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Gallstones(Biliary Colic; Calculus of Gallbladder; Cholangitis; Cholelithiasis; Cholecystitis; Cholecystolithiasis; Choledocholithiasis)
Definition

The gallbladder is located on the liver and near the stomach. Gallstones form when cholesterol or bile stored in the gallbladder hardens into pieces of stone-like material. Gallstones are made of cholesterol salts and bilirubin salts. Gallstones can be as small as a grain of sand or as large as a golf ball. The gallbladder can develop just one large stone, hundreds of tiny stones, or almost any combination.

Gallstones


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Causes

Gallstones are caused when bile or cholesterol crystalizes into gallstones.

Gallstones can form under the following conditions:

  • Too much cholesterol in the bile
  • Too much bilirubin
  • Not enough bile salts
  • When the gallbladder does not empty completely or often enough
Risk Factors

People who are older than 60 are at increased risk for gallstones. Women between 20-60 years old and those with high estrogen levels are also at increased risk. People of Native American, Mexican American, and Northern European descent are also at increased risk.

Other factors that may increase your risk of gallstones include:

  • Problems that affect the gallbladder such as:
    • Inflammation of the lining of the gallbladder
    • Poor gallbladder function
    • Diseases of the gallbladder and ducts
    • Previous gallstones
  • Dietary factors such as a:
    • Obesity
    • Rapid weight loss and fasting
    • High fat diet
  • Certain conditions such as diabetes or Crohn's disease
  • Blockage in the biliary tract
  • History of intestinal problems
  • Blood diseases that increase breakdown of hemoglobin and therefore bile production, including sickle cell anemia
  • Gastric bypass surgery
  • Metabolic syndrome
  • Lack of physical activity
  • Heredity

Certain medications can increase your risk of gallstones, including:

  • Thiazide diuretics
  • Cholesterol-lowering drugs—fibrates
  • Ceftriaxone
  • Octreotide
  • Somastatin
Symptoms

Many people have gallstones without symptoms, called silent gallstones. In some cases, these are treated.

Gallstones may cause pain in the upper abdomen. This is sometimes called an attack because it begins suddenly, often after a fatty meal. The pain is severe and may last for 30 minutes or several hours.

Other symptoms include:

  • Intermittent pain on the right, below the rib cage; the pain may spread
  • Bloating, nausea, and vomiting
  • Belching, gas, and indigestion

If you have the following symptoms, see your doctor right away:

  • Abdominal pain
  • Sweating
  • Chills
  • Low-grade fever
  • Yellowish color of the skin or whites of the eyes
  • Clay-colored stools
Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.

Your bodily fluids may be tested. This can be done with blood tests.

Images may be taken of your bodily structures. This can be done with:

Treatment

Talk to your doctor about the best treatment plan for you.

Options include:

Surgical Treatments
  • Laparoscopic cholecystectomy —the removal of the gallbladder through several small incisions in the abdomen. To view the gallbladder, a small, lighted tube with a camera is inserted into one of the incisions. Surgical instruments are used to remove the gallbladder through one of the other incisions.
  • Open cholecystectomy—the removal of the gallbladder through a large incision in the abdomen. This is necessary if there is an infection in the abdomen or a great deal of scar tissue.
Medications

You may be prescribed:

  • Over-the-counter or prescription medication to control pain
  • Bile salt tablets to dissolve gallstones; these medications may need to be taken for months or years until the stones are dissolved
Other Treatments

Another procedure that may be used to treat gallstones is called endoscopic retrograde cholangiopancreatography (ERCP). ERCP uses a combination of endoscopy and x-rays to locate and remove gallstones before or during gallbladder surgery.

Prevention

To reduce your chance of getting gallstones:

RESOURCES:

American Liver Foundation
http://www.liverfoundation.org

National Digestive Diseases Information Clearinghouse
http://digestive.niddk.nih.gov

CANADIAN RESOURCES:

Canadian Liver Foundation
http://www.liver.ca

Health Canada
http://www.hc-sc.gc.ca

References:

Gallstones. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 23, 2013. Accessed December 5, 2013.

Gallstones. American Academy of Family Physicians' FamilyDoctor website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/gallstones.html. Updated July 2010. Accessed December 5, 2013.

Gallstones. National Institute of Diabetes & Digestive & Kidney Diseases website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/gallstones. Updated November 27, 2013. Accessed December 5, 2013.

6/18/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Yarmish GM, Smith MP, et al. American College of Radiology (ACR) Appropriateness Criteria on right upper quadrant pain. Available at: http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/RightUpperQuadrantPain.pdf. Updated 2013. Accessed June 18, 2014.



Last reviewed December 2013 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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