Gallstones

What are gallstones?

Gallstones are small, pebble-like substances composed of cholesterol or calcium salts that form in your gallbladder or nearby bile ducts.

What causes gallstones?

Your liver produces liquid called bile. Bile contains bile salts, fatty compounds and cholesterol used to help digest fat in the food you eat. Bile produced in the liver is stored in the gallbladder which is a small pear-shaped sac located below your liver in the right upper abdomen. The bile pours out from the gallbladder via the cystic and bile ducts into the small intestine, where it helps in the digestion of food. Gallstones form when bile hardens into pieces of stone-like material.

Many factors may contribute to the formation of gallstones including:

  • Gender: gallstones are more common in women
  • Age: the risk of gallstones increases with age
  • Ethnicity: gallstones occur more frequently in Native Americans, and Mexican-Americans
  • Family History: gallstones tend to run in families
  • Other factors: pregnancy, use of estrogen, obesity, frequent fasting, rapid weight loss, lack of physical activity, diabetes mellitus, sickle cell disease and cirrhosis of the liver.

What are the symptoms of gallstones?

Gallstones may move from the gallbladder into the cystic and bile ducts and create a blockage. This can cause symptoms that are often referred to as a gallbladder "attack." These symptoms may include:

  • Chronic indigestion such as nausea, gas, and bloating which may be made worse after eating high-fat foods.
  • Upper abdominal pain that is sudden, steady in your upper middle or upper right abdomen. The pain may occur a half hour to two hours after eating and may last 30 minutes to several hours.
  • Pain in the back between the shoulder blades or pain under the right shoulder
  • Nausea and vomiting.
  • Fever with or without chills.
  • Yellowish color of the skin or whites of the eyes (jaundice).
  • Clay-colored stools.

Notify your doctor if you think you have experienced symptoms of a gallbladder attack. Although these attacks often pass as the gallstones move, your gallbladder can become infected if a blockage remains. Alternatively, a blockage in the bile ducts can cause a more serious infection manifesting as fever, pain and jaundice.

How are gallstones diagnosed?

Gallstones may not always cause symptoms and may be discovered during other tests. If you have symptoms of gallstones your doctor will take your medical history and perform a physical exam. Your doctor may also order blood tests to check for signs of infection, pancreatitis, or abnormal liver function. Your doctor may also order an ultrasound, a computerized tomography (CT) scan, a radionuclide scan (HIDA scan), or an endoscopic retrograde cholangiopancreatography (ERCP).

How are gallstones treated?

If you have gallstones without symptoms, you do not require treatment. If you are having frequent gallbladder attacks, your doctor may recommend you have your gallbladder removed (cholecystectomy). If you have stones in the bile duct as well as your gallbladder your doctor may recommend surgical removal of your gallbladder and removal of stones from your bile ducts using endoscopy or ERCP.

Non-surgical approaches are rarely used in special situations when surgery isn’t the best option. These are not a routine treatment option and are rarely recommended for healthy patients. Non-surgical options include bile salt tablets, sound wave therapy (extracorporeal shock wave lithotripsy), percutaneous electrohydraulic lithotripsy and topical gallstone dissolution.

Your doctor may recommend the following lifestyle changes to help prevent gallstones from reoccurring after treatment:

  • Maintain a healthy body weight
  • Avoid crash diets
  • Be active
  • Choose a low-fat, high fiber diet

When to seek medical advice

Call you doctor if you develop sudden intense pain in your abdomen, if you notice yellowing of your skin and whites of your eyes or if you notice dark urine and have a high fever with chills.