Where do gallstones form. What are the main types of gallstones. How do gallstones develop. Who is at higher risk for developing gallstones. What health conditions increase the likelihood of gallstone formation. How does diet affect gallstone risk. Can medications contribute to gallstone development.

Understanding Gallstones: A Comprehensive Overview

Gallstones are solid, pebble-like formations that develop in the gallbladder, a small organ located beneath the liver. These stones arise when bile, a digestive fluid, hardens and crystallizes. Gallstones can vary significantly in size, ranging from tiny granules resembling sand to larger masses comparable to golf balls. While a single large stone may form, it’s also possible for hundreds of smaller stones to develop simultaneously.

Interestingly, many individuals with gallstones remain asymptomatic. However, complications can arise when these stones obstruct the bile ducts, potentially leading to severe infections in the bile ducts, pancreas, or liver. It’s crucial to note that once gallstones have formed, the risk of developing more increases.

Two Primary Types of Gallstones

• Cholesterol stones: These are the most prevalent type, often appearing yellow-green and primarily composed of hardened cholesterol.
• Pigment stones: Less common than cholesterol stones, these dark-colored formations consist mainly of bilirubin, a yellowish pigment.

The Formation Process of Gallstones

Cholesterol stones typically form when the gallbladder doesn’t empty properly or when the bile composition is imbalanced. Factors contributing to their formation include:

• Excessive cholesterol in the bile
• High levels of bilirubin
• Insufficient bile salts

The exact cause of pigment stone formation remains unclear. However, they are more frequently observed in individuals with certain health conditions, such as liver cirrhosis, biliary tract infections, or hereditary blood disorders like sickle cell anemia.

Identifying High-Risk Groups for Gallstone Development

Several demographic factors can increase an individual’s susceptibility to gallstones:

• Native Americans: They exhibit the highest rates of gallstones in the United States, possibly due to genetic factors resulting in elevated cholesterol levels in their bile.
• Mexican Americans: This group shows above-average rates of gallstone occurrence.
• Women: Females are twice as likely as males to develop gallstones.
• Individuals over 60: The risk of gallstone formation increases with age.
• Those with a family history: Gallstones appear to have a hereditary component, suggesting a genetic link.

Health Conditions That Elevate Gallstone Risk

Various health issues can contribute to an increased likelihood of developing gallstones:

1. Obesity: This is a significant risk factor, particularly for women.
2. Estrogen-related factors: Pregnancy, hormone replacement therapy, and birth control pills can raise cholesterol levels in bile and slow gallbladder movement.
3. Diabetes: Individuals with diabetes often have elevated levels of triglycerides, which can promote gallstone formation.
4. Liver disease: Conditions like cirrhosis can alter bile composition and increase the risk of pigment stones.
5. Blood disorders: Hereditary conditions such as sickle cell anemia are associated with a higher incidence of pigment stones.

Dietary Influences on Gallstone Formation

Diet plays a crucial role in gallstone development. How does diet affect the risk of gallstones. A high-fat, high-cholesterol, or low-fiber diet can significantly increase the likelihood of gallstone formation. These dietary patterns can lead to:

• Increased cholesterol levels in bile
• Reduced gallbladder emptying
• Alterations in bile composition

Conversely, adopting a balanced diet rich in fiber and low in saturated fats may help reduce the risk of gallstone development.

The Impact of Medications on Gallstone Risk

Certain medications can influence the formation of gallstones. Cholesterol-lowering medicines, while beneficial for cardiovascular health, may inadvertently increase the amount of cholesterol in bile, potentially promoting gallstone formation. It’s essential for individuals taking these medications to be aware of this potential side effect and discuss any concerns with their healthcare provider.

Lifestyle Factors and Gallstone Prevention

While some risk factors for gallstones are beyond an individual’s control, several lifestyle modifications can help reduce the likelihood of their formation:

• Maintaining a healthy weight through balanced nutrition and regular exercise
• Avoiding rapid weight loss, as this can increase the risk of gallstone development
• Consuming a diet rich in fruits, vegetables, and whole grains
• Limiting intake of saturated fats and cholesterol
• Staying hydrated to support proper bile flow

Do regular exercise and physical activity impact gallstone risk. Indeed, engaging in regular physical activity has been associated with a reduced risk of gallstone formation. Exercise can help maintain a healthy weight, improve cholesterol levels, and promote healthy digestion, all of which contribute to a lower likelihood of developing gallstones.

Recognizing Gallstone Symptoms and Seeking Treatment

While many gallstones remain asymptomatic, it’s crucial to be aware of potential signs that may indicate their presence or complications. Common symptoms include:

• Sudden, intense pain in the upper right abdomen or center of the abdomen
• Pain that radiates to the right shoulder or between the shoulder blades
• Nausea or vomiting
• Fever or chills, which may indicate an infection
• Jaundice (yellowing of the skin and eyes)

When should you seek medical attention for suspected gallstones. If you experience severe abdominal pain, particularly if accompanied by fever or jaundice, it’s essential to seek immediate medical care. These symptoms could indicate a serious complication, such as a blockage in the bile ducts or an infection.

Treatment options for gallstones vary depending on the severity of symptoms and the individual’s overall health. They may include:

1. Watchful waiting for asymptomatic gallstones
2. Medications to dissolve small gallstones (though this approach is less common)
3. Surgical removal of the gallbladder (cholecystectomy), which is the most definitive treatment for symptomatic gallstones

Advances in Gallstone Research and Future Directions

Ongoing research in the field of gastroenterology continues to shed light on the complex mechanisms underlying gallstone formation. Recent studies have explored various aspects of gallstone development, including:

• The role of gut microbiota in influencing bile composition and gallstone risk
• Genetic factors that may predispose certain individuals to gallstone formation
• Novel non-invasive techniques for diagnosing and monitoring gallstones
• Potential new treatments that target the underlying causes of gallstone formation

How might future research impact gallstone prevention and treatment? As our understanding of gallstone formation deepens, we may see the development of more targeted preventive strategies and personalized treatment approaches. This could include:

• Tailored dietary recommendations based on an individual’s genetic profile and risk factors
• Advanced medications that more effectively dissolve existing gallstones or prevent their formation
• Improved surgical techniques that further reduce recovery time and potential complications

These advancements hold promise for improving the management of gallstones and reducing their impact on public health.

The Global Burden of Gallstone Disease

Gallstone disease represents a significant health concern worldwide, with prevalence rates varying across different populations and geographic regions. Understanding the global impact of gallstones is crucial for developing effective public health strategies and allocating resources appropriately.

How does the prevalence of gallstones differ across countries? While gallstone disease is common in many parts of the world, its prevalence shows notable variations:

• Western countries generally have higher rates of gallstones, particularly cholesterol stones
• Asian countries traditionally had lower rates, though these have been increasing with the adoption of Western diets
• Some indigenous populations, such as Native Americans, show exceptionally high rates of gallstone disease

These variations can be attributed to a combination of genetic, dietary, and lifestyle factors unique to each population.

The economic impact of gallstone disease is substantial, encompassing direct medical costs, lost productivity, and decreased quality of life for affected individuals. As populations age and lifestyle-related risk factors become more prevalent, the burden of gallstone disease is expected to increase in many parts of the world.

Addressing this growing health challenge will require a multifaceted approach, including:

• Public health initiatives aimed at promoting healthy lifestyles and reducing risk factors
• Improved access to diagnostic tools and treatment options in underserved areas
• Continued research into the underlying mechanisms of gallstone formation and potential new therapies
• Education programs to raise awareness about gallstone prevention and early symptom recognition

By focusing on these areas, healthcare systems and policymakers can work towards reducing the global burden of gallstone disease and improving outcomes for affected individuals.

Gallstones in Special Populations

While gallstones can affect individuals of all ages and backgrounds, certain populations require special consideration due to unique risk factors or management challenges. Understanding these special populations is crucial for providing targeted care and developing appropriate prevention strategies.

Pregnant Women

Pregnancy is associated with an increased risk of gallstone formation. Why do pregnant women have a higher risk of developing gallstones? Several factors contribute to this elevated risk:

• Increased estrogen levels, which can raise cholesterol in bile
• Reduced gallbladder motility during pregnancy
• Weight gain and changes in body composition

Management of gallstones during pregnancy requires careful consideration of both maternal and fetal health. While conservative management is often preferred, severe cases may necessitate surgical intervention, typically in the second trimester when risks are lowest.

Pediatric Patients

Although less common than in adults, gallstones can occur in children and adolescents. Risk factors in this population may include:

• Obesity, which is increasingly prevalent in pediatric populations
• Certain medications, such as oral contraceptives in adolescent girls
• Hereditary blood disorders
• Prolonged total parenteral nutrition

Diagnosis and management of gallstones in pediatric patients often require specialized expertise to ensure appropriate care while minimizing potential long-term complications.

Elderly Individuals

The risk of gallstone formation increases with age, making the elderly a particularly vulnerable population. Challenges in managing gallstones in older adults include:

• Higher prevalence of comorbidities that may complicate treatment
• Increased risk of complications from both the disease and its treatments
• Potential difficulties in symptom recognition due to atypical presentations

Tailored approaches that consider the individual’s overall health status and quality of life goals are essential when treating gallstones in the elderly.

Bariatric Surgery Patients

Individuals who undergo bariatric surgery for weight loss are at increased risk of developing gallstones, particularly during rapid weight loss phases. How does bariatric surgery affect gallstone risk? The mechanisms include:

• Rapid weight loss, which can increase cholesterol saturation in bile
• Changes in bile acid metabolism
• Alterations in gallbladder motility

Preventive strategies, such as prophylactic cholecystectomy or use of bile acid supplements, may be considered for high-risk patients undergoing bariatric procedures.

By recognizing the unique needs and risk factors of these special populations, healthcare providers can offer more targeted preventive measures and treatment strategies, ultimately improving outcomes and quality of life for individuals at risk of or affected by gallstone disease.

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What are gallstones?

Gallstones are lumps of solid material that form in your gallbladder. They are also
called cholelithiasis. They are made when the digestive juice called bile turns hard
and
stone-like.

The
gallbladder is a small organ under your liver. It stores bile made by the liver. Bile
is
made of several things such as cholesterol, bile salts, and a yellowish pigment
(bilirubin).

Gallstones can be as small as a grain of sand or as big as a golf ball. Your
gallbladder may form a single large stone, hundreds of tiny stones, or both sizes
at the
same time. Gallstones often don’t cause any symptoms. But in some cases, gallstones
block the tubes that carry bile (bile ducts). This can lead to a life-threatening
infections of the bile ducts, pancreas, or liver. Once you have had gallstones, you
are
at risk of having more.

There
are two types of gallstones: cholesterol and pigment.

Cholesterol stones

These stones are:

• Most
  common type of stone
• Often a yellow-green color
• Made
  mainly of hardened cholesterol

Pigment stones

These stones are:

• Less
  common
• Dark
  color
• Made
  of a yellowish pigment called bilirubin

What causes gallstones?

Cholesterol stones form when your gallbladder doesn’t empty the way it should. They
also form when bile has:

• Too much cholesterol
• Too much of a yellowish pigment called bilirubin
• Not enough bile salts

Health experts don’t know what causes pigment stones to form. But pigment stones are
more common in people who have:

• A liver disease (cirrhosis) where scar tissue replaces healthy liver tissue
• An infection in the vessels that transport bile (biliary tract infection)
• Blood
  disorders that are passed from parent to child (hereditary) such as sickle cell
  anemia

Who is at risk for gallstones?

Some people have a higher risk for gallstones. These include:

• Native
  Americans.
  They have the highest rates of gallstones in the U. S. This may be
  genetic as they have very high levels of cholesterol in their bile.
• Mexican
  Americans.
  They have higher than average rates of gallstones.
• Women.They are twice as likely to have gallstones as men.
• People over
  age 60.
  Risk for gallstones increases with age.
• People with a
  family history of gallstones.
  Gallstones seem to run in some families
  (inherited). There may be a genetic link.

Health issues that may raise your risk for gallstones include:

• Obesity.
  This is a major risk factor, mainly for women.
• Estrogen. Women may have extra estrogen from pregnancy, hormone replacement
  therapy, or birth control pills. This seems to raise cholesterol levels in bile and
  slow down gallbladder movement. Both can lead to gallstones.
• Diet.
  Eating a high-fat, high-cholesterol, or low-fiber diet raises your risk. They lead
  to
  more cholesterol in the bile and reduced gallbladder emptying.
• Cholesterol-lowering medicines. These medicines can increase the amount of
  cholesterol in bile.
• Diabetes. People with diabetes often have high levels of fatty acids
  (triglycerides). This raises the risk for gallstones.
• Very fast
  weight loss.
  As the body processes fat during very fast weight loss, the
  liver sends out extra cholesterol into bile.
• Not eating
  for a few days (prolonged fasting).
  Fasting slows down gallbladder movement.
  Over time, your bile has too much cholesterol.

What are the symptoms of gallstones?

Some people with gallstones don’t have any symptoms. These stones are called silent
stones. They don’t stop the gallbladder, liver, or pancreas from working properly.
In most cases they don’t need to be treated. Most gallstones don’t cause symptoms
right away.  

Gallstone symptoms (also called a gallbladder attack) may happen very suddenly. They
often:  

• Begin when gallstones get bigger
• Happen when the stones start to block bile ducts
• Occur after a fatty meal or at night

Each person’s symptoms may vary. Symptoms may include:

• Steady, severe pain in your upper belly (abdomen) that quickly gets worse
• Pain in your back between the shoulder blades
• Pain in your right shoulder
• Nausea
• Vomiting
• Fever
• Chills
• Yellowing of the skin or eyes (jaundice)

See your healthcare provider right away if you have any of these symptoms during or
after a gallbladder attack:

• Pain that lasts more than 5 hours
• Sweating
• Chills
• Low-grade fever
• Yellowish color of the skin or whites of the eyes
• Clay-colored stools

The symptoms of gallstones may look like other health problems. Always see your healthcare
provider to be sure.

How are gallstones diagnosed?

Many
people have gallstones but don’t know it because they don’t have symptoms. In some
cases, gallstones are found by accident. This may happen if you are being tested for
a
different health problem.

But if you have pain that doesn’t go away, your healthcare provider will look at your
past health and give you a physical exam. 

You may also have some tests to check for gallstones such as:

• Ultrasound. This imaging test uses high-frequency sound waves to create
  images of your internal organs on a computer screen. It is used to see the
  gallbladder and gallstones.
• HIDA or
  PIPIDA scan (hepatobiliary scintigraphy or cholescintigraphy).
  This scan
  checks for any abnormal contractions of the gallbladder and blockages in your bile
  ducts. A radioactive chemical or tracer is shot (injected) into your vein. The amount
  of radiation is very small. It is not harmful. It collects in your liver and flows
  into your gallbladder. A special scanner is used to watch the tracer move through
  your organs. You will take a medicine to make your gallbladder contract.
• Blood
  tests.
  These look for signs of infection, blockage, liver problems, jaundice,
  and inflammation of the pancreas (pancreatitis).
• CT scan.
  A CT scan is an imaging test that uses X-rays and a computer to make detailed
  pictures of any part of the body. It can show gallstones. It can also show infection
  or bursting of the gallbladder or bile ducts.
• MRCP (magnetic resonance cholangiopancreatography).
  This is a special MRI test that creates images using magnetic fields and pulsed radio
  wave energy.
• EUS (endoscopic ultrasound). This internal
  ultrasound (sonogram) is done with a flexible lighted scope. You are given medicine
  to help you relax and then a scope is passed through your mouth. It creates internal
  images using sound waves.
• ERCP
  (endoscopic retrograde cholangiopancreatography).
  ERCP uses both X-ray and a
  long flexible lighted tube with a camera near the end (catheter). . While you are
  sedated, the tube is put in your mouth and throat. It goes down your food pipe
  (esophagus), through your stomach, and into the first part of your small intestine
  (duodenum). Your healthcare provider can see the inside of these organs on a video
  screen and check for any problems. A dye is put into your bile ducts through the
  tube. The dye lets the bile ducts be seen clearly on the X-ray.

How are gallstones treated?

If your gallstones don’t cause any symptoms, you often don’t need treatment.

Gallstones that do cause symptoms should be treated right away. They may lead to damage
or infection if your bile ducts are blocked for a long time.

If your symptoms don’t go away, your treatment may include:

• ERCP
  (endoscopic retrograde cholangiopancreatography).
  ERCP uses both X-ray and a
  long flexible lighted tube (endoscope). While you are sedated, the tube is put into
  your mouth and throat. It goes down your food pipe (esophagus), through your stomach,
  and into the first part of your small intestine (duodenum). A dye is put into your
  bile ducts through the tube. The dye lets the bile ducts be seen clearly on X-rays.
  Small stones can be taken out through the scope.
• Sphincterotomy. This can also be done through the tube during an ERCP. Tight
  rings of muscle (called sphincters) are around the openings of the bile ducts. They
  can block gallstones. Cutting these rings lets the ducts open wider so that stones
  can pass into your intestine.
• Gallbladder
  removal (cholecystectomy).
  If stones are in your gallbladder, your
  gallbladder must be removed. These stones cannot be taken out with ERCP. Gallbladder
  removal is a common surgery. Your body will work well without your gallbladder. It
  is
  not essential for a healthy life.
• Percutaneous
  drainage/cholecystostomy.
  If stones in your gallbladder cause a blockage of
  bile acid and  subsequent infection, your gallbladder will have to be removed. But
  if
  you are too sick to have surgery or there are other complications, a drainage tube
  may be inserted into your gallbladder through the skin of your abdomen. This will
  temporarily bypass the blockage and drain any infection.
• Oral
  dissolution therapy.
  The stones are dissolved using medicines made from bile
  acid. But, it can take a couple of years to completely dissolve the stones. They also
  tend to come back when the medicine is stopped.
• Methyl-tert-butyl ether. This solution or a similar chemical can be shot
  (injected) through the skin into your gallbladder to dissolve stones. This is an
  uncommon procedure.

Most people respond very well once their stones are dissolved or taken out.

Key points about
gallstones

• Gallstones are lumps of solid material that form in your gallbladder.
• They are made when the digestive juice called bile gets hard and stone-like.
• If your gallstones cause no symptoms, treatment is often not needed.
• If
  symptoms don’t go away, you will need treatment to remove the gallstones.
• If
  stones are in your gallbladder, the gallbladder must generally be removed. This is
  a
  common surgery.

Next steps

Tips to help you get the most from a visit to your health care
provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember
  what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any
  new medicines, treatments, or tests. Also write down any new instructions your
  provider gives you.
• Know why a new medicine or treatment is prescribed, and how it
  will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results
  could mean.
• Know what to expect if you do not take the medicine or have the
  test or procedure.
• If you have a follow-up appointment, write down the date, time,
  and purpose for that visit.
• Know how you can contact your provider if you have questions.

Medical Reviewer: Jen Lehrer MD

Medical Reviewer: Ronald Karlin MD

Medical Reviewer: Raymond Kent Turley BSN MSN RN

© 2000-2022 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

Gallstones – Illnesses & conditions

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Hide guide parts

1. 1.

   About gallstones

2. 2.

   Symptoms of gallstones

3. 3.

   Causes of gallstones

4. 4.

   Diagnosing gallstones

5. 5.

   Treating gallstones

6. 6.

   Complications of gallstones

7. 7.

   Preventing gallstones

About gallstones

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

However, if a gallstone becomes trapped in a duct (opening) inside the gallbladder it can trigger a sudden intense abdominal pain 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), which can cause:

• persistent pain
• jaundice 
• a fever

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

• symptoms of gallstones
• complications of gallstones

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 through a series of channels, known as bile ducts, into the gallbladder.

The bile is stored in the gallbladder and over time it becomes more concentrated, which makes it better at digesting fats. The gallbladder releases bile into the digestive system when it’s needed.

What causes 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 that 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’ve had children
• 40 or over (the risk increases as you get older)

Read more about:

• causes of gallstones 
• preventing gallstones

Treating gallstones

Treatment is usually only necessary if gallstones are causing:

• symptoms – such as abdominal 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.

You can lead a perfectly normal life without a gallbladder. Your liver will still produce bile to digest food, but the bile will just drip continuously into the small intestine, rather than build up in the gallbladder.

Read more about:

• treating gallstones
• diagnosing gallstones

Outlook

Most cases of gallstone disease are easily treated with surgery.  Very severe cases can be life-threatening, especially in people who are already in poor health. However, deaths from gallstone disease are rare in the UK.

Symptoms of gallstones

Most cases of gallstones don’t cause any symptoms. But if a gallstone blocks one of the bile ducts, it can cause sudden, severe abdominal pain, known as biliary colic.

Other symptoms may develop if the blockage is more severe or develops in another part of the digestive system.

Abdominal pain (biliary colic)

Gallstones can cause sudden, severe abdominal pain that usually lasts 1 to 5 hours (although it can sometimes last just a few minutes).

The pain can be felt:

• in the centre of your abdomen (tummy)
• just under the ribs on your right-hand side – it may spread from here to your side or shoulder blade

The pain is constant and isn’t relieved when you go to the toilet, pass wind or are sick. It’s sometimes triggered by eating fatty foods, but may occur at any time of day and it may wake you up during the night.

Biliary colic doesn’t happen often. After an episode of pain, it may be several weeks or months before you experience another episode.

Some people also have periods where they sweat excessively and feel sick or vomit.

When gallstones cause episodes of biliary colic, it is known as ‘uncomplicated gallstone disease’.

Other symptoms

In a small number of people, gallstones can cause more serious problems if they obstruct the flow of bile for longer periods or move into other organs (such as the pancreas or small bowel).

If this happens, you may develop:

• a high temperature of 38C (100.4F) or above
• more persistent pain
• a rapid heartbeat
• yellowing of the skin and whites of the eyes (jaundice)
• itchy skin
• diarrhoea
• chills or shivering attacks
• confusion
• a loss of appetite

Doctors refer to this more severe condition as ‘complicated gallstone disease’.

Read more about the complications of gallstones.

When to seek medical advice

If you think you may be experiencing biliary colic, you should make an appointment with your GP.

Contact your GP immediately for advice if you develop:

• jaundice
• abdominal pain lasting longer than eight hours
• a high temperature and chills
• abdominal pain so intense that you can’t find a position to relieve it

If it’s not possible to contact your GP immediately, phone your local out-of-hours NHS 24 111 service.

Causes of gallstones

Gallstones are thought to be caused by an imbalance in the chemical make-up of bile inside the gallbladder. Bile is a liquid produced by the liver to aid digestion.

It’s still unclear exactly what leads to this imbalance, but gallstones can form if:

• there are unusually high levels of cholesterol inside the gallbladder (about 4 in every 5 gallstones are made up of cholesterol)
• there are unusually high levels of a waste product called bilirubin inside the gallbladder (about 1 in every 5 gallstones is made up of bilirubin)

These chemical imbalances cause tiny crystals to develop in the bile. These can gradually grow (often over many years) into solid stones that can be as small as a grain of sand or as large as a pebble.

Sometimes only 1 stone will form, but there are often several at the same time.

Who’s at risk?

Gallstones are more common if you:

• are female, particularly if you’ve had children, are taking the combined Pill, or are undergoing high-dose oestrogen therapy
• are overweight or obese
• are aged 40 years or older (the older you are, the more likely you are to develop gallstones)
• have a condition that affects the flow of bile – such as cirrhosis (scarring of the liver), primary sclerosing cholangitis, or obstetric cholestasis 
• have Crohn’s disease or irritable bowel syndrome (IBS)
• have a close family member who’s also had gallstones
• have recently lost weight (from either dieting or weight-loss surgery)
• are taking an antibiotic called ceftriaxone

Diagnosing gallstones

Gallstones may be discovered during tests for a different condition, as they often don’t cause any symptoms.

If you do have symptoms of gallstones, make an appointment with your GP so they can try to identify the problem.

Seeing your GP

Your GP will ask about your symptoms in detail and may carry out the Murphy’s sign test to help determine if your gallbladder is inflamed.

During this test, your GP places their hand or fingers on the upper-right area of your tummy and asks you to breathe in. If you find this painful, it usually means your gallbladder is inflamed and you may need urgent treatment.

Your GP may also recommend having blood tests to look for signs of infection, or to check if your liver is working normally. If gallstones have moved into your bile duct, the liver may not be able to function properly.

Further tests

If your symptoms and test results suggest you may have gallstones, you’ll usually be referred for further tests. You may be admitted to hospital for tests the same day if your symptoms suggest you have a more severe form of gallbladder disease.

Ultrasound scan

Gallstones can usually be confirmed using an ultrasound scan, which uses high frequency sound waves to create an image of the inside of the body.

The type of ultrasound scan used for gallstones is similar to the scan used during pregnancy, where a small handheld device called a transducer is placed onto your skin and moved over your upper abdomen.

Sound waves are sent from the transducer, through your skin and into your body. They bounce back off the body tissues, forming an image on a monitor. This is a painless procedure that usually takes about 10-15 minutes to complete.

When gallstones are diagnosed, there may be some uncertainty about whether any stones have passed into the bile duct.

Gallstones in the bile duct are sometimes seen during an ultrasound scan. If they’re not visible but your tests suggest the bile duct may be affected, you may need an MRI scan or a cholangiography.

MRI scan

A magnetic resonance imaging (MRI) scan may be carried out to look for gallstones in the bile ducts. This type of scan uses strong magnetic fields and radio waves to produce detailed images of the inside of the body.

Cholangiography

A procedure called a cholangiography can give further information about the condition of your gallbladder.

A cholangiography uses a dye that shows up on X-rays. The dye may be injected into your bloodstream or injected directly into your bile ducts during surgery or using an endoscope passed through your mouth.

After the dye has been introduced, X-ray images are taken. They’ll reveal any abnormality in your bile or pancreatic systems. If your gallbladder and bile systems are working normally, the dye will be absorbed in the places it’s meant to go (your liver, bile ducts, intestines and gallbladder).

If a blockage is detected during this test, your doctor may try to remove it at this point using an endoscope. This is known as an endoscopic retrograde cholangio-pancreatography (ERCP). See treating gallstones for more information about ERCP.

CT scan

A computerised tomography (CT) scan may be carried out to look for any complications of gallstones, such as acute pancreatitis. This type of scan involves taking a series of X-rays from many different angles.

CT scans are often done in an emergency to diagnose severe abdominal pain.

Treating gallstones

Your treatment plan for gallstones depends on how the symptoms are affecting your daily life.

If you don’t have any symptoms, a policy of ‘active monitoring’ is often recommended. This means you won’t receive immediate treatment, but you should let your GP know if you notice any symptoms.

As a general rule, the longer you go without symptoms, the less likely it is that your condition will get worse.

You may need treatment if you have a condition that increases your risk of developing complications, such as:

• scarring of the liver (cirrhosis)
• high blood pressure inside the liver – this is known as portal hypertension and is often a complication of alcohol-related liver disease
• diabetes

Treatment may also be recommended if a scan shows high levels of calcium inside your gallbladder, as this can lead to gallbladder cancer in later life.

If you have episodes of abdominal pain (biliary colic), treatment depends on how the pain affects your daily activities. If the episodes are mild and infrequent, you may be prescribed painkillers to control further episodes and given advice about eating a healthy diet to help control the pain.

If your symptoms are more severe and occur frequently, surgery to remove the gallbladder is usually recommended.

The gallbladder isn’t an essential organ and you can lead a perfectly normal life without one. Some people may experience symptoms of bloating and diarrhoea after eating fatty or spicy food. If certain foods do trigger symptoms, you may wish to avoid them in the future.

Keyhole surgery to remove the gallbladder

If surgery is recommended, you’ll usually have keyhole surgery to remove your gallbladder. This is known as a laparoscopic cholecystectomy.

During a laparoscopic cholecystectomy, 3 or 4 small cuts are made in your abdomen. One larger cut (about 2-3cm) will be by the belly button and the others (each 1cm or less) will be on the right side of your abdomen.

Your abdomen is temporarily inflated using carbon dioxide gas. This is harmless and makes it easier for the surgeon to see your organs.

A laparoscope (long thin telescope with a tiny light and video camera at the end) is inserted through one of the cuts in your abdomen. This allows your surgeon to view the operation on a video monitor. Your surgeon will then remove your gallbladder using special surgical instruments.

If it’s thought there may be gallstones in the bile duct, an X-ray or ultrasound scan of the bile duct is also taken during the operation. If gallstones are found, they may be removed during keyhole surgery. If the operation can’t be done this way or an unexpected complication occurs, it may have to be converted to open surgery (see below).

After the gallbladder has been removed, the gas in your abdomen escapes through the laparoscope and the cuts are closed with dissolvable stitches and covered with dressings.

Laparoscopic cholecystectomies are usually performed under a general anaesthetic, which means you’ll be asleep during the procedure and won’t feel any pain while it’s carried out. The operation takes 60-90 minutes and you can usually go home the same day. Full recovery typically takes around 10 days.

Single-incision keyhole surgery

Single-incision laparoscopic cholecystectomy is a newer type of keyhole surgery used to remove the gallbladder. During this type of surgery, only one small cut is made, which means you’ll only have one barely visible scar.

However, single-incision laparoscopic cholecystectomies haven’t been carried out as often as conventional laparoscopic cholecystectomies, so there are still some uncertainties about it. Access to this type of surgery is also limited because it needs an experienced surgeon with specialist training.

The National Institute for Health and Care Excellence (NICE) has more information on single-incision laparoscopic cholecystectomy.

Open surgery

A laparoscopic cholecystectomy may not always be recommended, for example if you:

• are in the third trimester (the last three months) of pregnancy
• are extremely overweight
• have an unusual gallbladder or bile duct structure that makes a keyhole procedure difficult and potentially dangerous

In these circumstances, an open cholecystectomy may be recommended. During this procedure, a 10-15cm (4-6in) incision is made in your abdomen underneath the ribs so the gallbladder can be removed. This is done under general anaesthetic, so you’ll be asleep and won’t feel any pain.

Open surgery is just as effective as laparoscopic surgery, but it does have a longer recovery time and causes more visible scarring. Most people have to stay in hospital for up to 5 days and it typically takes 6 weeks to fully recover.

Endoscopic retrograde cholangio-pancreatography (ERCP)

An endoscopic retrograde cholangio-pancreatography (ERCP) is a procedure that can be used to remove gallstones from the bile duct. The gallbladder isn’t removed during this procedure, so any stones in the gallbladder will remain unless removed using the surgical techniques mentioned above.

ERCP is similar to a diagnostic cholangiography (see diagnosing gallstones for more information), where an endoscope (long, thin flexible tube with a camera at the end) is passed through your mouth down to where the bile duct opens into the small intestine.

However, during ERCP the opening of the bile duct is widened with a small incision or an electrically heated wire. The bile duct stones are then removed or left to pass into your intestine and out of your body.

Sometimes a small tube called a stent is permanently placed in the bile duct to help the bile and stones pass.

An ERCP is usually carried out under sedation, which means you’ll be awake throughout the procedure but won’t experience any pain.

The ERCP procedure lasts about 30 minutes on average, but can take from 15 minutes to over an hour. You may need to stay overnight in hospital after the procedure so you can be monitored.

Medication to dissolve gallstones

If your gallstones are small and don’t contain calcium, it may be possible to take ursodeoxycholic acid tablets to dissolve them.

However, these aren’t prescribed very often because:

• they’re rarely very effective
• they need to be taken for a long time (up to 2 years)
• gallstones can recur once treatment is stopped

Side effects of ursodeoxycholic acid are uncommon and are usually mild. The most commonly reported side effects are feeling sick, being sick and itchy skin.

The use of ursodeoxycholic acid isn’t usually recommended for pregnant or breastfeeding women. Sexually active women should use either a barrier method of contraception, such as a condom, or a low-dose oestrogen contraceptive pill while taking ursodeoxycholic acid, as it may affect other types of oral contraceptive pills.

Ursodeoxycholic acid tablets are occasionally also prescribed as a precaution against gallstones if it’s thought you’re at risk of developing them. For example, you may be prescribed ursodeoxycholic acid if you’ve recently had weight loss surgery, as rapid weight loss can cause gallstones to grow.

Complications of gallstones

A small number of people with gallstones may develop serious problems if the gallstones cause a severe blockage or move into another part of the digestive system.

Inflammation of the gallbladder (acute cholecystitis)

In some cases of gallstone disease a bile duct can become permanently blocked, which can lead to a build-up of bile inside the gallbladder. This can cause the gallbladder to become infected and inflamed.

The medical term for inflammation of the gallbladder is acute cholecystitis. Symptoms include:

• pain in your upper abdomen that travels towards your shoulder blade (unlike biliary colic, the pain usually lasts longer than five hours)
• a high temperature (fever) of 38C (100.4F) or above
• a rapid heartbeat

An estimated 1 in 7 people with acute cholecystitis also experience jaundice (see below).

Acute cholecystitis is usually treated first with antibiotics to settle the infection and then keyhole surgery to remove the gallbladder. This operation can be more difficult when performed as an emergency and there’s a higher risk of it being converted to an open procedure.

Sometimes a severe infection can lead to a gallbladder abscess (empyema of the gallbladder). Antibiotics alone don’t always treat these and they may need to be drained.

Occasionally a severely inflamed gallbladder can tear, leading to peritonitis (inflammation of the inside lining of the abdomen).  If this happens, you may need to have antibiotics given directly into a vein (intravenous antibiotics) and surgery may be required to remove a section of the lining if part of it becomes severely damaged.

Read more about acute cholecystitis.

Jaundice

If a gallstone passes out of the gallbladder into the bile duct and blocks the flow of bile, jaundice occurs.

Symptoms of jaundice include:

• yellowing of the skin and eyes
• dark brown urine
• pale stools
• itching

Sometimes the stone passes from the bile duct on its own. If it doesn’t, the stone needs to be removed. See treating gallstones.

Infection of the bile ducts (acute cholangitis)

If the bile ducts become blocked, they’re vulnerable to infection by bacteria. The medical term for a bile duct infection is acute cholangitis.

Symptoms of acute cholangitis include:

• pain in your upper abdomen that travels towards your shoulder blade
• a high temperature
• jaundice
• chills
• confusion
• itchy skin
• generally feeling unwell

Antibiotics will help treat the infection, but it’s also important to help the bile from the liver to drain with an endoscopic retrograde cholangio-pancreatography (ERCP). See treating gallstones for more information.

Acute pancreatitis

Acute pancreatitis may develop when a gallstone moves out of the gallbladder and blocks the opening (duct) of the pancreas, causing it to become inflamed.

The most common symptom of acute pancreatitis is a sudden severe dull pain in the centre of your upper abdomen, around the top of your stomach.

The pain of acute pancreatitis often gets steadily worse until it reaches a constant ache. The ache may travel from your abdomen and along your back and may feel worse after you have eaten. Leaning forward or curling into a ball may help to relieve the pain.

Other symptoms of acute pancreatitis can include:

• feeling sick
• being sick
• diarrhoea 
• loss of appetite
• a high temperature (fever) of 38C (100.4F) or above
• tenderness of the abdomen
• less commonly, jaundice

There’s currently no cure for acute pancreatitis, so treatment focuses on supporting the functions of the body until the inflammation has passed.

This usually involves admission to hospital so you can be given:

• fluids into a vein (intravenous fluids)
• pain relief
• nutritional support
• oxygen through tubes into your nose

With treatment, most people with acute pancreatitis improve within a week and are well enough to leave hospital after 5-10 days.

Read more about acute pancreatitis.

Cancer of the gallbladder

Gallbladder cancer is a rare but serious complication of gallstones. An estimated 660 cases of gallbladder cancer are diagnosed in the UK each year.

Having a history of gallstones increases your risk of developing gallbladder cancer. Approximately 4 out of every 5 people who have cancer of the gallbladder also have a history of gallstones.

However, people with a history of gallstones have a less than one in 10,000 chance of developing gallbladder cancer.

If you have additional risk factors, such as a family history of gallbladder cancer or high levels of calcium inside your gallbladder, it may be recommended that your gallbladder be removed as a precaution, even if your gallstones aren’t causing any symptoms.

The symptoms of gallbladder cancer are similar to those of complicated gallstone disease, including:

• abdominal pain
• high temperature (fever) of 38C (100.4F) or above
• jaundice

Gallbladder cancer can be treated with a combination of surgery, chemotherapy and radiotherapy.

Gallstone ileus

Another rare but serious complication of gallstones is known as gallstone ileus. This is where the bowel becomes obstructed by a gallstone.

Gallstone ileus can occur when an abnormal channel, known as a fistula, opens up near the gallbladder. Gallstones are then able to travel through the fistula and can block the bowel.

Symptoms of gallstone ileus include:

• abdominal pain
• being sick
• swelling of the abdomen 
• constipation

A bowel obstruction requires immediate medical treatment. If it’s not treated, there’s a risk that the bowel could split open (rupture). This could cause internal bleeding and widespread infection.

If you suspect you have an obstructed bowel, contact your GP as soon as possible. If this isn’t possible, phone the NHS 24 111 service.

Surgery is usually required to remove the gallstone and unblock the bowel. The type of surgery you receive depends on where in the bowel the obstruction has occurred.

Preventing gallstones

From the limited evidence available, changes to your diet and losing weight (if you’re overweight) may help prevent gallstones.

Diet

Because of the role cholesterol appears to play in the formation of gallstones, it is advisable to avoid eating too many foods with a high saturated fat content.

Foods high in saturated fat include:

• meat pies
• sausages and fatty cuts of meat
• butter, ghee and lard
• cream
• hard cheeses 
• cakes and biscuits
• food containing coconut or palm oil

A healthy, balanced diet is recommended. This includes plenty of fresh fruit and vegetables (at least 5 portions a day) and wholegrains.

There’s also evidence that regularly eating nuts, such as peanuts or cashews, can help reduce your risk of developing gallstones. 

Drinking small amounts of alcohol may also help reduce your risk of gallstones. However, you shouldn’t regularly drink more than 14 units of alcohol a week as this can lead to liver problems and other health conditions. Regularly drinking any amount of alcohol can increase the risk to your health.

Read more about: 

• high cholesterol
• how to lower your cholesterol
• healthy eating

Losing weight

Being overweight, particularly being obese, increases the amount of cholesterol in your bile, which increases your risk of developing gallstones. You should control your weight by eating a healthy diet and taking plenty of regular exercise.

However, avoid low-calorie, rapid-weight-loss diets. There’s evidence they can disrupt your bile chemistry and increase your risk of developing gallstones. A more gradual weight loss plan is recommended.

Read more about losing weight and getting started with exercise.

A modern view on the causes of the formation of stones in the gallbladder

The gallbladder is a reservoir for the accumulation and thickening of bile, which is a complex liquid consisting of 85% water. Bile contains organic and inorganic substances: bile acids; cholesterol; bilirubin; phospholipids; immunoglobulins; non-metal ions; metals and other substances. Gallstones are hardened formations made up of substances found in bile.

Depending on the substance predominant in the composition of gallstones, they are divided into two types. The most common type are cholesterol gallstones yellow-gray (up to 80%). They consist mainly of undissolved cholesterol, but may contain other components. The second type is pigment gallstones , brown or black stones with a predominance of bilirubin.

The exact cause of the formation of gallstones is still being established, according to available data, they appear when the gallbladder occurs excessive concentration of bile and imbalance of substances contained in it .

Causes of gallstones

When there is too much cholesterol in bile

Bile usually contains enough chemicals to dissolve the cholesterol secreted by the liver. But if your liver secretes more cholesterol than bile can dissolve, the excess cholesterol can be converted into crystals and eventually into cholesterol stones.

When there is too much bilirubin in bile

Bilirubin is a chemical produced when red blood cells (erythrocytes) are broken down in the body. Certain conditions can stimulate your liver to produce too much bilirubin, including cirrhosis of the liver, biliary tract infections, and certain types of anemia. Excess bilirubin contributes to the formation of pigment stones.

When there are disorders of gallbladder emptying and stagnation of bile

If the gallbladder is not emptied completely or often enough, bile can become very concentrated, which contributes to sedimentation and the formation of gallstones.

When there is a bacterial infection in the gallbladder

Chronic inflammation in the gallbladder leads to disturbances in its functioning and changes in the composition of bile and the formation of pigmented gallstones.

Gallstone risk factors

There are factors that increase the risk of gallstone formation, and they differ depending on the type of stone.

Risk factors for cholesterol gallstones

• family predisposition;
• female;
• age 40 and older;
• congenital features of the structure of the gallbladder;
• sedentary;
• diet high in fat and simple carbohydrates;
• high cholesterol low fiber diet;
• overweight or obese;
• pregnancy;
• fast weight loss.
• type 2 diabetes mellitus;
• taking medications containing estrogen, such as contraceptives or hormonal drugs and drugs that affect the contractility of the gallbladder.

Risk factors for the formation of pigmented gallstones

• old age;
• the presence of diseases of the liver, blood and intestines;
• biliary tract infections and helminths.

How to reduce the risk of gallstones?

You can reduce your risk of gallstones with simple remedies, either on your own or with the help of a doctor.

Do not skip meals . Try to stick to your regular meals every day. Skipping meals or fasting can increase your risk of gallstones.

Lose weight slowly . If you need to lose weight, take your time. Rapid weight loss can increase the risk of gallstones. Aim to lose 0.5-1 kg per week.

Include fiber in your diet . It is recommended to consume up to 30 g of dietary fiber per day. Most fiber is found in cereals, slightly less in fruits. Wholemeal bread, whole-grain pasta, cereals from whole grains or large cereals are the basis of nutrition for a patient at risk of gallstone disease.

Maintain a healthy weight . To lose weight, use a reduced-calorie diet and increase physical activity. Once you’ve lost your weight, continue to eat healthy and stay active.

Seek medical attention . If there is a predisposition to the development of gallstone disease, the observation of a gastroenterologist and preventive therapy in most cases will help to avoid the formation of stones in the gallbladder.

Cholelithiasis – (Clinic Di Center)

Gallbladder stones: diagnosis and treatment

Gallstone disease (GSD) is a disease in which stones form in the gallbladder or bile ducts.

Gallstone disease occurs quite often. In Europe and America, 1/3 of women and ¼ of men have it. As a rule, adult people suffer from cholelithiasis, especially overweight older women.

Reasons

Two main factors are to blame for the formation of stones: stagnation of bile in the gallbladder and an increase in the concentration of salts in bile due to metabolic disorders.

Provoke the occurrence of gallstone disease can:

• overeating, fasting, irregular meals;

• sedentary lifestyle, especially sedentary work;

• pregnancy;

• receiving pancreatic disease.

What’s happening?

The formation of stones in the gallbladder occurs as a result of the deposition of dense particles of bile. Most of the stones consist of cholesterol, bilirubin (bile pigment) and calcium salts. They interfere with the normal functioning of the gallbladder, which serves as a reservoir of bile.

Sometimes, with a bumpy ride, overeating, or the action of other provoking factors, a stone can come out at the mouth of the bile duct (biliary colic) and clog it. As a result, the outflow of bile from the bladder is disturbed, its walls are overstretched and the person feels severe pain. This can lead to inflammation of the gallbladder – acute cholecystitis. Inflammation can also spread to nearby organs – the pancreas, duodenum, stomach.

How is it manifested?

As long as the stones are not in the duct, but lie quietly in the gallbladder, a person may not even be aware of his illness. The first warning signs by which gallstone disease can be suspected are heaviness in the right hypochondrium, bitterness in the mouth, nausea and belching.

Sometimes the stone passes from the gallbladder into the bile ducts. In this case, an attack of the so-called biliary colic occurs: a sharp pain occurs in the right hypochondrium or in the upper abdomen. It can “give” to the right collarbone, right arm or back. At the same time, bitterness appears in the mouth, nausea and vomiting, which does not bring relief.

If the stone (with a relatively small size) was able to bypass the ducts and fall into the duodenum, the attack stops on its own, and the stone comes out with feces. Otherwise, there is a blockage of the biliary tract and there is a danger of developing acute cholecystitis and mechanical (subhepatic) jaundice.

Diagnostics

Diagnosis and treatment of uncomplicated cholelithiasis (GSD) is carried out by a gastroenterologist. The diagnosis can be established on the basis of patient complaints and a number of additional studies.

First of all, the patient will have an ultrasound of the abdominal organs. In more complex cases, an x-ray examination with preliminary administration of a contrast agent (through the mouth or intravenously) may be required – cholecystocholangiography. The contrast medium can also be injected directly into the bile ducts by puncturing with a special thin needle (percutaneous transhepatic cholangiography) or through an endoscope (endoscopic retrograde cholangiopancreatography or ERCP). During ERCP, it is possible to remove small stones from the bile ducts.

Treatment

Gallstone disease can be treated therapeutically (without surgery) and surgically. As a rule, treatment begins with therapeutic methods.

• Diet. Recommended 4-6 meals a day with the exception of fatty, fried, spicy, chocolate, carbonated drinks. Smoked meats, fatty meats (lamb, pork), irritating seasonings, alcoholic beverages are prohibited. Plant foods and dairy products are recommended. It is useful to add wheat bran to food.

• Dissolution of stones in the gallbladder with the help of special preparations (ursodeoxycholic and chenodeoxycholic acids). The method is used only in the case of single small (up to 2 cm) cholesterol (X-ray negative) stones, in the absence of contraindications. The course of treatment lasts 1−1.5 years. After a few years, more than half of patients again form stones.

• Extracorporeal shock wave lithotripsy is the destruction of stones by a shock wave, which is created by special devices. It is indicated in the case of cholesterol stones up to 3 cm in diameter, no more than 3 in number, with sufficient contractility of the gallbladder. Stones are crushed into small pieces (up to 1-2 mm in size) and independently leave the body with feces. The procedure is painless, well tolerated and can be performed on an outpatient basis.

Surgical treatment is prescribed in most cases. It consists in the removal of the gallbladder, which can be carried out in three ways:

1. Classical cholecystectomy: during the operation, a fairly wide incision is made in the abdomen. After the operation, a suture 10–12 cm long remains.

2. Laparoscopic cholecystectomy: performed using special instruments that are inserted into the abdominal cavity through small holes (up to one centimeter).