Cholelithiasis

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Introduction

What is cholelithiasis?

Cholelithiasis is the medical name for hard deposits (gallstones) that may form in the gallbladder. Cholelithiasis is common in the United States population. Six percent of adult men and 10% of adult women are affected.

The cause of cholelithiasis is not completely understood, but it is thought to have multiple factors. The gallbladder stores bile and releases it into the small intestine when it is needed for digestion. Gallstones can develop if the bile contains too much cholesterol or too much bilirubin (one of the components of bile), or if the gallbladder is dysfunctional and cannot release the bile.

Different types of gallstones form in cholelithiasis. The most common type, called a cholesterol stone, results from the presence of too much cholesterol in the bile. Another type of stone, called a pigment stone, is formed from excess bilirubin, a waste product created by the breakdown of the red blood cells in the liver. The size and number of gallstones varies in cholelithiasis; the gallbladder can form many small stones or one large stone.

The course of cholelithiasis varies among individuals. Most people with cholelithiasis have no symptoms at all. A minority of patients with gallstones develop symptoms: severe abdominal pain, nausea and vomiting, and complete blockage of the bile ducts that may pose the risk of infection.

Cholelithiasis can lead to cholecystitis, inflammation of the gallbladder. Acute gallstone attacks may be managed with intravenous medications. Chronic (long-standing) cholelithiasis is treated by surgical removal of the gallbladder.

Left untreated, cholelithiasis can lead to serious complications such as tissue damage, tears in the gallbladder, and infection that spreads to other parts of your body. Seek immediate medical care (call 911) for serious symptoms, such as high fever (higher than 101 degrees Fahrenheit), severe abdominal pain, abdominal swelling, and nausea with or without vomiting.

Seek prompt medical care if you are being treated for cholelithiasis, but mild symptoms recur or are persistent.

Symptoms

What are the symptoms of cholelithiasis?

Cholelithiasis may cause irritation and inflammation of the gallbladder (cholecystitis) that can result in a number of symptoms. The symptoms can vary in intensity among individuals.

Common symptoms of cholelithiasis

You may experience cholecystitis symptoms daily or just once in a while. At times, any of these common symptoms can be severe:

  • Abdominal pain (typically localized to the right upper quadrant of the abdomen)

  • Abdominal swelling, distension or bloating

  • Abdominal tenderness

  • Clay-colored stools

  • Fever and chills

  • Loss of appetite

  • Nausea with or without vomiting

  • Pain that radiates from the abdomen to the right shoulder or back

  • Sweating

  • Yellowing of the skin and whites of the eyes (jaundice)

Serious symptoms that might indicate a life-threatening condition

In some cases, cholelithiasis can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Abdominal swelling, distension or bloating
  • High fever (higher than 101 degrees Fahrenheit)
  • Nausea with or without vomiting
  • Severe abdominal pain
Causes

What causes cholelithiasis?

In most cases, cholelithiasis is caused by excessive amounts of cholesterol in the bile that is stored in the gallbladder. The cholesterol hardens to form stone-like substances. Increased body weight and older age are associated with increased levels of cholesterol in the bile. Thus, gallstones are more likely to occur in women, in people who are obese, and in older individuals.

Some gallstones develop because the bile contains too much bilirubin, a waste product of the liver that is a component of bile. Gallstones that develop from excess bilirubin are called pigment stones.

What are the risk factors for cholelithiasis?

A number of factors increase your risk of developing cholelithiasis. Not all people with risk factors will get cholelithiasis. Risk factors for cholelithiasis include:

  • Age over 40 years

  • Crash dieting, or losing weight rapidly (the bile then contains more cholesterol)

  • Diabetes

  • Ethnicity (risk is higher in American Indians and Mexican Americans)

  • Family history

  • Female gender

  • Liver disease

  • Overweight or obesity

  • Pregnancy (decreases the gallbladder’s ability to empty bile)

  • Use of certain medications (cholesterol-lowering drugs increase cholesterol in the bile)

Reducing your risk of cholelithiasis

Although some risk factors, such as age and gender, cannot be modified, you may be able to lower your risk of cholelithiasis through lifestyle changes including:

  • Eating a healthy diet
  • Getting regular physical activity
  • Losing weight slowly
  • Maintaining a healthy weight
Treatments

How is cholelithiasis treated?

Treatment of cholelithiasis begins with seeking medical care from your health care provider. To determine if you have cholelithiasis, your health care provider may ask you to provide blood samples and undergo diagnostic tests.

Some people with cholelithiasis never have any symptoms. If you have symptoms of cholelithiasis, you may be hospitalized and given antibiotics to prevent an infection. Food intake is normally stopped, and intravenous fluids are administered to let the digestive system rest. You may also receive medication for the abdominal pain associated with cholelithiasis.

If you have recurrent episodes of cholelithiasis, the most common treatment is surgery to remove the gallbladder (cholecystectomy). There are two methods for this surgery: open cholecystectomy, when the whole organ is removed through a single incision; and laparoscopic cholecystectomy, when the gallbladder is removed in pieces through several smaller incisions. The laparoscopic technique is now used more frequently. Because the gallbladder is not an essential organ, most people who have had a cholecystectomy can live a normal life afterwards.

Treatment options for cholelithiasis

Several treatment options are now available for cholelithiasis. Laparoscopic cholecystectomy is currently the most frequently used technique. Options include:

  • Endoscopic retrograde cholangiopancreatography (ERCP), an imaging procedure that allows treatment of some bile duct problems, including removal of gallstones that are causing obstruction

  • Laparoscopic cholecystectomy (removal of the gallbladder through multiple small incisions; this is less invasive and a more commonly used technique)

  • Lithotripsy (technique that uses electric shock waves to dissolve gallstones; it is not commonly used today)

  • Medication to dissolve gallstones (this treatment takes a long time, and gallstones may recur)

  • Open cholecystectomy (removal of the gallbladder through a single, large incision; this is a more invasive and less commonly used technique)

What are the potential complications of cholelithiasis?

Cholelithiasis may cause serious complications if gallstones lodge in the common bile duct, which is the large duct formed where the major gallbladder bile duct joins the major liver bile duct. You can help minimize your risk of serious complications by following the treatment plan that you and your health care professional design specifically for you. Complications of cholelithiasis include:

  • Acute cholecystitis (sudden inflammation of the gallbladder)

  • Cholangitis (an infection or inflammation of the common bile duct)

  • Choledocholithiasis (gallstone in the common bile duct)

  • Pancreatitis (infection or inflammation of the pancreas)

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Jan 5
  1. Gallstones. National Digestive Diseases Information Clearinghouse (NDDIC). http://digestive.niddk.nih.gov/ddiseases/pubs/gallstones/index.htm.
  2. Gallstones. PubMed Health, a service of the NLM from the NIH http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001318/.
  3. Bope ET, Kellerman RD (Eds.) Conn’s Current Therapy.Philadelphia: Saunders, 2012.
  4. Festi D, Reggiani ML, Attili AF, et al. Natural history of gallstone disease: Expectant management or active treatment? Results from a population-based cohort study. J Gastroenterol Hepatol 2010; 25:719.
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