Where are gallstones. Gallstones: Symptoms, Causes, and Treatment Options Explained

24.11.202215.07.2023 by alexxlab

What are gallstones and where do they form. How common are gallstones and who is at risk. What symptoms do gallstones cause. How are gallstones diagnosed and treated. Can gallstones be prevented.

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What Are Gallstones and How Do They Form?

Gallstones are small, hard deposits that form in the gallbladder. They typically develop when there is an imbalance in the chemical composition of bile stored in the gallbladder. Bile is a fluid produced by the liver to aid in digestion of fats.

There are two main types of gallstones:

Cholesterol stones – These are the most common type, forming when bile contains too much cholesterol.
Pigment stones – These develop when bile contains excess bilirubin.

Gallstones can range in size from as small as a grain of sand to as large as a golf ball. They may be few in number or numerous. Some people develop just one large stone, while others have many smaller stones.

How Common Are Gallstones and Who Is at Risk?

Gallstones are very common, affecting an estimated 10-15% of adults in developed countries. However, many people with gallstones never experience symptoms.

Certain factors can increase your risk of developing gallstones:

Being female
Being over age 40
Being overweight or obese
Pregnancy
Rapid weight loss
Diabetes
Family history of gallstones
Certain medications (e.g. hormone therapy)

Women are at higher risk than men, likely due to estrogen increasing cholesterol in bile. The risk also increases with age, with gallstones being most common in people over 60.

What Symptoms Do Gallstones Cause?

Many people with gallstones have no symptoms at all. These “silent” gallstones are often discovered incidentally during tests for other conditions.

When gallstones do cause symptoms, they typically include:

Sudden, intense pain in the upper right abdomen or center of the abdomen
Pain that may spread to the right shoulder or back
Nausea and vomiting
Fever and chills
Jaundice (yellowing of skin and eyes)

A gallstone attack, also known as biliary colic, occurs when a stone blocks a bile duct. The pain typically lasts 1-5 hours and often starts after a fatty meal.

When Should You See a Doctor for Gallstone Symptoms?

Seek immediate medical care if you experience:

Abdominal pain so intense you can’t sit still or find a comfortable position
Yellowing of your skin and the whites of your eyes (jaundice)
High fever with chills

These symptoms may indicate a serious complication like inflammation or infection requiring prompt treatment.

How Are Gallstones Diagnosed?

If gallstones are suspected, your doctor may order one or more of the following tests:

Ultrasound – This is the most common test for gallstones. It uses sound waves to create images of the gallbladder.
CT scan – This can provide detailed images of the gallbladder and surrounding organs.
HIDA scan – This nuclear medicine test checks gallbladder function and looks for blockages.
Blood tests – These can check for signs of infection or inflammation.

In some cases, more invasive tests like endoscopic retrograde cholangiopancreatography (ERCP) may be needed to diagnose or treat gallstone complications.

What Are the Treatment Options for Gallstones?

Treatment for gallstones depends on the severity of symptoms and any complications. Options include:

Watchful Waiting

If gallstones are not causing symptoms, treatment may not be necessary. Many people with silent gallstones never develop symptoms.

Surgical Removal (Cholecystectomy)

For symptomatic gallstones, the most common treatment is surgical removal of the gallbladder. This is typically done laparoscopically through small incisions. Most people can lead normal lives without a gallbladder.

Medications

In some cases, medications like ursodeoxycholic acid may be used to dissolve small gallstones. However, this treatment is less common and takes months or years to be effective.

ERCP

For gallstones in the bile ducts, a procedure called endoscopic retrograde cholangiopancreatography (ERCP) may be used to remove the stones.

Can Gallstones Be Prevented?

While not all gallstones can be prevented, certain lifestyle changes may help reduce your risk:

Maintain a healthy weight
Avoid rapid weight loss
Eat a balanced diet rich in fiber and healthy fats
Exercise regularly
Stay hydrated

It’s important to note that even with these measures, some people may still develop gallstones due to factors beyond their control, such as genetics or certain medical conditions.

What Is the Outlook for People with Gallstones?

The prognosis for people with gallstones is generally good, especially when treated promptly. Most people who undergo gallbladder removal surgery recover quickly and experience no long-term complications.

However, untreated gallstones can lead to serious complications, including:

Cholecystitis (inflammation of the gallbladder)
Choledocholithiasis (stones in the bile duct)
Pancreatitis (inflammation of the pancreas)
Cholangitis (infection of the bile duct)

These complications can be severe and even life-threatening if not treated promptly. Therefore, it’s crucial to seek medical attention if you experience symptoms of gallstones.

Living with Gallstones: Diet and Lifestyle Considerations

If you have gallstones or have had your gallbladder removed, certain dietary and lifestyle changes may help manage symptoms and prevent future problems:

Dietary Recommendations

Limit high-fat foods, especially saturated and trans fats
Eat smaller, more frequent meals
Increase fiber intake
Stay hydrated
Avoid rapid weight loss diets

Lifestyle Changes

Maintain a healthy weight
Exercise regularly
Manage stress
Avoid smoking and excessive alcohol consumption

While these changes can help, it’s important to work with your healthcare provider to develop a personalized plan that addresses your specific needs and medical history.

Gallstones in Special Populations

Certain groups may have unique considerations when it comes to gallstones:

Pregnant Women

Pregnancy increases the risk of gallstones due to hormonal changes. Treatment during pregnancy may be more complicated and often focuses on managing symptoms until after delivery.

Older Adults

Gallstones are more common in older adults. Treatment decisions may need to consider other health conditions and overall health status.

People with Diabetes

Diabetes can increase the risk of gallstones and may complicate treatment. Close monitoring and management of both conditions is important.

Individuals with Certain Genetic Conditions

Some genetic conditions, such as certain blood disorders, can increase the risk of pigment stones. These individuals may require specialized care and monitoring.

Understanding these special considerations can help ensure appropriate management and treatment of gallstones in diverse populations.

Emerging Research and Future Directions in Gallstone Treatment

While surgical removal of the gallbladder remains the gold standard for treating symptomatic gallstones, researchers are exploring new approaches:

Non-Surgical Treatments

Scientists are investigating new medications and techniques to dissolve or break up gallstones without surgery. These could provide alternatives for people who are not good surgical candidates.

Minimally Invasive Techniques

Advances in surgical techniques are making gallbladder removal even less invasive, potentially reducing recovery time and complications.

Genetic Research

Understanding the genetic factors that contribute to gallstone formation could lead to new prevention strategies and treatments.

Microbiome Studies

Research into the role of gut bacteria in gallstone formation may open up new avenues for prevention and treatment.

While these areas show promise, more research is needed before they can be widely applied in clinical practice. As always, consult with your healthcare provider for the most up-to-date and personalized advice on managing gallstones.

Gallstones – NHS

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

Symptoms of gallstones

Gallstones often have no symptoms.

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

This type of abdominal pain is known as biliary colic.

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

This can cause:

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

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

The gallbladder

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

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

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

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

Causes of gallstones

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

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

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

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

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

Treating gallstones

Treatment is usually only necessary if gallstones are causing:

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

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

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

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

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

Outlook

Gallstone disease is usually easily treated with surgery.

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

But deaths from gallstone disease are rare in the UK.

Video: gallstones

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

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

Community content from HealthUnlocked

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

Gallstones | Johns Hopkins Medicine

What are gallstones?

Gallstones form when bile stored in the gallbladder hardens into stone-like
material. Too much cholesterol, bile salts, or bilirubin (bile pigment) can
cause gallstones.

When gallstones are present in the gallbladder itself, it is called
cholelithiasis. When gallstones are present in the bile ducts, it is called
choledocholithiasis. Gallstones that obstruct bile ducts can lead to a
severe or life-threatening infection of the bile ducts, pancreas, or liver.
Bile ducts can also be obstructed by cancer or trauma, but this is not
related to gallstones.

What causes gallstones?

Cholesterol stones are believed to form when bile contains too much
cholesterol, too much bilirubin, not enough bile salts, or when the
gallbladder does not empty as it should for some other reason.

Pigment stones tend to develop in people who have cirrhosis, biliary tract
infections, and hereditary blood disorders such as sickle cell anemia. The
causes of these stones are uncertain.

What are the symptoms of gallstones?

At first, most gallstones do not cause symptoms. However, when gallstones
become larger, or when they begin obstructing bile ducts, symptoms or
“attacks” begin to occur. Attacks of gallstones usually occur after a fatty
meal and at night. The following are the most common symptoms of
gallstones. However, each individual may experience symptoms differently.
Symptoms may include:

Steady, severe pain in the upper abdomen that increases rapidly and
may last from 30 minutes to several hours
Pain in the back between the shoulder blades
Pain in the right shoulder
Nausea
Vomiting
Fever
Chills
Jaundice. A yellowing of the skin or eyes.
Abdominal bloating
Intolerance of fatty foods
Belching or gas
Indigestion

People who experience the following symptoms should consult their doctor
immediately:

Some people with gallstones do not have any symptoms. These stones are
called “silent stones,” because they do not interfere with the function of
the gallbladder, liver, or pancreas, and do not require treatment in most
cases.

The symptoms of gallstones may resemble other conditions or medical
problems, such as heart attack, appendicitis, ulcers, irritable bowel
syndrome, hiatal hernia, pancreatitis, or hepatitis. Always consult your
health care provider for a diagnosis.

Who is affected by gallstones?

The following are suggested risk factors for gallstones:

Obesity.
Obesity is a major risk factor for gallstones, especially in women.
Estrogen.
Excess estrogen from pregnancy, hormone replacement therapy, or
birth control pills appears to increase cholesterol levels in bile
and decrease gallbladder movement, both of which can lead to
gallstones.
Ethnicity.
Native Americans have the highest rates of gallstones in this
country and seem to have a genetic predisposition to secrete high
levels of cholesterol in bile.
Gender.
Women are twice as likely to develop gallstones than men.
Age.
People over 60 are more likely to develop gallstones than younger
people.
Cholesterol-lowering drugs.
Drugs that lower cholesterol in blood can actually increase the
amount of cholesterol secreted in bile, which, in turn, increases
the risk of gallstones.
Diabetes.
People with diabetes generally have high levels of fatty acids,
called triglycerides, which increase the risk for gallstones.
Rapid weight loss.
As the body metabolizes fat during rapid weight loss, it causes the
liver to secrete extra cholesterol into bile, which can cause
gallstones.
Fasting.
Fasting decreases gallbladder movement, which causes the bile to
become overconcentrated with cholesterol.

How are gallstones diagnosed?

In some cases, asymptomatic gallstones are discovered by
accident–during testing for another diagnosis. However, when pain
persists or happens again and again, your health care provider may want
to conduct a complete medical history and physical examination, in
addition to the following diagnostic procedures for gallstones:

Ultrasound.
A diagnostic technique that uses high-frequency sound waves to
create an image of the internal organs.
Cholecystography.
X-ray that shows the flow of contrast fluid through the
intestines into the gallbladder.
Blood tests.
These look for signs of infection, obstruction, jaundice,
and/or pancreatitis.
Computed tomography scan (also called a CT or CAT scan).

A diagnostic imaging procedure that uses a combination of
X-rays and computer technology to produce horizontal, or axial,
images (often called slices) of the body. A CT scan shows
detailed images of any part of the body, including the bones,
muscles, fat, and organs. CT scans are more detailed than
general X-rays.
Endoscopic retrograde cholangiopancreatography (ERCP).

A procedure that involves inserting an endoscope (viewing tube)
through the stomach and into the small intestine. A special dye
injected during this procedure shows the ducts in the biliary
system.
Sphincterotomy.
Opening the muscle sphincter, a ring of muscle around a natural
opening that acts like a valve, wide enough so stones can pass
into the intestine.

Treatment for gallstones

Specific treatment for gallstones will be determined by your health
care provider based on:

Your age, overall health, and medical history
Extent of the condition
Your tolerance of specific medicines, procedures, or therapies
Expectations for the course of the condition
Your opinion or preference

If the gallstones cause no symptoms, treatment is usually not
necessary. However, if pain persists, treatment may include:

Gallbladder removal (cholecystectomy).
Once removed, the bile flows directly from the liver to the
small intestine. Side effects of this may include diarrhea
because the bile is no longer stored in the gallbladder.
Oral dissolution therapy.
Drugs made from bile acid are used to dissolve the stones.
Methyl-tert-butyl ether.
A solution injected into the gallbladder to dissolve stones.
Extracorporeal shockwave lithotripsy (ESWL).
A procedure that uses shock waves to break stones up into tiny
pieces that can pass through the bile ducts without causing
blockages.
Contact dissolution therapy.
An experimental procedure that involves injecting a drug
directly into the gallbladder to dissolve the stones.

symptoms and when to see a doctor

Gallstone disease (GSD) is the formation of stones (calculi) in the gallbladder and bile ducts. Gallstones are hardened deposits of digestive fluid that most commonly form in your gallbladder. Your gallbladder is a small, pear-shaped organ on the right side of your abdomen, just below your liver. The gallbladder contains a digestive fluid called bile, which is secreted into the small intestine to aid in the digestion of food.

Gallbladder stones range in size from a grain of sand to a golf ball. Some people develop only one gallstone, while others develop many small stones at the same time.

The presence of stones carries the risk of developing dangerous conditions and severe complications.

Symptoms

Gallstones often cause no signs or symptoms. If a gallstone gets stuck in the duct and causes a blockage, the following symptoms develop:

Sudden and rapidly increasing pain in the center of the abdomen, just below the sternum, on the right
Pain in the back between the shoulder blades
Right shoulder pain
Nausea or vomiting
Pain associated with gallstone disease can last from several minutes to several hours

When to see a doctor

Make an appointment with your doctor if you have any signs or symptoms that worry you.

Read about the diagnosis and treatment of cholelithiasis at the link.

Seek care right away if you develop signs and symptoms of a serious complication associated with gallstones, for example:

Abdominal pain so severe that you cannot sit still or find a comfortable position
Yellowing of the skin and whites of the eyes (jaundice)
High fever with chills

Number for calling an ambulance in Moscow – 103

Causes of cholelithiasis

It is unclear what causes gallstones. Doctors believe that gallstones can occur in the following cases:

Your bile contains too much cholesterol . Normally, your bile contains enough chemicals to dissolve the cholesterol secreted by your liver. But if your liver secretes more cholesterol than bile can dissolve, the excess cholesterol can turn into crystals and eventually stones.

Your bile contains too much bilirubin . Bilirubin is a chemical produced when red blood cells are broken down in the body. Under certain conditions, the liver produces too much bilirubin, including cirrhosis of the liver, biliary tract infections, and certain blood disorders. Excess bilirubin contributes to the formation of gallstones.

Your gallbladder is not emptying properly. If the gallbladder does not empty completely or often enough, the bile can become very concentrated, which promotes the formation of gallstones.

Types of gallstones

Types of gallstones that can form in the gallbladder include:

Cholesterol stones in the gallbladder. The most common type of gallstones, called cholesterol gallstones, are often yellow in color. These gallstones are made up primarily of undissolved cholesterol, but may contain other components.

Pigment stones in the gallbladder. These dark brown or black stones form when your bile contains too much bilirubin.

Risk factors

Factors that may increase the risk of gallstones include:

Female sex
Age 40 and over
Overweight or obese
Sedentary
Pregnancy
High fat diet
High cholesterol diet
Low fiber diet
Family history of gallstones
Diabetes
Presence of certain blood disorders such as sickle cell anemia or leukemia
Very fast weight loss
Taking medications containing estrogen, such as oral contraceptives or hormone therapy drugs.
Liver disease

Complications

Complications of gallstones may include:

Inflammation of the gallbladder . A gallstone lodged in the neck of the gallbladder can cause inflammation of the gallbladder (cholecystitis). Cholecystitis can cause severe pain, peritonitis.

Blockage of the common bile duct . Gallstones can block the channels (ducts) that carry bile from the gallbladder or liver to the small intestine. This can lead to severe pain, jaundice, and bile duct infection.

Obstruction of the pancreatic duct . The pancreatic duct is a tube from the pancreas and joins the common bile duct just before entering the duodenum. The pancreatic juices that aid digestion pass through the pancreatic duct.

A gallstone can cause blockage of the pancreatic duct, which can lead to inflammation of the pancreas (pancreatitis). Pancreatitis causes severe, persistent abdominal pain and usually requires hospitalization. Severe forms of pancreatitis often end in the death of the patient.

Gall bladder cancer . People with gallstones have an increased risk of developing gallbladder cancer.

Prevention of gallstones

You can reduce the risk of gallstones:

Do not skip meals . Try to stick to your regular meal times 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.

Eat more high fiber foods . Include more fiber-rich foods in your diet, such as fruits, vegetables, and whole grains.

Maintain a healthy weight . Obesity and overweight increase the risk of gallstones. Work towards a healthy weight by cutting calories and increasing physical activity. Once you reach a healthy weight, work on maintaining it by continuing to eat a healthy diet and keep exercising.

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Contents

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Stones in the gallbladder (cholelithiasis) – a disease of the gallbladder, which is accompanied by the formation of stones. Stones in the bladder disrupt the process of digestion, interfere with the normal outflow of bile, and cause acute conditions such as colic.

Gallstones are solid masses of various sizes, shaped like rounded stones. They are formed during the hardening of bile, caused by an excess of cholesterol, bile salts, bilirubin.

The gallbladder is a small sac-like organ located under the liver. The main functions are the accumulation and concentration of bile.

In turn, bile is a fluid that is synthesized in the liver. Bile consists of acids, pigments, enzymes. Bile is involved in the breakdown of fats. The liver, gallbladder, duodenum and pancreas are connected by a duct system.

Types of gallstones

Cholesterol stones. Yellow-green in color. Predominantly formed in women and obese people. The share of cholesterol stones accounts for up to 80%.
Pigment stones. Black-brown in color. Formed with concomitant diseases of the liver, cirrhosis, inflammation of the bile ducts.