Gallstones
Cholelithiasis; Gallbladder attack; Biliary colic; Gallstone attack; Biliary calculus: gallstones chenodeoxycholic acids (CDCA); Ursodeoxycholic acid (UDCA, ursodiol); Endoscopic retrograde cholangiopancreatography (ERCP) - gallstonesGallstones are hard deposits that form inside the gallbladder. These may be as small as a grain of sand or as large as a golf ball.
Causes
The cause of gallstones varies. There are two main types of gallstones:
- Stones made of cholesterol -- This is the most common type. Cholesterol gallstones are not related to cholesterol level in the blood. In most cases, they are not visible on CT scans but are visible on a sonogram (ultrasound) of the abdomen.
- Stones made of bilirubin -- These are called pigment stones. They occur when red blood cells are destroyed and too much bilirubin is in the bile.
Cholelithiasis
Normally a balance of bile salts, lecithin and cholesterol keep gallstones from forming. If there are abnormally high levels of bile salts or, more commonly, cholesterol, stones can form. Symptoms usually occur when the stones block one of the biliary ducts or gallstones may be discovered upon routine x-ray or abdominal CT study.
Gallstones are more common in:
- Female sex
- Native Americans and people of Hispanic descent
- People over age 40
- People who are overweight
- People with family history of gallstones
The following factors also make you more likely to develop gallstones:
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Bone marrow or solid organ transplant
Bone marrow
A bone marrow transplant is a procedure to replace damaged or diseased bone marrow with healthy bone marrow stem cells. Bone marrow is the soft, fatt...
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Diabetes
Diabetes
Diabetes is a long-term (chronic) disease in which the body cannot regulate the amount of sugar in the blood.
Read Article Now Book Mark Article - Failure of the gallbladder to empty bile properly (this is more likely to happen during pregnancy)
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Liver cirrhosis and biliary tract infections (pigmented stones)
Liver cirrhosis
Cirrhosis is scarring of the liver and poor liver function. It is the last stage of chronic liver disease.
Read Article Now Book Mark Article - Medical conditions that cause too many red blood cells to be destroyed
Red blood cells to be destroyed
Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. Normally, red ...
Read Article Now Book Mark Article - Rapid weight loss from eating a very low-calorie diet, or after weight loss surgery
- Receiving nutrition through a vein for a long period of time (intravenous feedings)
- Taking birth control pills
Symptoms
Many people with gallstones do not have any symptoms. These are often found during a routine x-ray, abdominal surgery, or other medical procedure.
However, if a large stone blocks a tube or duct that drains the gallbladder, you may have a cramping pain in the middle to right upper abdomen. This is known as biliary colic. The pain goes away if the stone passes into the first part of the small intestine.
Stone blocks a tube
Choledocholithiasis is the presence of at least one gallstone in the common bile duct. The stone may be made up of bile pigments or calcium and chol...
Read Article Now Book Mark ArticleSymptoms that may occur include:
- Pain in the right upper or middle upper abdomen for at least 30 minutes. The pain may be constant or cramping. It can feel sharp or dull.
- Fever.
- Yellowing of skin and whites of the eyes (jaundice).
Other symptoms may include:
- Clay-colored stools
- Nausea and vomiting
Exams and Tests
Tests used to detect gallstones or gallbladder inflammation include:
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Ultrasound, abdomen
Ultrasound, abdomen
Abdominal ultrasound is a type of imaging test. It is used to look at organs in the abdomen, including the liver, gallbladder, spleen, pancreas, and...
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CT scan, abdomen
CT scan, abdomen
An abdominal CT scan is an imaging method. This test uses x-rays to create cross-sectional pictures of the belly area. CT stands for computed tomog...
Read Article Now Book Mark Article - Endoscopic retrograde cholangiopancreatography (ERCP)
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Gallbladder radionuclide scan
Gallbladder radionuclide scan
Gallbladder radionuclide scan is a test that uses radioactive material to check gallbladder function. It is also used to look for bile duct blockage...
Read Article Now Book Mark Article - Endoscopic ultrasound
- Magnetic resonance cholangiopancreatography (MRCP)
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Percutaneous transhepatic cholangiogram (PTCA)
Percutaneous transhepatic cholangiogram
A percutaneous transhepatic cholangiogram (PTC) is an x-ray of the bile ducts. These are the tubes that carry bile from the liver to the gallbladder...
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Your health care provider may order the following blood tests:
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Bilirubin
Bilirubin
The bilirubin blood test measures the level of bilirubin in the blood. Bilirubin is a yellowish pigment found in bile, a fluid made by the liver. Bi...
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Liver function tests
Liver function tests
Liver function tests are common tests that are used to see how well the liver is working. Tests include:AlbuminAlpha-1 antitrypsinAlkaline phosphata...
Read Article Now Book Mark Article - Complete blood count
- Pancreatic enzyme (amylase or lipase)
Treatment
SURGERY
Most of the time, surgery is not needed unless symptoms begin. However, people planning weight loss surgery may need to have gallstones removed before undergoing the procedure. In general, people who have symptoms will need surgery right away or soon after the stone is found.
- A technique called laparoscopic cholecystectomy is most commonly used. This procedure uses small surgical incisions, which allow for a faster recovery. A patient can often go home from the hospital within 1 day of surgery.
Laparoscopic cholecystectomy
Laparoscopic gallbladder removal is surgery to remove the gallbladder using a medical device called a laparoscope. The gallbladder is an organ that s...
Read Article Now Book Mark Article - In the past, open cholecystectomy (gallbladder removal) was most often done. However, this technique is less common now.
Cholecystectomy
Open gallbladder removal is surgery to remove the gallbladder through a large cut in your abdomen. The gallbladder is an organ that sits below the li...
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ERCP and a procedure called a sphincterotomy may be done to find or treat gallstones in the common bile duct.
Gallstones in the common bile duct
Choledocholithiasis is the presence of at least one gallstone in the common bile duct. The stone may be made up of bile pigments or calcium and chol...
Read Article Now Book Mark ArticleMEDICINES
Medicines may be given in pill form to dissolve cholesterol gallstones. However, these drugs may take 2 years or longer to work, and the stones may return after treatment ends.
Rarely, chemicals are passed into the gallbladder through a catheter. The chemical rapidly dissolves cholesterol stones. This treatment is hard to perform, so it is not done very often. The chemicals used can be toxic, and the gallstones may return.
LITHOTRIPSY
Shock wave lithotripsy (ESWL) of the gallbladder has also been used for people who cannot have surgery. This treatment is not used as often as it once was because gallstones often come back.
Outlook (Prognosis)
You may need to be on a liquid diet or take other steps to give your gallbladder a rest after you are treated. Your provider will give you instructions when you leave the hospital.
Liquid diet
You have gallstones. These are hard, pebble-like deposits that formed inside your gallbladder. This article tells you how to take care of yourself ...
Read Article Now Book Mark ArticleThe chance of symptoms or complications from gallstone surgery is low. Nearly all people who have their gallbladder taken out by surgery do not have their symptoms return.
Possible Complications
Blockage by gallstones may cause swelling or infection in the:
- Gallbladder (cholecystitis)
- Tube that carries bile from the liver to the gallbladder and intestines (cholangitis)
Cholangitis
Cholangitis is an infection of the bile ducts, the tubes that carry bile from the liver to the gallbladder and intestines. Bile is a liquid made by ...
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When to Contact a Medical Professional
Contact your provider if you have:
- Pain in the upper part of your abdomen
- Yellowing of the skin or whites of the eyes
Prevention
In most people, gallstones can't be prevented. In people who are obese, avoiding rapid weight loss may help prevent gallstones.
References
Fogel EL, Sherman S. Diseases of the gallbladder and bile ducts. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 146.
Radkani P, Hawksworth J, Fishbein T. Biliary system. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 55.
Wang D Q-H, Afdhal NH. Gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 65.
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Digestive system - illustration
The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.
Digestive system
illustration
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Kidney cyst with gallstones - CT scan - illustration
A CT scan of the upper abdomen showing a fist-sized cyst of the left kidney and gallstones (the kidney cyst was found by chance; there were no symptoms).
Kidney cyst with gallstones - CT scan
illustration
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Gallstones, cholangiogram - illustration
A cholecystogram in a patient with gallstones.
Gallstones, cholangiogram
illustration
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Cholecystolithiasis - illustration
Cholecystolithiasis. CT scan of the upper abdomen showing multiple gallstones.
Cholecystolithiasis
illustration
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Cholelithiasis - illustration
Normally a balance of bile salts, lecithin and cholesterol keep gallstones from forming. If there are abnormally high levels of bile salts or, more commonly, cholesterol, stones can form. Symptoms usually occur when the stones block one of the biliary ducts or gallstones may be discovered upon routine x-ray or abdominal CT study.
Cholelithiasis
illustration
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Gallbladder - illustration
The gallbladder is a muscular sac located under the liver. It stores and concentrates the bile produced in the liver that is not immediately needed for digestion. Bile is released from the gallbladder into the small intestine in response to food. The pancreatic duct joins the common bile duct at the small intestine adding enzymes to aid in digestion.
Gallbladder
illustration
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Gallbladder removal - Series
Presentation
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Digestive system - illustration
The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.
Digestive system
illustration
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Kidney cyst with gallstones - CT scan - illustration
A CT scan of the upper abdomen showing a fist-sized cyst of the left kidney and gallstones (the kidney cyst was found by chance; there were no symptoms).
Kidney cyst with gallstones - CT scan
illustration
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Gallstones, cholangiogram - illustration
A cholecystogram in a patient with gallstones.
Gallstones, cholangiogram
illustration
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Cholecystolithiasis - illustration
Cholecystolithiasis. CT scan of the upper abdomen showing multiple gallstones.
Cholecystolithiasis
illustration
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Cholelithiasis - illustration
Normally a balance of bile salts, lecithin and cholesterol keep gallstones from forming. If there are abnormally high levels of bile salts or, more commonly, cholesterol, stones can form. Symptoms usually occur when the stones block one of the biliary ducts or gallstones may be discovered upon routine x-ray or abdominal CT study.
Cholelithiasis
illustration
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Gallbladder - illustration
The gallbladder is a muscular sac located under the liver. It stores and concentrates the bile produced in the liver that is not immediately needed for digestion. Bile is released from the gallbladder into the small intestine in response to food. The pancreatic duct joins the common bile duct at the small intestine adding enzymes to aid in digestion.
Gallbladder
illustration
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Gallbladder removal - Series
Presentation
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Gallstones and gallbladder disease - InDepth
(In-Depth)
Review Date: 5/2/2023
Reviewed By: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.