Gallstones are crystal-like deposits that develop in the gallbladder — a small, pear-shaped organ that stores bile, a digestive fluid produced by the liver.
These deposits may be as small as a grain of sand or as large as a golf ball; they may be hard or soft, smooth or jagged. You may have several gallstones or just one.
Some 30 million American adults suffer from gallstones. Yet most of those who have the condition do not realize it. In this case, what you don’t know probably won’t hurt you; gallstones that are simply floating around inside the gallbladder generally cause no symptoms and no harm.
These “silent” stones usually go unnoticed unless they show up in an ultrasound exam conducted for some other reason. However, the longer a stone exists in the gallbladder, the more likely it is to become problematic. People who have gallstones without symptoms have 20% chance of having an episode of pain during their lifetime.
When symptoms do occur, it’s usually because the gallstone has moved and become lodged within a duct that carries bile, such as the cystic duct, a small conduit that connects the gallbladder to another tube called the common bile duct. The typical symptom is abdominal pain, perhaps accompanied by nausea, indigestion, or fever. The pain, caused by the gallbladder’s contraction against the lodged stone, generally occurs within an hour of eating a large meal or in the middle of the night. Stones can also clog the common bile duct, which carries bile into the small intestine, and the hepatic ducts, which take bile out of the liver.
Obstructions in the bile pathway may cause a duct to become inflamed and possibly infected. Blockage of the common bile duct, which merges with the pancreatic duct at the small intestine, can also lead to inflammation of the pancreas (gallstone pancreatitis).
In a rare but dangerous condition that occurs most often in older women, gallstones migrate into the small intestine and block the passageway into the large intestine; symptoms include severe and frequent vomiting. Although gallstones are present in about 80% of people with gallbladder cancer, it is uncertain whether gallstones play a role, except when really large stones (greater than 3 centimeters in diameter) are present.
- 7 Signs That You Might Have Gallstones
- Gallstones – causes, symptoms, treatment
- The Location and Purpose of the Liver
- What are Liver Stones?
- General Statistics about Liver Concerns
- 9 Herbs That Promote Liver Cleansing
- 4 Common Diseases of the Liver
- Symptoms of a Sluggish Liver
- Can Any Organisms Harm the Liver?
- What Chemicals Affect the Liver?
- Choosing a Liver Cleansing Supplement
- What are gallstones?
- What is the biliary tract?
- What causes gallstones?
- Who is at risk for gallstones?
- What are the symptoms and complications of gallstones?
- When should a person talk with a health care provider about gallstones?
- How are gallstones diagnosed?
- How are gallstones treated?
- Eating, Diet, and Nutrition
- Points to Remember
- Clinical Trials
7 Signs That You Might Have Gallstones
Anywhere from 20 to 25 million people in the U.S. have a problem with their gallbladder, a small pear-shaped organ that sits underneath the liver and stores bile, a digestive fluid that helps break down fats.
The most common gallbladder problem is gallstones, crystallized clumps of bile and dissolved cholesterol that form in the gallbladder or bile duct, the tube that carries the bile to the small intestine. Gallstones can cause inflammation and pain, and lots of people have them—up to 20% of women and 10% of men in the U.S. by the age of 60—and they can be as small as a grain of sand or as large as a golf ball.
For more on digestive conditions, check out our Digestive Health Condition Center
Women are more likely to develop gallstones, and changes in the sex hormones estrogen and progesterone can slightly increase gallstone production. Estrogen boosts the amount of cholesterol in your bile, and progesterone slows the emptying of the gallbladder. The risk of forming gallstones is increased slightly by pregnancy or even oral contraception, which affect hormone levels.
Most people have these stones with no symptoms, often called “silent stones,” and they do not require treatment, but for people experiencing symptoms from gallstones or low-grade gallbladder inflammation, surgery to remove the gallbladder is the most common recommended treatment.
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A bit like the appendix, the gallbladder can be removed without harming normal function. However, the body needs to adjust to having bile dump directly into the digestive tract, rather than being released as needed. Digesting fatty meals can be a problem after the surgery.
Gallstones are often detected incidentally while investigating other health problems, according to the American College of Gastroenterology. But if you experience the following signs and symptoms, seek out medical care.
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The occasional recurrence of a dull pain by your liver is the most common sign that you have gallstones. The pain often strikes after eating and can last a couple hours before it resolves, says Edward Levine, MD, a gastroenterologist and an associate professor of clinical medicine at Wexner Medical Center at The Ohio State University in Columbus. Pain is typically experienced in the upper right abdomen, near the rib cage, but it can also radiate to the upper back and the center of the abdomen.
Pain following a meal can happen once in a while or after every meal. Known as biliary colic pain, or a gallbladder attack, it can last anywhere from an hour to several hours and is more likely to be triggered by large and fatty meals. This kind of pain comes and goes repeatedly. Chronic, ongoing pain that persists beyond a few hours may also occur, and may suggest a more severe gallbladder issue.
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The timing of the pain is important, says Allison Yang, MD, a gastroenterology and hepatology fellow at Brigham and Women’s Hospital in Boston. Pain symptoms typically come within a couple hours after a meal, so if you are experiencing pain sooner, while eating or immediately after, that might be a tip off that it is not gallbladder disease.
Pain relievers don’t help
If either biliary or chronic pain doesn’t improve with an OTC pain reliever, it may also be an indication that you have a gallbladder problem. Experiencing little improvement after a change in position, bowel movement, or after passing gas are also indications. “These kind of rule out other things and may help us target the gallbladder more specifically,” says Dr. Yang.
Jaundice is a symptom of liver trouble that manifests as a yellowing of the skin and the whites of the eyes, along with symptoms like dark urine and pale colored stools. Jaundice is common in newborns, but it’s also an indication of a gallbladder problem in adults. The gallbladder releases bile into the small intestines through a tube called the cystic duct, which connects to the bile duct. Jaundice occurs when you obstruct these ducts. “If you think of this tube as a hose, if the gallbladder forms a stone and the stone gets stuck inside the tube, there’s essentially a stone inside the hose and it causes a blockage,” says Dr. Yang.
That blockage can cause bile to build up in the gallbladder and increase the concentration of a yellowish substance called bilirubin.
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A lot of people mistake gallbladder problems for an upset stomach, heartburn, or acid reflux. “Sometimes people may mistake gallbladder pain as muscle pain from exercise,” says Dr. Yang. But if the nausea or vomiting recurs with repeated episodes of pain after eating, that might be an indication of gallbladder disease. While nausea is not as common a symptom as abdominal pain, if there’s significant nausea or vomiting, those are signs that you should probably go to a physician, urgent care, or the emergency room.
If you develop pancreatitis, an inflammation of the pancreas, you should be checked for gallstones, says Dr. Yang. The pancreas sits next to the liver and discharges digestive enzymes into the same area of the digestive tract as bile; because the two ducts meet up near the intestine, a stone in one can affect the function of the other. If a gallstone exits the gallbladder and gets stuck in the pancreatic duct, it can cause inflammation and abdominal pain. Dr. Yang says that if this occurs, doctors usually recommend that the gallbladder be removed. Pancreatitis symptoms can include abdominal pain, nausea and vomiting, a rapid pulse, and a fever.
Obesity or sudden weight loss
These are problems associated with gallstones, and are not necessarily symptoms. Typically the weight or weight loss happens first, and then gallbladder issues develop. Why? People who are obese are at greater risk of gallstones. And while losing weight can help decrease the risk, very rapid weight loss can make you more prone to forming gallstones. “Patients who experience gastric bypass surgery or stapling surgery, when they lose a lot of weight very quickly, that’s often associated with forming gallstones,” says Dr. Yang.
Pacing is important. Dr. Yang recommends, “slow, steady, healthy weight loss” over crash diets.
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Abnormalities in ultrasound, MRI, HIDA scan
The gallbladder is a hollow organ, and gallstones can show as solid masses in the gallbladder or the bile duct on an ultrasound. This non-invasive test is the usually the first step to investigating problems in the gallbladder, explains Dr. Yang. Doctors can take note of the size of the gallbladder and if any swelling or thickening of the walls has occurred, as those may be signs of inflammation. Other tests include magnetic resonance imaging, or MRIS, which can be more helpful to look at ducts. Finally, a hepatobiliary, or HIDA, scan can show how well the gallbladder is emptying itself. During the test, a radioactive tracer in injected in your arm and used to visualize the ducts. Sometimes these procedures can be helpful when a gallbladder disease diagnosis isn’t clear on an ultrasound. ” may explain why someone may be having gallbladder symptoms without clearly a stone or something causing obstruction,” says Dr. Yang.
While right-sided abdominal pain is a classic symptom of gallbladder disease, sometimes what feels like abdominal pain is actually a heart or lung condition. “People (especially women) may have atypical presentations of heart attacks or other cardiac problems, and these may present as abdominal pain rather than chest pain,” says Dr. Yang.
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Pneumonia, especially if it is in the lower part of the right lung, Dr. Yang continues, may also feel like right-sided upper abdominal pain. And if you experience fever and chills along with the abdominal pain, it could mean there’s an acute inflammation of the gallbladder that’s due to an infection, not gallstones. These symptoms may raise concerns that gut bacteria that are normally present in the intestines have invaded the gallbladder. Dr. Yang says this warrants immediate medical attention and may require surgery.
Overall, if any symptoms recur or persist, patients “should definitely be evaluated by their doctor,” Dr. Yang recommends. “They should speak with their doctor to see if they need to be evaluated more urgently in the ER or if they can be seen in the office the next day for further work up.”
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Gallstones – causes, symptoms, treatment
In general, treatment will depend on the frequency and severity of the symptoms experienced. Because it is possible that people who experience biliary colic will not experience a further episode, your doctor may advise a wait and see approach.
If attacks are occasional and mild, they may be able to be managed with pain-relieving medications, applying heat to the affected area, resting and taking sips of water. Reducing the amount of fat in your diet and maintaining a healthy body weight may also be beneficial. If attacks are frequent or severe surgery is usually recommended.
Cholecystectomy is the surgical removal of the gallbladder and is a common and routine procedure. It may be recommended when the symptoms of gallstones are problematic. If there is infection or acute inflammation of the gallbladder, this may need to be treated with antibiotics before the gallbladder can be removed.
The gallbladder is not essential to live or to digest food. When the gallbladder is removed, bile is still produced by the liver and flows directly into the small intestine.
The two cholecystectomy techniques are:
This is the “traditional” but now-a-days less common surgical technique for removing the gallbladder and is performed under a general anaesthetic. A single incision is made below the rib cage. Through the incision, the surgeon can view the area and remove the gallbladder.
Laparoscopic cholecystectomy is also performed under general anaesthetic but is less invasive and much more commonly used than the open cholecystectomy technique. It has a faster recovery time and a shorter hospital stay (usually just one night). A telescope-like instrument (a laparoscope) is inserted through one incision (allowing the surgeon to view the inside of the abdominal cavity on a television monitor) and surgical instruments are inserted through other incisions. The gallbladder is located and removed through an incision in the belly button.
Surgery risks and complications
As with any surgery, there are possible risks and complications which you should discuss with your doctor before surgery. These include:
- Anaesthetic complications
- Wound infection
- Injury to or leakage from the bile duct
- Discomfort or numbness around the area of incision
For small gallstones that don’t contain calcium, it may be possible to dissolve them by taking ursodeoxycholic acid tablets. However, ursodeoxycholic acid tablets are not often recommended because they are not always effective, need to be taken for a long time (up to 2 years), and gallstones are likely to form again once treatment is stopped. They are usually used for people who are unable to undergo surgery. Occasionally, they may be used to prevent gallstones in people at high risk of developing them.
Last Reviewed – September 2019
Each year, millions of people in the United States suffer from gallstone-related pain. However, it may surprise many of these individuals to discover they are, in fact, suffering from the presence of liver stones. Liver stones are the less publicized cousins of the gallstone, as the two are essentially the same. Ultimately, location defines the difference between the two. To help reduce the risk of suffering from this painful condition, everyone should understand how the liver functions and what can be done to support its health.
The Location and Purpose of the Liver
The liver is the largest gland in the body and it’s located at the beginning of the small intestine. The gallbladder, for comparison, is located behind the liver, near its base. The main purpose of the liver is to produce bile, which is an essential secretion for breaking down digested lipids into smaller particles so fats and fat-soluble vitamins can be absorbed by the small intestine.
The liver forms bile from water, electrolytes, and other molecules including cholesterol, bilirubin, bile acids, and phospholipids. Adults produce between 400 and 800 ml of bile each day and it’s stored in the gallbladder until needed. Besides manufacturing bile, the liver works as a filter to detoxify and purge harmful chemicals (such as alcohol) from the body.
What are Liver Stones?
Liver stones are commonly formed whenever an excess of cholesterol exists in the body. When excess dietary cholesterol is present, the remainder often crystallizes into small, pebble-shaped masses. Recently, researchers at the University of Bonn in Germany discovered that heredity may also be a contributor to the condition. The scientists believe they have isolated a gene within the body that greatly increases a person’s chances of forming liver and/or gallstones.
General Statistics about Liver Concerns
- Physical injuries to the liver are responsible for just 5% of all hospital admissions.
- 80% of all cases of liver toxicity are caused by pharmacological drug reactions.
- More than 900 prescription drugs are known to cause injury to the liver. Toxicity is the leading reason for withdrawing a drug from the market.
- Liver and gallstones are present in 10% to 20% of the population.
9 Herbs That Promote Liver Cleansing
The top nine herbs that promote liver cleansing include:
- Chicory root
- Dandelion leaf
- Dandelion root
- Greater celandine
- Milk thistle seed
- Peppermint leaf
- Yellow dock root
- Chanca piedra
Check out this article for a more detailed list of the top 9 herbs for liver cleansing.
4 Common Diseases of the Liver
Due to the liver’s role as the body’s detoxifying system, much of what we eat and drink can greatly affect its health. Here are some of the more common diseases of the liver:
Damage to the liver causes scarring which further prevents the liver from functioning the way it should. Common causes of cirrhosis include alcoholism and hepatitis. About 5% of cirrhosis patients develop liver cancer and end up receiving liver transplants due to excessive scarring.
2. Fatty Liver
“Fatty liver” is a common condition in people who drink too much alcohol. The liver becomes enlarged by the accumulation of fat cells. Usually, the only symptom presented is a slight discomfort within the abdomen. The condition normally improves if the person in question ceases drinking alcohol. In addition to alcohol-induced fatty liver, there is also non-alcoholic fatty liver disease that typically presents the exact same symptoms but without alcohol as the cause. Non-alcoholic fatty liver disease is often related to insulin resistance (type 2 diabetes) and obesity, so weight loss and managing carbohydrate intake may be helpful.
Alcoholic hepatitis (liver inflammation) is also caused by the intake of too much alcohol and is often a precursor to cirrhosis and eventual liver failure. If detected early enough, damage to the liver may be somewhat reversed. Viral Hepatitis, on the other hand, attacks the liver directly. Actually five different types of viral Hepatitis exist:
- Hepatitis A (HAV) – Can affect anyone and ranges from single cases to widespread epidemics
- Hepatitis B (HBV) – A deadly disease causing cirrhosis, cancer, liver failure, and even death
- Hepatitis C (HCV) – Easily spread by coming into contact with the blood of an infected person
- Hepatitis D (HDV) – A virus found in the blood of affected individuals, and the patient usually has HBV as well
- Hepatitis E (HEV) – Similar to HAV, but rarely found in the United States.
4. Gilbert Syndrome
Gilbert Syndrome is caused by a defect in the uptake of bilirubin into the liver cells. Gilbert Syndrome can be very difficult to identify and is sometimes confused with liver disease.
Symptoms of a Sluggish Liver
When your liver isn’t functioning at peak performance, you may experience some or all of the following symptoms:
- Chronic Fatigue
- Digestive Difficulties
- Chemical Sensitivities
It’s interesting that the symptoms for impaired hepatic detoxification are commonly the same as those attributed to patients suffering from exposure to toxic chemicals.
Can Any Organisms Harm the Liver?
Yes! Liver flukes (Trematodes) are a type of flatworm which infects the digestive system and other organs in the body. Adult flukes have external suckers which allow it to attach and leech nourishment. Trematodes normally enter the body through the act of eating uncooked fish or plants and fish from fluke-infested waters. Trichinosis is another type of parasitic disease that can harm the liver. Trichinosis is contracted from eating under-cooked meat (usually pork) and it affects the bile ducts that drain the liver. A condition known as schistosomiasis occurs when parasites enter the body through the skin, usually from walking barefoot in infested fresh water. The organisms travel through the body, settling in the small veins of the liver. Ultimately, schistosomiasis results in cirrhosis of the liver due to the scarring caused by the inflammation. Also, many people may not realize Hepatitis A is a virus that enters the liver as an organism. The most common way to contract Hepatitis A is to eat food prepared or handled by someone who didn’t thoroughly wash their hands after using the bathroom.
What Chemicals Affect the Liver?
Chemicals which can cause hepatotoxicity include Acetaminophen, Isoniazid, aflatoxins, arsenic, and carbon tetrachloride. Taking more than the recommended amount of Acetaminophen causes the glutathione pathway to become overwhelmed with NAPQI-Acetaminophen’s metabolite. Ultimately, this toxic compound accumulates in the liver and the glutathione is unable to remove it, thus damaging the liver in the process.
Used to treat Tuberculosis, Isoniazid is a powerful medication necessitating the patient to undergo constant liver tests. Isoniazid is believed to cause granulomas (chronic inflammatory nodules) within the liver.
Aflatoxins occur naturally and can be found in soil, decaying vegetation, and other natural settings. Aflatoxins typically flourish in areas of high heat and moisture and normally contaminate crops of cereals, spices, peanuts, and other dried goods. High exposure to aflatoxins causes carcinoma, cirrhosis, and eventual necrosis of the liver.
Arsenic is a well-known carcinogen and teratogen. The most common exposure for humans comes from drinking tap water. High levels of arsenic can be fatal within 12-48 hours after ingestion with some deaths occurring within one hour. Once absorbed into the body, arsenic is stored in the liver where it can contribute to the onset of cancer.
Carbon tetrachloride is very dangerous to humans and animals when inhaled. Clinical signs of carbon tetrachloride inhalation include elevated levels of the hepatic enzyme Aspartate Aminotransferase, elevated levels of bilirubin, decreased levels of albumin and fibrinogen, and a swollen and tender liver.
What Diet Promotes A Strong Liver?
Besides the intake of pharmaceutical drugs, a poor diet is a major contributor to most liver concerns. High alcohol intake is the most common form of dietary danger to the liver. However, you can improve your diet a number of ways to promote overall liver function.
- A diet too high in protein may cause a condition called hepatic encephalopathy or “mental confusion”. While the exact cause of hepatic encephalopathy is still unknown, it is theorized that when the body digests high amounts of proteins, excessive ammonia is formed, which affects the central nervous system. Your doctor should always be consulted before altering the protein in your diet.
- A diet high in calories, especially carbohydrates and trans and saturated fats, can equally result in liver concerns. Excess caloric intake can lead to fatty deposits within the liver.
- Watch your Vitamin A intake, as it is high in saturated fat and cholesterol and can be very toxic to the liver when taken in large amounts. However, Emulsified Vitamin A does not contain fat or cholesterol. Emulsified Vitamin A is a liquid form of the vitamin that is derived from the carotene found in green and yellow vegetables and egg yolk. Emulsified Vitamin A is a powerful antioxidant for supplementing your diet. Vitamin A also helps promote cell differentiation and supports the body’s normal immune system response.
The best diet for the liver is one low in protein and also sodium. Eating plenty of raw fruits and vegetables will help to keep your body, especially your liver from overtaxing itself. Approximately 30% to 40% of your diet should consist of dark green leafy vegetables and orange, red, purple, and yellow colored fruits and vegetables. A diet high in trans and saturated fats causes the liver to work extra hard, so reducing your intake of those fats is critical to a healthy liver. Avocados and oily fish such as salmon, tuna, and sardines are excellent choices for promoting liver health. Many varieties of raw seeds such as flaxseed, sunflower, and alfalfa seeds are beneficial in this regard as well. Certain oils (primrose, black currant seed, and cold-pressed olive oil to name a few) assist the liver as well.
Choosing a Liver Cleansing Supplement
Along with a healthy and cleansing diet, you must routinely cleanse your liver to promote optimum function and health. A number of liver and even gallbladder cleansing products can be found in health stores and on the Internet, but the most effective of these are manufactured with only 100% organic and wildcrafted herbs and are produced using proprietary processes.
Liver cleansers produced with these methods, such as Livatrex®, provide you with herbs extracted using pure Kosher-certified vegetable glycerin rather than alcohol, thus making them the safest and most effective class of supplements for supporting your health improvement initiatives.
†Results may vary. Information and statements made are for education purposes and are not intended to replace the advice of your doctor. If you have a severe medical condition or health concern, see your physician.
What are gallstones?
Gallstones are hard particles that develop in the gallbladder. The gallbladder is a small, pear-shaped organ located in the upper right abdomen—the area between the chest and hips—below the liver.
Gallstones can range in size from a grain of sand to a golf ball. The gallbladder can develop a single large gallstone, hundreds of tiny stones, or both small and large stones. Gallstones can cause sudden pain in the upper right abdomen. This pain, called a gallbladder attack or biliary colic, occurs when gallstones block the ducts of the biliary tract.
By BruceBlaus (Own work) , via Wikimedia Commons
What is the biliary tract?
The biliary tract consists of the gallbladder and the bile ducts. The bile ducts carry bile and other digestive enzymes from the liver and pancreas to the duodenum—the first part of the small intestine.
The liver produces bile—a fluid that carries toxins and waste products out of the body and helps the body digest fats and the fat-soluble vitamins A, D, E, and K. Bile mostly consists of cholesterol, bile salts, and bilirubin. Bilirubin, a reddish-yellow substance, forms when hemoglobin from red blood cells breaks down. Most bilirubin is excreted through bile.
The Biliary Tract
The bile ducts of the biliary tract include the hepatic ducts, the common bile duct, the pancreatic duct, and the cystic duct. The gallbladder stores bile. Eating signals the gallbladder to contract and empty bile through the cystic duct and common bile duct into the duodenum to mix with food.
What causes gallstones?
Imbalances in the substances that make up bile cause gallstones. Gallstones may form if bile contains too much cholesterol, too much bilirubin, or not enough bile salts. Scientists do not fully understand why these imbalances occur. Gallstones also may form if the gallbladder does not empty completely or often enough.
The two types of gallstones are cholesterol and pigment stones:
- Cholesterol stones, usually yellow-green in color, consist primarily of hardened cholesterol. In the United States, more than 80 percent of gallstones are cholesterol stones.1
- Pigment stones, dark in color, are made of bilirubin.
Who is at risk for gallstones?
Certain people have a higher risk of developing gallstones than others:2
- Women are more likely to develop gallstones than men. Extra estrogen can increase cholesterol levels in bile and decrease gallbladder contractions, which may cause gallstones to form. Women may have extra estrogen due to pregnancy, hormone replacement therapy, or birth control pills.
- People over age 40 are more likely to develop gallstones than younger people.
- People with a family history of gallstones have a higher risk.
- American Indians have genetic factors that increase the amount of cholesterol in their bile. In fact, American Indians have the highest rate of gallstones in the United States—almost 65 percent of women and 30 percent of men have gallstones.
- Mexican Americans are at higher risk of developing gallstones.
Other factors that affect a person’s risk of gallstones include2
- Obesity. People who are obese, especially women, have increased risk of developing gallstones. Obesity increases the amount of cholesterol in bile, which can cause stone formation.
- Rapid weight loss. As the body breaks down fat during prolonged fasting and rapid weight loss, the liver secretes extra cholesterol into bile. Rapid weight loss can also prevent the gallbladder from emptying properly. Low-calorie diets and bariatric surgery—surgery that limits the amount of food a person can eat or digest—lead to rapid weight loss and increased risk of gallstones.
- Diet. Research suggests diets high in calories and refined carbohydrates and low in fiber increase the risk of gallstones. Refined carbohydrates are grains processed to remove bran and germ, which contain nutrients and fiber. Examples of refined carbohydrates include white bread and white rice.
- Certain intestinal diseases. Diseases that affect normal absorption of nutrients, such as Crohn’s disease, are associated with gallstones.
- Metabolic syndrome, diabetes, and insulin resistance. These conditions increase the risk of gallstones. Metabolic syndrome also increases the risk of gallstone complications. Metabolic syndrome is a group of traits and medical conditions linked to being overweight or obese that puts people at risk for heart disease and type 2 diabetes.
More information about these conditions is provided in the NIDDK health topic, Insulin Resistance and Prediabetes.
Pigment stones tend to develop in people who have
- cirrhosis—a condition in which the liver slowly deteriorates and malfunctions due to chronic, or long lasting, injury
- infections in the bile ducts
- severe hemolytic anemias—conditions in which red blood cells are continuously broken down, such as sickle cell anemia
What are the symptoms and complications of gallstones?
Many people with gallstones do not have symptoms. Gallstones that do not cause symptoms are called asymptomatic, or silent, gallstones. Silent gallstones do not interfere with the function of the gallbladder, liver, or pancreas.
If gallstones block the bile ducts, pressure increases in the gallbladder, causing a gallbladder attack. The pain usually lasts from 1 to several hours.1 Gallbladder attacks often follow heavy meals, and they usually occur in the evening or during the night.
Gallbladder attacks usually stop when gallstones move and no longer block the bile ducts. However, if any of the bile ducts remain blocked for more than a few hours, complications can occur. Complications include inflammation, or swelling, of the gallbladder and severe damage or infection of the gallbladder, bile ducts, or liver.
A gallstone that becomes lodged in the common bile duct near the duodenum and blocks the pancreatic duct can cause gallstone pancreatitis—inflammation of the pancreas.
Left untreated, blockages of the bile ducts or pancreatic duct can be fatal.
When should a person talk with a health care provider about gallstones?
People who think they have had a gallbladder attack should notify their health care provider. Although these attacks usually resolve as gallstones move, complications can develop if the bile ducts remain blocked.
People with any of the following symptoms during or after a gallbladder attack should see a health care provider immediately:
- abdominal pain lasting more than 5 hours
- nausea and vomiting
- fever—even a low-grade fever—or chills
- yellowish color of the skin or whites of the eyes, called jaundice
- tea-colored urine and light-colored stools
These symptoms may be signs of serious infection or inflammation of the gallbladder, liver, or pancreas.
How are gallstones diagnosed?
A health care provider will usually order an ultrasound exam to diagnose gallstones. Other imaging tests may also be used.
- Ultrasound exam. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. A specially trained technician performs the procedure in a health care provider’s office, outpatient center, or hospital, and a radiologist—a doctor who specializes in medical imaging—interprets the images. Anesthesia is not needed. If gallstones are present, they will be visible in the image. Ultrasound is the most accurate method to detect gallstones.
- Computerized tomography (CT) scan. A CT scan is an x ray that produces pictures of the body. A CT scan may include the injection of a special dye, called contrast medium. CT scans use a combination of x rays and computer technology to create three-dimensional (3-D) images. CT scans require the person to lie on a table that slides into a tunnel-shaped device where the x rays are taken. An x-ray technician performs the procedure in an outpatient center or hospital, and a radiologist interprets the images. Anesthesia is not needed. CT scans can show gallstones or complications, such as infection and blockage of the gallbladder or bile ducts. However, CT scans can miss gallstones that are present.
- Magnetic resonance imaging (MRI). MRI machines use radio waves and magnets to produce detailed pictures of the body’s internal organs and soft tissues without using x rays. A specially trained technician performs the procedure in an outpatient center or hospital, and a radiologist interprets the images. Anesthesia is not needed, though people with a fear of confined spaces may receive light sedation. An MRI may include the injection of contrast medium. With most MRI machines, the person lies on a table that slides into a tunnel-shaped device that may be open ended or closed at one end; some newer machines allow the person to lie in a more open space. MRIs can show gallstones in the ducts of the biliary system.
- Cholescintigraphy. Cholescintigraphy—also called a hydroxyl iminodiacetic acid scan, HIDA scan, or hepatobiliary scan—uses an unharmful radioactive material to produce pictures of the biliary system. In cholescintigraphy, the person lies on an exam table and a health care provider injects a small amount of unharmful radioactive material into a vein in the person’s arm. The health care provider may also inject a substance that causes the gallbladder to contract. A special camera takes pictures of the radioactive material as it moves through the biliary system. A specially trained technician performs the procedure in an outpatient center or hospital, and a radiologist interprets the images. Anesthesia is not needed. Cholescintigraphy is used to diagnose abnormal contractions of the gallbladder or obstruction of the bile ducts.
- Endoscopic retrograde cholangiopancreatography (ERCP). ERCP uses an x ray to look into the bile and pancreatic ducts. After lightly sedating the person, the health care provider inserts an endoscope—a small, flexible tube with a light and a camera on the end—through the mouth into the duodenum and bile ducts. The endoscope is connected to a computer and video monitor. The health care provider injects contrast medium through the tube into the bile ducts, which makes the ducts show up on the monitor. The health care provider performs the procedure in an outpatient center or hospital. ERCP helps the health care provider locate the affected bile duct and the gallstone. The stone is captured in a tiny basket attached to the endoscope and removed. This test is more invasive than other tests and is used selectively.
Health care providers also use blood tests to look for signs of infection or inflammation of the bile ducts, gallbladder, pancreas, or liver. A blood test involves drawing blood at a health care provider’s office or commercial facility and sending the sample to a lab for analysis.
Gallstone symptoms may be similar to those of other conditions, such as appendicitis, ulcers, pancreatitis, and gastroesophageal reflux disease.
Sometimes, silent gallstones are found when a person does not have any symptoms. For example, a health care provider may notice gallstones when performing ultrasound for a different reason.
How are gallstones treated?
If gallstones are not causing symptoms, treatment is usually not needed. However, if a person has a gallbladder attack or other symptoms, a health care provider will usually recommend treatment. A person may be referred to a gastroenterologist—a doctor who specializes in digestive diseases—for treatment. If a person has had one gallbladder attack, more episodes will likely follow.
The usual treatment for gallstones is surgery to remove the gallbladder. If a person cannot undergo surgery, nonsurgical treatments may be used to dissolve cholesterol gallstones. A health care provider may use ERCP to remove stones in people who cannot undergo surgery or to remove stones from the common bile duct in people who are about to have gallbladder removal surgery.
Surgery to remove the gallbladder, called cholecystectomy, is one of the most common operations performed on adults in the United States.
The gallbladder is not an essential organ, which means a person can live normally without a gallbladder. Once the gallbladder is removed, bile flows out of the liver through the hepatic and common bile ducts and directly into the duodenum, instead of being stored in the gallbladder.
Surgeons perform two types of cholecystectomy:
Laparoscopic cholecystectomy. In a laparoscopic cholecystectomy, the surgeon makes several tiny incisions in the abdomen and inserts a laparoscope—a thin tube with a tiny video camera attached. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close-up view of organs and tissues. While watching the monitor, the surgeon uses instruments to carefully separate the gallbladder from the liver, bile ducts, and other structures. Then the surgeon removes the gallbladder through one of the small incisions. Patients usually receive general anesthesia.
Most cholecystectomies are performed with laparoscopy. Many laparoscopic cholecystectomies are performed on an outpatient basis, meaning the person is able to go home the same day. Normal physical activity can usually be resumed in about a week.3
Open cholecystectomy. An open cholecystectomy is performed when the gallbladder is severely inflamed, infected, or scarred from other operations. In most of these cases, open cholecystectomy is planned from the start. However, a surgeon may perform an open cholecystectomy when problems occur during a laparoscopic cholecystectomy. In these cases, the surgeon must switch to open cholecystectomy as a safety measure for the patient.
To perform an open cholecystectomy, the surgeon creates an incision about 4 to 6 inches long in the abdomen to remove the gallbladder.4 Patients usually receive general anesthesia. Recovery from open cholecystectomy may require some people to stay in the hospital for up to a week. Normal physical activity can usually be resumed after about a month.3
A small number of people have softer and more frequent stools after gallbladder removal because bile flows into the duodenum more often. Changes in bowel habits are usually temporary; however, they should be discussed with a health care provider.
Though complications from gallbladder surgery are rare, the most common complication is injury to the bile ducts. An injured common bile duct can leak bile and cause a painful and possibly dangerous infection. One or more additional operations may be needed to repair the bile ducts. Bile duct injuries occur in less than 1 percent of cholecystectomies.5
Nonsurgical Treatments for Cholesterol Gallstones
Nonsurgical treatments are used only in special situations, such as when a person with cholesterol stones has a serious medical condition that prevents surgery. Gallstones often recur within 5 years after nonsurgical treatment.6
Two types of nonsurgical treatments can be used to dissolve cholesterol gallstones:
- Oral dissolution therapy. Ursodiol (Actigall) and chenodiol (Chenix) are medications that contain bile acids that can dissolve gallstones. These medications are most effective in dissolving small cholesterol stones. Months or years of treatment may be needed to dissolve all stones.
- Shock wave lithotripsy. A machine called a lithotripter is used to crush the gallstone. The lithotripter generates shock waves that pass through the person’s body to break the gallstone into smaller pieces. This procedure is used only rarely and may be used along with ursodiol.
Eating, Diet, and Nutrition
Factors related to eating, diet, and nutrition that increase the risk of gallstones include
- rapid weight loss
- diets high in calories and refined carbohydrates and low in fiber
People can decrease their risk of gallstones by maintaining a healthy weight through proper diet and nutrition.
Ursodiol can help prevent gallstones in people who rapidly lose weight through low-calorie diets or bariatric surgery. People should talk with their health care provider or dietitian about what diet is right for them.
Points to Remember
- Gallstones are hard particles that develop in the gallbladder.
- Imbalances in the substances that make up bile cause gallstones. Gallstones may form if bile contains too much cholesterol, too much bilirubin, or not enough bile salts. Scientists do not fully understand why these imbalances occur.
- Women, people over age 40, people with a family history of gallstones, American Indians, and Mexican Americans have a higher risk of developing gallstones.
- Many people with gallstones do not have symptoms. Gallstones that do not cause symptoms are called asymptomatic, or silent, gallstones.
- If gallstones block the bile ducts, pressure increases in the gallbladder, causing a gallbladder attack.
- Gallbladder attacks often follow heavy meals, and they usually occur in the evening or during the night.
- Gallstone symptoms may be similar to those of other conditions.
- If gallstones are not causing symptoms, treatment is usually not needed. However, if a person has a gallbladder attack or other symptoms, a health care provider will usually recommend treatment.
- The usual treatment for gallstones is surgery to remove the gallbladder. If a person cannot undergo surgery, nonsurgical treatments may be used to dissolve cholesterol gallstones. A health care provider may use endoscopic retrograde cholangiopancreatography (ERCP) to remove stones in people who cannot undergo surgery or to remove stones from the common bile duct in people who are about to have gallbladder removal surgery.
- The gallbladder is not an essential organ, which means a person can live normally without a gallbladder. Once the gallbladder is removed, bile flows out of the liver through the hepatic and common bile ducts and directly into the duodenum, instead of being stored in the gallbladder.
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Michael G. Sarr, M.D., Mayo Clinic