Gallstones

What are gallstones?

Gallstones are natural deposits that can form in your gallbladder. Your gallbladder is a small organ located on the right side of your abdomen under your liver. It stores bile (a digestive fluid) that is released into your small intestine after you eat.

Gallstones are very common and occur when the substances in your bile (such as cholesterol, calcium, and bilirubin) become imbalanced enough to develop into solid pieces.  Gallstones can vary in size, ranging from the size of a grain of sand to the size of golf balls or even larger. You can develop just one gallstone or lots of them. 

What is a gallbladder attack?

A gallbladder attack (also called biliary colic or symptomatic cholelithiasis) happens when gallstones block the cystic duct and trap bile in your gallbladder causing pain after eating.  This can lead to the gallbladder becoming inflamed and eventually infected. The blockage can be intermittent due to the gallstone moving around leading to on and off symptoms.  For example, you might only have symptoms after a certain meal when your gallbladder squeezes out more bile to help with digestion.

Since gallbladder attacks often follow meals, they are more common in the evening and at night.

Symptoms of gallstones

Sometimes, gallstones don’t cause any symptoms and are just present. You might not even know you have them.  Oftentimes they may be discovered during the diagnosis of another health condition.

If they cause symptoms, you may notice:

• Strong pain in your upper abdomen (usually on the right side under the ribs, but may spread to your back and shoulder blades and may last several minutes to several hours)
• Nausea and vomiting, especially after meals
• Indigestion, bloating, or discomfort after eating fatty or greasy foods
• Jaundice (where your skin and eyes look yellow)
• Light-colored stools
• Dark-colored urine

Seek medical attention right away if you have:

• Ongoing or severe abdominal pain that’s so bad you can’t get comfortable
• Fever and chills
• Jaundice
• Symptoms that are getting worse

Causes of gallstones

Gallstones happen when the ingredients that make up bile become unbalanced. This could be due to:

• Too much cholesterol
• High levels of bilirubin (a substance that’s made when red blood cells break down)
• Inadequate amount of bile salts
• The gallbladder failing to empty properly

You may be more likely to develop gallstones if you have these risk factors:

• Overweight or obese
• Female
• Over age 40
• Pregnancy
• Diabetes
• Native American or Latin American heritage
• A family history of gallstones or gallbladder attacks
• Blood disorders, such as sickle cell disease
• Liver disease
• A bone marrow transplant or an organ transplant
• A diet high in saturated and trans fats, which can increase cholesterol levels
• Not enough fiber in your diet
• Taking medication that contains estrogen, such as birth control or hormone replacement therapy (HRT)
• Rapid weight loss
• Not enough physical activity

Diagnosing gallstones

If you think you might have gallstones or a gallbladder attack, contact a health care provider right away. Gallstones can be hard to diagnose because they have symptoms similar to other conditions, such as gastroesophageal reflux disease (GERD), pancreatitis and ulcers. A provider can make a diagnosis and develop a treatment plan to help you feel better. 

For a diagnosis, your provider may recommend tests such as:

• Ultrasound: This non-invasive test uses sound waves to create images of the gallbladder.
• Blood tests: Your blood can show infection, liver function and bilirubin levels.
• CT scan or MRI: These tests give detailed images of the gallbladder and nearby areas.
• Endoscopic retrograde cholangiopancreatography (ERCP): This study combines an upper gastrointestinal (GI) endoscopy and X-rays to look for problems in your bile ducts.
• Cholescintigraphy (HIDA scan): This test checks how well the gallbladder squeezes and empties your gallbladder.

There are two main types of gallstones:

• Cholesterol gallstones: They are made mainly of cholesterol and look yellow and are the most common. 
• Pigment gallstones: They develop when you make too much bilirubin, mostly from liver or blood borne diseases, and they are dark brown or black.

Treating gallstones

Gallstones that aren’t causing any pain may not need any treatment. You may be able to manage them by choosing a low-fat, high-fiber diet that can help reduce cholesterol levels. 

For those that need treatment, options include surgery or medication. The best choice depends on the size and type of gallstones you have, how severe your symptoms are and your overall health. For most people, surgery is preferred.

Surgery

You can treat gallstones by having your gallbladder surgically removed (also known as a cholecystectomy). Your gallbladder serves as a storage unit for your bile. However, your body can function without your gallbladder since your liver has the ability to release bile directly into the small intestine. 

You may be able to have your gallbladder removed laparoscopically. That’s where surgeons use small incisions and a camera and instruments to do the surgery. With this method, you usually have a shorter hospital stay, recover more quickly and have less risk of complications. However, for various reasons this minimally invasive surgery may be challenging, and you may need open surgery thru a larger incision instead.

With either type of surgery, you’ll need general anesthesia.

Medication

Ursodeoxycholic acid may dissolve cholesterol gallstones in some cases. You’ll need regular follow-up appointments if you use medicine to treat gallstones. It can take a long time for medication to work, and it’s not effective for everyone. So it’s usually an option only for people who can’t have surgery.

If you’ve had gallstones, it’s important to follow-up with your health care provider regularly and let them know if you have any additional symptoms.

It’s important to treat gallstones. Otherwise, they could cause complications such as gallbladder inflammation and infection (cholecystitis) or blockages in your common bile or pancreatic ducts.

Preventing gallstones

You can lower your risk of developing gallstones if you:

• Choose a balanced diet rich in fiber, which helps support your digestive system. Center your diet around fruits, vegetables, legumes, whole grains and lean proteins.
• Limit saturated and trans fats and cholesterol-rich foods like fatty meat, full-fat dairy and some processed foods.
• Eat at regular mealtimes and don’t skip meals.
• Get regular physical activity like walking or jogging to promote overall and digestive health. Aim for 150 minutes of moderate intensity exercise each week.
• Drink enough water throughout the day, since hydration is good for your digestive system.
• Maintain a healthy weight. If you need to lose weight, lose it slowly. Rapid weight loss is linked with gallstones.
• Limit or stop using alcohol.
• Have regular checkups and talk to your provider about your risk for gallstones.

If you are experiencing symptoms of gallstones, timely care is important. Contact a health care provider for evaluation and diagnosis.