surgery
• Endoscopic innovations: New tools and techniques for removing stones from bile ducts with minimal intervention
• Gallbladder-preserving procedures: Methods to remove stones while keeping the gallbladder intact

What role might artificial intelligence play in gallstone management? AI and machine learning are increasingly being applied to medical imaging analysis. These technologies could potentially improve the accuracy and speed of gallstone detection, help predict which patients are most likely to develop symptomatic gallstones, and assist in treatment planning.

Personalized Medicine Approaches

The future of gallstone management may lie in personalized medicine, tailoring prevention and treatment strategies to individual patients based on their genetic profile, lifestyle factors, and other personal characteristics. This approach could lead to more effective interventions and better outcomes for patients.

As research in these areas continues, it’s important for individuals at risk of gallstones to stay informed about the latest developments and discuss potential new treatment options with their healthcare providers. While many of these approaches are still in the experimental stages, they offer hope for improved gallstone management in the years to come.

Gallstones Without a Gallbladder: What You Need to Know

Editor’s note: This blog post was medically reviewed by Va’Ronda Varnado, FNP-C and the Ezra medical team.

Gallstones form due to imbalances in bile composition which may result in abdominal pain, bile duct infections, and other health issues.

What you might not know, however, is that gallstones can still form outside of the gallbladder.

We’ll explore why in this article, as well as what symptoms look for, how gallstones are diagnosed, and what you can do today to prevent gallstone formation.

Table of contents

• What Are Gallstones
• How Gallstones Typically Form in the Gallbladder
• How Gallstones Form Without a Gallbladder
• Where Do Gallstones Go Without a Gallbladder?
• Types of Gallstones
• Gallstone Formation: Risk Factors To Look Out For
• Symptoms of Gallstone Formation
• How Gallbladder Stones are Diagnosed
• Management and Treatment of Gallstones
• Your Next Steps

What Are Gallstones

Gallstones are small, hard deposits of cholesterol and bile salts that form inside the gallbladder or other parts of the biliary tract, disrupting normal bile flow.

The gallbladder is a tiny organ on the right side of your abdomen, just below your liver. Its main role is to store and concentrate bile, a digestive liquid produced in the liver.

When gallstones are present in the gallbladder, it is called cholelithiasis. Meanwhile, choledocholithiasis develops when stones form in the common bile duct.

Gallstones can form outside the gallbladder. The liver, pancreas, and surrounding bile ducts are other areas where gallstones are sometimes found.

They range in size and number, and can cause complications if left untreated. For example, blocked bile ducts can lead to severe or life-threatening infection of the pancreas, liver, or the bile ducts themselves.

How Gallstones Typically Form in the Gallbladder

Gallstones form due to imbalances in cholesterol levels, bilirubin, or salts in the bile. Stones may form over time as cholesterol or bilirubin accumulates in the gallbladder or bile ducts.

Researchers are still unsure of the exact cause of gallstones. Lifestyle factors like being overweight, having an unhealthy diet, or not exercising, can increase the risk of developing gallstones.  

Certain diets or surgeries that cause rapid weight loss may also lead to gallstone formation. If you don’t eat for a long period or you lose weight quickly, your liver tends to release extra cholesterol into the bile.

Gallstones may also form if the gallbladder is not emptied fully or often enough.

Gallstones usually form in the bile duct, sometimes passing through into the organ. As more gallstones accumulate, they can block the flow of bile, causing inflammation and pain.

The incidence of symptomatic gallstones is relatively low — 1 to 2 out of 10 Americans will have gallstones at some point in their lives, but up to 80% will not experience any symptoms. However, the number of people living with the condition is increasing due to an aging population, changes in lifestyle, and a rise in obesity rates.

How Gallstones Form Without a Gallbladder

A gallbladder is removed if it is affected by certain diseases like gallstones, tumors, and inflammation of the gallbladder. Gallstones may form even after the removal of the gallbladder.

When a gallbladder is removed, the bile produced by the liver cannot be stored. For this reason, gallstones can form anywhere along the bile duct system.

When a gallstone blocks the flow of digestive fluid through the bile ducts, inflammation or infection of the liver or one of the bile ducts can occur. This can cause intense pain in the upper right side of your abdomen.

It can also lead to complications, such as pancreatitis (inflammation of the pancreas) or cholangitis (inflammation of the bile duct system).

Potential Complications of Gallstones Without a Gallbladder

Potential complications of bile duct stones (also known as choledocholithiasis) include:

• acute pancreatitis
• inflammation
• blockage of the bile ducts and infection

Other potential complications include jaundice, increased risk of cancer of the bile ducts, cysts, and formation of granulomatous tissue.

In rare cases, the bile ducts may become completely blocked and require surgery to repair. In serious cases, sepsis and/or death may result.

Where Do Gallstones Go Without a Gallbladder?

Without a gallbladder, gallstones may form in other organs connected to the bile ducts, such as the pancreas. In some cases, the stones may pass from one area to another and cause complications.

Gallstones can also form in the liver, but this is rare. When stones form in the liver, they are called intrahepatic stones. They are common in people with cirrhosis or other diseases of the liver.

The formation of gallstones outside of the gallbladder is usually linked to elevated levels of cholesterol and bile salts in the digestive system, as well as other diseases such as diabetes, obesity, and pancreatitis.

If gallstones form in other organs, surgery or medications may be recommended to reduce the stones’ size or even prevent the stones from forming in the first place.

Types of Gallstones

Yes, there is more than one type of gallstone. Stones from any of the following types can vary in size, from a few millimeters to several centimeters in diameter.

• Cholesterol gallstones: The most common type of gallstones, and are primarily made up of cholesterol.

• Pigment gallstones: Made from bilirubin and other pigments from the breakdown of red blood cells. These stones are more common in people with liver diseases, such as cirrhosis, or those with a blood disorder.

• Mixed gallstones: These are a combination of cholesterol and pigment stones.

• Resident gallstones: Rare and made of calcium salts or proteins that stay in the gallbladder, these stones can increase in size and cause complications if left untreated.

• Calcium bilirubinate stones: These stones form when there is an excess amount of bilirubin in the bile, which binds to calcium.

• Recurring gallstones: As the name suggests, these stones form and dissolve frequently.

Gallstone Formation: Risk Factors To Look Out For

Several factors may increase the risk of gallstone formation, even without a gallbladder.

• Age: Gallstones are more likely to form as you age, especially after the age of 40, due to changes in bile salt level over time.
• Weight: Being obese is associated with a higher risk of gallstones, as increased fat in the body can lead to changes in the levels of cholesterol in the bile.
• Diet: Eating high-fat and high-cholesterol foods can lead to gallstones. Diets high in cholesterol and fats can cause gallstones to form even if you don’t have a gallbladder.
• Gender: Women are more likely to develop gallstones than men due to changes in sex hormones (like estrogen) that can potentially increase biliary cholesterol secretion.
• Family history: Having a family member with gallstones (or history of gallstones) increases your risk.
• Medications: Certain medications, such as some cholesterol-lowering drugs, can increase your risk of developing gallstones.
• Ethnicity: People from certain ethnic groups, such as Native Americans, are at a higher risk for cholelithiasis or gallstones.
• Pregnancy: During pregnancy, estrogen and progesterone levels increase, which can increase the risk of gallstones.

If you have any of the risk factors listed above and are concerned about developing gallstones, reach out to your doctor about the best way to reduce your risk.

Symptoms of Gallstone Formation

Gallstones create blockages within the biliary system, either in the ducts or inside organs. As such, symptoms often appear as gallstones develop and grow in size.

These include the following:

• Abdominal pain/discomfort: Gallstones can cause intense abdominal pain and discomfort. The pain can occur anywhere in the abdomen and may be sharp or dull. The pain may last for just a few minutes or several hours.

• Bloating/Cramping: As the stones block bile from entering the small intestine, bloating and cramping may accompany pain in the upper abdominal region.

• Nausea: Gallstones can cause nausea and vomiting, as bile may be blocked by the stones, leading to acid reflux. There is also a loss of appetite, abdominal pain, and a feeling of fullness.

• Vomiting: Severe nausea and vomiting can lead to dehydration and electrolyte imbalances.

• Fever: Gallstones can lead to an infection in the gallbladder, which can cause a fever.

• Dark urine: Due to bile in the urine, gallstones may cause a patient to produce darkly-colored urine.

• Yellowish skin/eyes (jaundice): This occurs due to bile being blocked by the stones and unable to reach the intestine.

• Indigestion: Gallstones can cause indigestion, as they can interfere with the digestion of food. Other symptoms may include abdominal pain, nausea, and vomiting.

Some patients may also experience asymptomatic or silent gallstones, where gallstones form without distinct symptoms. These stones may remain undetected until imaging tests for other issues reveal their presence.

Imaging tests such as abdominal CT scans or ultrasound are ordered to detect asymptomatic gallstones. MRI scans can also detect gallstones in the ducts of the biliary tract.

Treatment for asymptomatic gallstones is not necessary unless the patient begins to experience symptoms or if the patient is at risk of complications.

Important note: Gallstone symptoms may often be confused with other disorders like appendicitis, irritable bowel syndrome, or gastroenteritis.

How Gallbladder Stones are Diagnosed

A clear diagnosis by a health practitioner is crucial for proper treatment once symptoms have been confirmed.

Here are several diagnostic methods used to examine gallstones:

• Ultrasound imaging utilizes sound waves to produce an image of the gallbladder and the surrounding organs to detect inflammation, disease, or abnormal growth.

• Lab tests to measure the levels of alkaline phosphatase and bilirubin in the blood to identify the chemical composition of gallstones.

• Endoscopic retrograde cholangiopancreatography (ERCP) combines endoscopy and x-ray imaging to visualize the gallbladder and its duct. This is a test in which a small camera is inserted into the body to get a detailed view of the interior of the gallbladder and to detect any blockages or abnormalities.

• Blood tests to measure the level of certain bile acids and other substances which can indicate issues in the gallbladder. These tests can also detect cancer, infection, or other diseases.

• Magnetic resonance imaging (MRI) involves magnetic fields and radio waves to get detailed images of the gallbladder and its surrounding organs.

• Computed tomography (CT) scan utilizes a combination of x-rays and a computer to get detailed images of the gallbladder and its surrounding organs to diagnose any blockages, inflammation or tumors.

• Magnetic resonance cholangiopancreatography (MRCP) is an MRI exam that takes detailed pictures of the liver, gallbladder, pancreas, bile ducts, and pancreatic duct. The detailed images can help identify gallstone formation and inflammation of the bile ducts.

Did you know?

In less than an hour, Ezra’s full-body MRI screens up to 13 organs for potential cancers or other abnormalities such as the presence of gallstones.

Management and Treatment of Gallstones

Gallbladder stones that do not produce symptoms or complications may not need to be treated.

Otherwise, treatment options for gallstones may include the following:

Medication

Medication for gallstones may be prescribed, including medications that dissolve the stones or medications to help them pass. Specific medications include Ursodiol and Chenodiol, which helps in dissolving cholesterol gallstones.

Dietary Changes

Dietary changes, such as reducing fat and cholesterol intake, can help reduce the formation of gallstones. Balancing cholesterol, salts, and bilirubin levels in the bile fluid reduces the chances of gallstones forming in the body.

Surgery

Open surgery for gallstones involves removing the gallbladder where the stones are located, called a cholecystectomy.

A traditional or open cholecystectomy is a medical procedure where a surgeon makes a 6-inch cut along your right abdomen below the ribs, exposing your liver and gallbladder. The gallbladder is then removed.

Laparoscopic cholecystectomy is a minimally invasive procedure that uses a thin tube with a camera. This tube is inserted into the abdomen, where the surgeon removes the gallbladder.

When gallstones are formed outside of the gallbladder, open surgery is still necessary to remove the stones and any tissue that has been damaged. A surgeon makes small incisions into your abdomen to assess and treat the areas where gallstones have formed.

Your Next Steps

The good news? You don’t have to wait until painful symptoms appear to prevent gallstones from forming, whether you have a gallbladder or not.

You can stay one step ahead of gallstones by managing risk factors and regular screening for abnormalities.

At Ezra, our full-body MRI scan examines your organs for signs of abnormalities, including the presence of any forming gallstones. This non-invasive whole-body screening helps you understand where you are on your health journey, and may help guide you to making long-term changes toward better health.

Recommending reading: How — and Why — an MRI of the Gallbladder May Help Catch Early Cancer

Book a full-body MRI scan today, or gift one to a loved one.

You can also schedule a call with our team to learn more. Contact us at (888) 402-3972 or [email protected]

Gallstones | HealthLink BC

Condition Basics

What are gallstones?

Gallstones are stones that form in the gallbladder. The gallbladder is a small sac located just under the liver. It stores bile released by the liver. Bile helps you digest fats. Gallstones can be smaller than a grain of sand or as large as a golf ball.

Gallstones form when cholesterol and other things found in bile make stones. They can also form if the gallbladder doesn’t empty as it should.

Gallstones can also form in the common bile duct or cystic duct. These tubes carry bile from the gallbladder and the liver to the small intestine.

What causes them?

Gallstones form when cholesterol and other substances found in bile make stones. They can also form if the gallbladder doesn’t empty as it should. People who are overweight or who are trying to lose weight quickly are more likely to get gallstones.

What are the symptoms?

Most people who have gallstones don’t have symptoms. If you have symptoms, you likely will have pain in your stomach or the upper right part of your belly. Pain may spread to your right upper back or shoulder blade area. When gallstones block a bile duct, you may have pain with fever and chills.

How are they diagnosed?

Your doctor will do a physical examination and ask you questions about when the pain in your belly started, where it is, and if it comes and goes or is always there. If your doctor thinks you have gallstones, he or she may order an ultrasound of the belly to confirm the diagnosis.

How are gallstones treated?

If you don’t have symptoms, you probably don’t need treatment. If your first gallstone attack causes pain, your doctor may tell you to take pain medicine and wait to see if the pain goes away. If you have more attacks, you may want to have your gallbladder removed.

How can you prevent them?

There is no sure way to prevent gallstones. But you can reduce your risk of forming gallstones that can cause symptoms.

• Stay at a healthy weight. If you need to lose weight, do so slowly and sensibly.
• Eat regular, balanced meals.
• Be active, and exercise regularly.

Health Tools

Health Tools help you make wise health decisions or take action to improve your health.

Decision Points focus on key medical care decisions that are important to many health problems.

Cause

Gallstones develop when cholesterol and other substances in the bile form crystals that become hard stones in the gallbladder. The gallbladder is a small sac located just under the liver. Gallstones can form when too much cholesterol is in the bile or when the gallbladder does not empty properly.

What Increases Your Risk

Your chances of forming gallstones that can cause symptoms are higher if you:

• Are female. Females are twice as likely as males to have gallstones.
• Are older than 55.
• Are Indigenous or Hispanic.
• Have a family history of gallstones.

You may also be increasing your risk for gallstones if you:

• Are overweight.
• Lose weight rapidly or lose weight by dieting and then gain weight back again.
• Are pregnant.
• Are taking estrogen (after menopause) or high-dose birth control pills.
• Get very little or no exercise.
• Do not eat for a period of time (fast).

Symptoms

Most people who have gallstones don’t have symptoms. When symptoms occur, they can include:

• Pain in the pit of your stomach or in the upper right part of your belly. It may spread to your right upper back or shoulder blade area.
• Pain that may come and go or be steady. It may get worse when you eat.
• Fever and chills, if a gallstone is blocking a bile duct and causing an infection.
• Yellowing of your skin and the whites of your eyes.

Pain can last 15 minutes to 24 hours. Continuous pain for 1 to 5 hours is common. The pain may begin at night and be severe enough to wake you. Pain often starts after eating food that is high in fat. The pain usually makes it hard to get comfortable. Moving around doesn’t make the pain go away.

What Happens

The progression of gallstones depends on whether you have symptoms. Most people with gallstones have no symptoms and do not need treatment.

The most common problem caused by gallstones occurs when a gallstone blocks the cystic duct that drains the gallbladder. It often causes bouts of pain that come and go as the gallbladder contracts and expands. The bouts of pain are often severe and steady. The pain can last from 15 minutes to up to 6 hours. And the pain may get worse after a meal. Symptoms usually improve within a few days.

If the pain is severe or if you have had gallbladder pain before, you may need to have your gallbladder removed.

In rare cases, gallstones can cause pancreatitis, an inflammation of the pancreas. Gallstones back up the flow of digestive enzymes made by the pancreas. Pancreatitis may cause sudden, severe belly pain, loss of appetite, nausea and vomiting, and fever.

Learn more

When to Call

Call
911
or other emergency services immediately if you:

• Have sudden or severe abdominal pain.
• Have trouble breathing.
• Faint or lose consciousness.

Call your doctor now if you have:

• Pain that may be caused by gallstones (continuous moderate to severe pain in the upper right abdomen) along with a fever and chills that are clearly not caused by a stomach infection or any other reason.
• Pain in the upper midsection or upper right abdomen, along with a yellow tint to your skin and the white part of your eyes, dark yellow-brown urine, or light-coloured stools.
• Diabetes or an impaired immune system and you have symptoms that may be caused by gallstones.

If you have symptoms of gallstones but no fever, chills, or yellowing of your skin or the white part of your eyes, you may still need to be checked and treated. Schedule an appointment with your doctor.

Watchful waiting

Watchful waiting means taking a wait-and-see approach. You and your doctor watch your symptoms or condition to see if you need treatment. It’s often the first approach to a first attack of gallstone pain.

Check your symptoms

Examinations and Tests

Most people who have gallstones don’t know it because they don’t have symptoms.

If you have symptoms, your doctor will do a physical examination. He or she will ask you questions about when the pain in your belly started, where it is, and if it comes and goes or is always there. If your doctor thinks you have gallstones, your doctor may order tests to confirm the diagnosis. Tests might include:

• An abdominal ultrasound. This is the best way to confirm gallstones. A technologist moves a wand across your belly to create pictures on a screen.
• A gallbladder scan. Your doctor may do this if your ultrasound didn’t show gallstones. In this test, a special dye is injected into a vein in your arm.
• An endoscopic retrograde cholangiopancreatogram (ERCP). This test checks the tubes (ducts) that drain the liver, gallbladder, and pancreas. A flexible, lighted scope (endoscope) and X-ray pictures are used.

What a gallstone looks like on an abdominal

ultrasound

Courtesy of Intermountain Medical Imaging, Boise, Idaho.

Figure 1 shows a normal gallbladder on ultrasound. Figure 2 shows a large gallstone in the gallbladder.

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Treatment Overview

If you don’t have symptoms, you probably don’t need treatment.

If you do have symptoms and your first gallstone attack causes pain, your doctor may tell you to take pain medicine and wait to see if the pain goes away. You may never have another attack. Waiting to see what happens usually won’t cause problems.

If you have a second attack, you may want to have your gallbladder removed. A second attack means you’re more likely to have future attacks. Many people have their gallbladders removed. And the body works fine without a gallbladder.

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Self-Care

• Rest until you feel better.
• Be safe with medicines. Read and follow all instructions on the label.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• Avoid foods that cause symptoms, especially fatty foods. These can make the gallbladder tighten and cause pain.

Surgery

Surgery to remove the gallbladder (cholecystectomy) is the treatment of choice for gallstones that cause moderate to severe pain or other symptoms. Symptoms usually don’t return after the gallbladder is removed. If you have certain health problems, surgery may also be done even if you don’t have symptoms. In a small number of cases, surgery may be done to prevent other problems from gallstones.

Laparoscopic surgery is the most common way to remove the gallbladder. A doctor puts a lighted viewing tool and surgical tools into your belly through several small cuts. People who have this surgery usually recover in about 1 week.

Open surgery involves one larger cut. The gallbladder is removed through this cut. It may be done if laparoscopic surgery isn’t an option. Or it may be done when other problems are found during laparoscopic surgery. This type of surgery requires a longer recovery period. It also causes more pain.

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Credits

Treatment of cholelithiasis – news from the Department of Oncology, St. Petersburg State University

Cholelithiasis (GSD). This is the formation of stones (calculi) in the gallbladder, bile ducts. Stones in the gallbladder lead to the development of cholecystitis.

It is possible to single out external and internal factors predisposing to the development of the disease.

Internal factors:

Gender – women suffer from gallstone disease 3-5 times more often than men.
Age – as the life progresses, the incidence increases and becomes maximum after 70 years
Congenital anomalies of development – stenosis and cysts of the common bile duct, which impede the outflow of bile outflow.

What are the manifestations of this disease?

This disease develops very slowly and gradually. For a number of years, you feel a slight bitterness in your mouth, heaviness in the right hypochondrium after eating, especially after eating fatty foods, fried meat, smoked, salty, pickled foods or wine. In the future, biliary colic, nausea, vomiting, flatulence are observed.

Biliary colic is a sudden onset of severe pain that tends to recur repeatedly. This pain is localized in the right hypochondrium and is extremely intense. It has a piercing, cutting, tearing character. Pain in biliary colic often radiates to the entire right half of the body, and sometimes to the region of the heart, which sometimes causes a lot of difficulties in diagnosis.

Biliary colic is always accompanied by anxiety of patients, they moan, scream, do not find a place in bed, and this despite the fact that the attack can last up to 6-8 hours. Sometimes this condition requires emergency surgical intervention, so it is very important to diagnose cholelithiasis in time.

The main method of diagnosis is ultrasound examination (ultrasound) of the abdominal cavity. In the case of an ultrasound scan by a qualified specialist, there is no need for additional examinations.

External factors:

external factors are associated with geographical, national and
economic characteristics of the life of the population. The increase in the prevalence of cholelithiasis throughout the 20th century,
mainly in economically developed countries, is explained by an increase in the consumption of food rich in fat and animal proteins.

Treatment

The only radical way to treat gallstone disease is to remove the diseased gallbladder.

If biliary colic was at least once in a lifetime, then removal of the gallbladder is simply necessary in the near future, since the next colic can result in serious complications and an emergency operation. But it is much better to perform a planned laparoscopic cholecystectomy, in which the risk of side effects will be minimal and after 5-7 days patients return to their normal lifestyle, while emergency cholecystectomy will put you out of action for at least 2-3 weeks and is fraught with a difficult postoperative period .
Laparoscopic cholecystectomy is a low-traumatic operation performed under general anesthesia. The entire operation is performed through three or four punctures up to 1 cm in diameter. If the patient is not obese, then there are practically no scars after the intervention. After the puncture is made, air is pumped into the abdomen to create space for work. AT
, a camera with illumination is inserted into one hole, an ultrasonic or electric scalpel
is inserted into the other, and an auxiliary
manipulator is inserted into the third. A special clamp
is applied to the neck of the gallbladder, after which it is separated and one of the holes, more often the umbilical one, is removed through
, since a wider incision in
this area will not be noticeable.

Prevention of cholelithiasis – Tula Regional Clinical Hospital

Cholelithiasis is a disease characterized by a disorder in the synthesis and circulation of bile in the hepatobiliary system as a result of a violation of cholesterol or bilirubin metabolism, resulting in the formation of stones (calculi) in the bile ducts and gall bladder. Gallstone disease is dangerous by the development of severe complications with a high probability of death.

Risk factors for the development of cholelithiasis are: advanced and senile age, medications that interfere with the metabolism of cholesterol and bilirubin, genetic factors, malnutrition (obesity, rapid weight loss, starvation, elevated levels of cholesterol and high-density lipoproteins in the blood, hypertriglycerinemia), multiple pregnancies , metabolic diseases, diseases of the gastrointestinal tract, postoperative conditions (after resection of the stomach, stem vagoectomy).

Cholelithiasis is much more common in women.

Causes of stone formation.

In case of violation of the quantitative ratio of bile components in the body, the formation of solid formations (flakes) occurs, which, with the course of the disease, grow and merge into stones. The most common cholelithiasis occurs with impaired cholesterol metabolism (excessive content in bile). Cholesterol-rich bile is called lithogenic.

Excess cholesterol is formed due to the following factors:

• with obesity and consumption of large amounts of cholesterol-containing foods;
• with a decrease in the amount of bile acids entering the bile;
• with a decrease in the amount of phospholipids, which, like bile acids, do not allow cholesterol and bilirubin to pass into a solid state and settle;
• with congestion in the bile circulation system (bile thickening due to absorption of water and bile acids in the gallbladder).

Bile stasis, in turn, can be mechanical and functional. With mechanical stagnation, there is an obstruction to the outflow of bile from the bladder. Functional disorders are associated with disorders of the motility of the gallbladder and biliary tract.

Infections, inflammation of the biliary system, allergic reactions, autoimmune conditions can also lead to the development of cholelithiasis.

Clinical manifestations of cholelithiasis.

A characteristic pain symptom in cholelithiasis is biliary or hepatic colic – a pronounced acute sudden pain under the right rib of a cutting, stabbing character. After a couple of hours, the pain is finally concentrated in the projection of the gallbladder. It can radiate to the back, under the right shoulder blade, to the neck, to the right shoulder. Sometimes irradiation to the region of the heart can cause angina pectoris.

Pain most often occurs after eating spicy, spicy, fried, fatty foods, alcohol, stress, heavy physical exertion, prolonged work in an inclined position. The causes of the development of pain syndrome are a spasm of the muscles of the gallbladder and ducts as a reflex response to irritation of the wall with calculi and as a result of overdistension of the bladder with excess bile in the presence of obstruction in the biliary tract.

Depending on the severity of intoxication, there is an increase in temperature from subfebrile numbers to severe fever. When the calculus obstructs the common bile duct and obstructs it, obstructive jaundice and discoloration of the feces are observed.

Complications of cholelithiasis.

The most common complication of cholelithiasis is inflammation of the gallbladder (acute and chronic) and obstruction of the biliary tract by a calculus. Blockage of the bile ducts in the pancreas can cause acute biliary pancreatitis. Also, a common complication of gallstone disease is inflammation of the bile ducts – cholangitis.

Treatment of cholelithiasis.

If acute or chronic calculous cholecystitis develops, removal of the gallbladder is indicated as a source of stone formation. Surgical intervention (cholecystotomy) is abdominal or laparoscopic, depending on the state of the body, pathological changes in the walls of the bladder and surrounding tissues, and the size of the stones.

There are methods for dissolving stones with ursodeoxycholic and chenodeoxycholic acid preparations, but this kind of therapy does not lead to a cure for cholelithiasis and, over time, the formation of new stones is possible. Taking drugs that enhance the secretion of bile in the presence of stones in the bladder is contraindicated.

Prognosis and prevention of cholelithiasis.

Prevention of cholelithiasis consists in avoiding factors that contribute to increased cholesterolemia and bilirubinemia, bile stasis. A balanced diet, normalization of body weight, an active lifestyle with regular physical activity can avoid metabolic disorders, and timely detection and treatment of pathologies of the biliary system (dyskinesia, obstruction, inflammatory diseases) can reduce the likelihood of bile stasis and sedimentation in the gallbladder. Particular attention should be paid to the exchange of cholesterol and the state of the biliary system in persons with a genetic predisposition to stone formation.

In the presence of stones in the gallbladder, prevention of attacks of biliary colic will be following a strict diet (exclusion from the diet of fatty, fried foods, muffins, confectionery creams, sweets, alcohol, carbonated drinks, etc.