What are gallstones?
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 gallstones 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 vary among individuals; the gallbladder can form many small stones or one large stone.
The course of gallstones also varies among individuals. Some people with gallstones have no symptoms at all, while others may have severe abdominal pain, nausea and vomiting, and complete blockage of the bile duct, posing a risk of infection. Gallstones can lead to cholecystitis, inflammation of the gallbladder. Acute gallstone attacks may be managed with intravenous medications. Chronic (long-term) occurrence or recurrence of gallstones is treated by surgical removal of the gallbladder.
Left untreated, gallstones can lead to serious complications such as tissue damage, tears in the gallbladder, and infection that spreads to other parts of the 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 gallstones but mild symptoms recur or are persistent.
What are the symptoms of gallstones?
Gallstones 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 cholecystitis
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 symptoms that occur within minutes after a meal
Fever and chills
Nausea with or without vomiting
Pain that radiates from the abdomen to the right shoulder or back
Yellowing of the skin and whites of the eyes (jaundice)
Serious symptoms that might indicate a life-threatening condition
In some cases, gallstones 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:
What causes gallstones?
In most cases, gallstones are caused by excessive amounts of cholesterol in the bile that is stored in the gallbladder. The cholesterol hardens to form stone-like substances. The presence of a stone or multiple stones in the gallbladder is known as cholelithiasis. 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.
A number of factors increase your risk of developing gallstones. Not all people with risk factors will get gallstones. Risk factors for gallstones include:
Age over 40 years
Crash dieting or losing weight rapidly (bile then contains more cholesterol)
Ethnicity (risk is higher in American Indians and Mexican Americans)
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 gallstones
Although some risk factors, such as age or gender, cannot be modified, you may be able to lower your risk of gallstones through lifestyle changes including:
Eating a healthy diet
Getting regular physical activity
Losing weight slowly
Maintaining a healthy weight
How are gallstones treated?
Treatment of gallstones begins with seeking medical care from your health care provider. To determine if you have gallstones, your health care provider will ask you to provide blood samples and undergo diagnostic tests.
Some people with gallstones never have any symptoms. If you have symptoms of gallstones, 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 gallstones.
If you have recurrent episodes of gallstones, 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 gallstones
Several treatment options are now available for gallstones. Laparoscopic cholecystectomy is currently the most frequently used technique. Examples of treatment 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 a less invasive and more commonly used technique)
Lithotripsy (this procedure uses electric shock waves to dissolve gallstones; it is not commonly used today)
Medications 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)
Gallstones may cause serious complications if they 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 gallstones include:
Acute cholecystitis (sudden inflammation of the gallbladder)
Cholangitis (infection or inflammation of the common bile duct)
Choledocholithiasis (gallstone in the common bile duct)
Pancreatitis (infection or inflammation of the pancreas)