Definition

The gallbladder is located under the liver and near the stomach. Gallstones are pieces of stone-like material that collect in the gallbladder. Gallstones are made of cholesterol salts or 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 of these.

Gallstones
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Causes

Gallstones are caused when bile or cholesterol crystalizes into stones.

Gallstones can form under the following conditions:

  • Too much cholesterol in the bile
  • Too much bilirubin in the bile
  • Not enough bile salts
  • When the gallbladder does not empty completely or often enough because of blockage or poor contraction

Risk Factors

People aged 60 years of older 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 chances of gallstones:

  • Problems that affect the gallbladder such as:
    • Poor gallbladder function
    • Diseases of the gallbladder and ducts
    • Previous gallstones
  • Dietary factors such as:
    • Obesity
    • Rapid weight loss and fasting
    • Eating a high fat diet
  • Certain conditions such as diabetes or Crohn 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
  • Liver disease, such as cirrhosis
  • Metabolic syndrome
  • Lack of physical activity
  • Heredity

Certain medications can increase your risk of gallstones such as:

  • Estrogen
  • 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 a gallbladder 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—jaundice
  • 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:

Surgery

  • 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

Other treatments may include:

  • Shock wave lithotripsy—a machine shockwaves that pass through the body to break the gallstone into smaller pieces
  • ERCP—a combination of endoscopy and x-rays are used to locate and remove gallstones before or during gallbladder surgery

Prevention

To help reduce your chances of gallstones:

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