Learn About Gallstones

What is the definition of Gallstones?

Gallstones are hard deposits that form inside the gallbladder. These may be as small as a grain of sand or as large as a golf ball.

Cholelithiasis
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What are the alternative names for Gallstones?

Cholelithiasis; Gallbladder attack; Biliary colic; Gallstone attack; Biliary calculus: gallstones chenodeoxycholic acids (CDCA); Ursodeoxycholic acid (UDCA, ursodiol); Endoscopic retrograde cholangiopancreatography (ERCP) - gallstones

What are the causes of Gallstones?

The cause of gallstones varies. There are two main types of gallstones:

  • Stones made of cholesterol -- This is the most common type. Cholesterol gallstones are not related to cholesterol level in the blood. In most cases, they are not visible on CT scans but are visible on a sonogram of the abdomen.
  • Stones made of bilirubin -- These are called pigment stones. They occur when red blood cells are destroyed and too much bilirubin is in the bile.

Gallstones are more common in:

  • Female sex
  • Native Americans and people of Hispanic descent
  • People over age 40
  • People who are overweight
  • People with family history of gallstones

The following factors also make you more likely to develop gallstones:

  • Bone marrow or solid organ transplant
  • Diabetes
  • Failure of the gallbladder to empty bile properly (this is more likely to happen during pregnancy)
  • Liver cirrhosis and biliary tract infections (pigmented stones)
  • Medical conditions that cause too many red blood cells to be destroyed
  • Rapid weight loss from eating a very low-calorie diet, or after weight loss surgery
  • Receiving nutrition through a vein for a long period of time (intravenous feedings)
  • Taking birth control pills
What are the symptoms of Gallstones?

Many people with gallstones do not have any symptoms. These are often found during a routine x-ray, abdominal surgery, or other medical procedure.

However, if a large stone blocks a tube or duct that drains the gallbladder, you may have a cramping pain in the middle to right upper abdomen. This is known as biliary colic. The pain goes away if the stone passes into the first part of the small intestine.

Symptoms that may occur include:

  • Pain in the right upper or middle upper abdomen for at least 30 minutes. The pain may be constant or cramping. It can feel sharp or dull.
  • Fever.
  • Yellowing of skin and whites of the eyes (jaundice).

Other symptoms may include:

  • Clay-colored stools
  • Nausea and vomiting
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What are the current treatments for Gallstones?

SURGERY

Most of the time, surgery is not needed unless symptoms begin. However, people planning weight loss surgery may need to have gallstones removed before undergoing the procedure. In general, people who have symptoms will need surgery right away or soon after the stone is found.

  • A technique called laparoscopic cholecystectomy is most commonly used. This procedure uses small surgical incisions, which allow for a faster recovery. A patient can often go home from the hospital within 1 day of surgery.
  • In the past, open cholecystectomy (gallbladder removal) was most often done. However, this technique is less common now.

ERCP and a procedure called a sphincterotomy may be done to find or treat gallstones in the common bile duct.

MEDICINES

Medicines may be given in pill form to dissolve cholesterol gallstones. However, these drugs may take 2 years or longer to work, and the stones may return after treatment ends.

Rarely, chemicals are passed into the gallbladder through a catheter. The chemical rapidly dissolves cholesterol stones. This treatment is hard to perform, so it is not done very often. The chemicals used can be toxic, and the gallstones may return.

LITHOTRIPSY

Shock wave lithotripsy (ESWL) of the gallbladder has also been used for people who cannot have surgery. This treatment is not used as often as it once was because gallstones often come back.

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What is the outlook (prognosis) for Gallstones?

You may need to be on a liquid diet or take other steps to give your gallbladder a rest after you are treated. Your provider will give you instructions when you leave the hospital.

The chance of symptoms or complications from gallstones surgery is low. Nearly all people who have gallbladder surgery do not have their symptoms return.

What are the possible complications of Gallstones?

Blockage by gallstones may cause swelling or infection in the:

  • Gallbladder (cholecystitis)
  • Tube that carries bile from the liver to the gallbladder and intestines (cholangitis)
  • Pancreas (pancreatitis)
When should I contact a medical professional for Gallstones?

Call your provider if you have:

  • Pain in the upper part of your abdomen
  • Yellowing of the skin or whites of the eyes
How do I prevent Gallstones?

In most people, gallstones can't be prevented. In people who are obese, avoiding rapid weight loss may help prevent gallstones.

Digestive system
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Gallstones, cholangiogram
Cholecystolithiasis
Gallbladder
Gallbladder removal - Series
What are the latest Gallstones Clinical Trials?
A Multi-center, Phase IV, Extension Study in PEGASUS-D Trial to Evaluate Efficacy of Ursodeoxycholic Acid (UDCA) for the Prevention of Gallstone Formation After Gastrectomy in Patients With Gastric Cancer
Summary: Of those patients who participated in PEGASUS-D FAS clinical trial, patient must sign the informed consent form in order to participate in this extension study.~The medical records of the patients will be reviewed throughout the study.
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Sensitivity and Specificity of Fluorescent Cholangiography to Detect Bile Duct Stones in Patients Undergoing Laparoscopic Cholecystectomy
Summary: Background. X-ray cholangiography has a high sensitivity and specificity of detecting bile duct stones and is the gold standard. There are no studies describing the sensitivity and specificity of IFC for bile duct stone detection.~Research question. What is the sensitivity of IFC to visualize bile duct stones? Method. Prospective study with 40 patients undergoing planned laparoscopic cholecystecto...
What are the Latest Advances for Gallstones?
Secondary Choledocholithiasis in Obstructive Jaundice Patient due to Choledochoduodenal-fistula Stricture.
Summary: Secondary Choledocholithiasis in Obstructive Jaundice Patient due to Choledochoduodenal-fistula Stricture.
Effect of Endoscopic Retrograde Cholangiopancreatography Lithotomy Combined with Laparoscopic Cholecystectomy on Pain and Prognosis of Patients with Gallstones and Extrahepatic Bile Duct Stones.
Summary: Effect of Endoscopic Retrograde Cholangiopancreatography Lithotomy Combined with Laparoscopic Cholecystectomy on Pain and Prognosis of Patients with Gallstones and Extrahepatic Bile Duct Stones.
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The Latest Knowledge on Endoscopic Retrograde Cholangiopancreatography-related Pancreatitis.
Summary: The Latest Knowledge on Endoscopic Retrograde Cholangiopancreatography-related Pancreatitis.
Who are the sources who wrote this article ?

Published Date: April 20, 2021
Published By: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

What are the references for this article ?

Fogel EL, Sherman S. Diseases of the gallbladder and bile ducts. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 146.

Radkani P, Hawksworth J, Fishbein T. Biliary system. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. Philadelphia, PA: Elsevier; 2022:chap 55.

Wang D Q-H, Afdhal NH. Gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 65.