Cholelithiasis (Gallstones): What to Know

Medically Reviewed By Cynthia Taylor Chavoustie, MPAS, PA-C
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Cholelithiasis is the medical name for gallstones — hard deposits of cholesterol or bilirubin that form in the gallbladder. Gallstones can cause upper right abdominal pain. Contact your doctor for persistent symptoms and seek immediate medical care (call 911) for serious symptoms such as severe pain and high fever. The gallbladder stores bile and releases it into the small intestine during digestion. Gallstones can develop if bile contains too much cholesterol or bilirubin, one of the components of bile. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) explains that certain genetic factors and medical conditions, such as diabetes, increase one’s likelihood of developing gallstones.

Gallstones can also occur if the gallbladder is not working properly and cannot release bile. Gallstones are common in the United States, affecting about 10–15% of people, according to the NIDDK.

Left untreated, cholelithiasis can lead to serious complications. These include 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°F [38°C]), severe abdominal pain, abdominal swelling, and nausea with or without vomiting. Seek prompt medical care if your doctor is treating you for gallstones but your symptoms recur or are persistent.

This article explains the types, symptoms, and causes of gallstones. It also explores treatment options, when to see a doctor, and the types of complications that can occur.

What are the different types of gallstones?

illustration of gallstones in the gallbladder and common bile duct to the pancreas
Original illustration by Diego Sabogal

Different types of gallstones can form in cholelithiasis. A cholesterol stone is the most common type. It results from the presence of too much cholesterol in the bile.

Another type of stone, a pigment stone, forms from excess bilirubin. Bilirubin is a waste product from 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.

Silent gallstones with no symptoms do not require treatment. They will not stop the gallbladder form working the way it should.

Gallstone attacks cause symptoms and usually need surgery to remove the gallbladder to prevent complications.

What are the symptoms of cholelithiasis?

female lying down holding stomach
Beavera/Getty Images

Cholelithiasis can irritate and inflame the gallbladder, resulting in a number of symptoms that vary in intensity. Sometimes, people develop a complete blockage of the bile ducts, which poses a risk of infection. Gallstones can also lead to cholecystitis, which is inflammation of the gallbladder.  

Common symptoms of cholelithiasis

You may experience cholelithiasis symptoms daily or just once in a while, according to the NIDDK. At times, any of these common symptoms can be severe:

  • abdominal pain, typically in the right upper quadrant of the abdomen
  • clay-colored stools
  • 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)

What type of pain does cholelithiasis cause?

When a gallstone completely blocks a bile duct, the pain is usually severe, sudden, and constant. The pain of this attack usually affects the upper right area of the abdomen. It can also radiate to the upper back.

Gallstones can also cause biliary colic. This is pain that comes and goes, usually after eating a fatty meal.

Symptoms that might indicate a serious condition

In some cases, cholelithiasis can be life threatening and can lead to complications. Seek immediate medical care (call 911) for any of these potentially serious symptoms, including:

When to contact a doctor

Make an appointment with your doctor if you have any ongoing digestive symptoms.

Contact a doctor right away for any of the following symptoms:

  • abdominal pain that is severe or lasts more than a few hours
  • pain radiating to your right shoulder or between your shoulder blades
  • nausea or vomiting that occur with abdominal pain
  • change in stool or urine color
  • jaundice
  • high fever with chills

What causes cholelithiasis?

In most cases, cholelithiasis is due to excessive amounts of cholesterol in the bile the gallbladder stores. The cholesterol hardens to form stone-like masses.

Some gallstones develop because the bile contains too much bilirubin, a waste product of the liver that is a component of bile. The name for gallstones that develop from excess bilirubin is “pigment stones.”

Cholelithiasis is not cancer, but it is a risk factor for developing gallbladder cancer. However, this type of cancer is rare, even in people with a history of gallstones.

What are the risk factors for cholelithiasis?

A number of factors increase the risk of developing cholelithiasis. Not all people with risk factors will develop cholelithiasis. The American Academy of Family Physicians (AAFP) notes the following risk factors for cholelithiasis:

  • over 60 years old
  • body mass index of 30–34.9
  • diabetes
  • family history
  • female sex
  • low calorie diet or losing weight too rapidly
  • pregnancy
  • use of certain medications, such as birth control pills

Reducing your risk of cholelithiasis

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 moderate weight

What is the difference between cholecystitis and cholelithiasis?

Cholelithiasis is the formation of gallstones in the gallbladder. Cholecystitis is inflammation of the gallbladder. They are related because gallstones can inflame the gallbladder. In fact, gallstones are the most common cause of cholecystitis.

How is cholelithiasis (gallstones) diagnosed?

To diagnose gallstones, your doctor will take a medical history, perform an exam, and possibly order testing. Questions your doctor may ask include:

  • What symptoms are you having?
  • When did your symptoms begin?
  • Are your symptoms constant or do they come and go?
  • How severe are your symptoms?
  • Do you have pain, and where is it?
  • How would you describe the pain, such as dull or sharp?
  • How long does the pain last?
  • How often do you feel this pain?
  • Does eating or drinking trigger the pain or make it worse?
  • What other medical conditions do you have?
  • What medications and over-the-counter products do you take?

During the exam, your doctor will feel your abdomen. They will be exploring for tender areas and checking the size of your internal organs. Depending on the results, testing may be necessary. Common tests for diagnosing gallstones include:

  • blood tests to look for signs of infection and check liver function, pancreatic enzyme levels, and bilirubin levels
  • abdominal ultrasound
  • endoscopic ultrasound, which uses an endoscope to take ultrasound images internally
  • other advanced imaging exams

How is cholelithiasis treated?

Some people with cholelithiasis never have any symptoms and do not require treatment. If you have symptoms, the usual treatment is surgery to remove the gallbladder. Doctors recommend surgery in most cases because gallstones often recur. If gallstones are causing cholecystitis, your doctor may recommend immediate surgery. Otherwise, you may be able to schedule it for later.

There are two methods for removing the gallbladder.

The most common option is laparoscopic cholecystectomy. The surgeon makes two to three small incisions for the tools they use to view, detach, and remove the gallbladder. The gallbladder is removed in its entirety through one of the incisions.

In cases of gallbladder infection or severe inflammation, doctors may opt for an open cholecystectomy. With this method, doctors remove the whole organ through a single larger incision.

Other treatment options for cholelithiasis

Other possible treatment options include:

  • endoscopic retrograde cholangiopancreatography, an imaging procedure that allows treatment of some bile duct problems, including removal of gallstones that are obstructing the bile duct
  • lithotripsy, a technique that uses electric shock waves to dissolve gallstones
  • medication to dissolve gallstones, but this can take a long time, and gallstones may recur

Doctors mainly use these alternatives for people who are not good candidates for surgery.

What happens if the gallbladder is removed?

The gallbladder is not an essential organ. Most people who have a cholecystectomy can live a normal life afterward. Some people have softer stools and frequent bowel movements in the first few weeks after surgery. This usually resolves within 3 months. Eating a low fat diet can help while your body learns to adjust.

Learn more about living without a gallbladder and foods to avoid after gallbladder removal.

What are the potential complications of cholelithiasis?

Untreated gallstones can lead to serious complications, including: 

  • acute cholecystitis, or sudden inflammation of the gallbladder with severe pain and fever
  • blockage of the common bile duct, which is the large duct that forms where the major gallbladder bile duct joins the major liver bile duct
  • cholangitis, which is an infection or inflammation of the common bile duct
  • pancreatitis, which is infection or inflammation of the pancreas

You can help reduce your risk of serious complications by following your treatment plan.

Frequently asked questions

Here are other common questions about gallstones. They have been answered by Cynthia Taylor Chavoustie, MPAS, PA-C.

How can you dissolve gallstones without surgery?

If your gallstones are small or if, for some reason, you cannot have surgery, you may be able dissolve your gallstones with a medication called ursodiol (Actigall, Urso). It is a naturally occurring bile acid that dissolves cholesterol in bile. It may take several months before it has any effect on your gallstones.

How do gallstones pass?

If they are small enough, gallstones can easily pass through the bile duct into the rest of the digestive tract when the gallbladder contracts to release bile for digestion.

How do you get rid of gallstones with apple cider vinegar?

There are no studies to support the use of apple cider vinegar for the treatment of gallstones.

What does a gallstone attack feel like?

Patients often report a gallstone attack as feeling like an intense, sharp, stabbing pain that starts in the upper right quadrant or upper-middle portion of the abdomen. The pain then radiates to the mid-upper back near the shoulder blade.

What happens if gallstones are left untreated?

If gallstones are small and are not causing any symptoms, they are usually left untreated. However, large gallstones pose the risk of getting stuck in the ducts, or tubes, that lead out of the gallbladder. This can cause a blockage and thus pain, swelling, and even a serious infection.

Summary

Gallstones can develop in the gallbladder from excessive cholesterol in the bile. They may or may not cause symptoms, which can include upper right abdominal pain and nausea or vomiting.

Gallstones that cause symptoms, block the bile duct, or lead to gallbladder inflammation (cholecystitis) may require surgical removal of the gallbladder to prevent serious complications.

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Medical Reviewer: Cynthia Taylor Chavoustie, MPAS, PA-C
Last Review Date: 2022 May 11
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