Gallstones are an accumulation of cholesterol and other substances found in the bile that occasionally block a duct connecting the gallbladder and small intestine. A gallstone can be as tiny as a grain of sand or as large as a golf ball. Many gallstones do not cause problems; only 1-2% of those with gallstones develop disease. A person can develop a single gallstone or several.
Bile is produced by the liver and used to digest fats. When too much cholesterol builds up in the bile or a person’s gallbladder does not empty properly, crystals, or gallstones, can form. Symptoms of gallstones include pain in the stomach or just under the ribs. Often, the pain can make it difficult to breathe or get comfortable. The pain sometimes occurs after a meal, can last several hours, and can even wake a person from sleep.
When a stone blocks the duct that drains the gallbladder, other symptoms can include nausea, vomiting, and fever, in addition to pain. Some patients must have surgery to remove the gallbladder. Occasionally, gallstones can cause another condition, pancreatitis, which blocks the flow of digestive enzymes produced by the pancreas. In this case, the symptoms are similar: severe pain, loss of appetite, fever, nausea, and vomiting.
Those at risk for gallstones include females, people over 55, those who are overweight or have a high body mass index, and people who lose weight rapidly. People of Native American or Hispanic descent, along with those who get little exercise or fast periodically, are also at risk. Others at increased risk of gallstones have elevated triglycerides, a disease of the intestines, or family members with a history of gallstones.
Pregnant women can also be at risk for developing gallstones. Sufferers of cirrhosis or sickle cell disease and people who take cholesterol-lowering medicines might have an increased risk of gallstones. Any one experiencing severe abdominal pain should see a doctor. People who are over 60 or have a heart condition, diabetes, or an impaired immune system should seek immediate medical attention.
Ultrasounds and scans are used to diagnose gallstones. Medications are not commonly used to treat gallstones, but might be necessary for patients who cannot withstand surgery. When the gallbladder is removed, the symptoms normally do not return.
To prevent gallstones, maintain a healthy weight, eat a balanced diet and get regular exercise. Also, avoid rapid weight loss and subsequent weight gain to reduce the risk of developing gallstones.
Gallstones occur when bile forms solid particles (stones) in the gallbladder.
The stones form when the amount of cholesterol or bilirubin in the bile is high.
Other substances in the bile may promote the formation of stones.
Pigment stones form most often in people with liver disease or blood disease, who have high levels of bilirubin.
Poor muscle tone may keep the gallbladder from emptying completely. The presence of residual bile may promote the formation of gallstones.
Risk factors for the formation of cholesterol gallstones include the following:
female gender,
being overweight,
losing a lot of weight quickly on a "crash" or starvation diet, or
taking certain medications such as cholesterol lowering drugs.
Gallstones are the most common cause of gallbladder disease.
As the stones mix with liquid bile, they can block the outflow of bile from the gallbladder. They can also block the outflow of digestive enzymes from the pancreas.
If the blockage persists, these organs can become inflamed. Inflammation of the gallbladder is called cholecystitis. Inflammation of the pancreas is called pancreatitis.
Contraction of the blocked gallbladder causes increased pressure, swelling, and, at times, infection of the gallbladder.
When the gallbladder or gallbladder ducts become inflamed or infected as the result of stones, the pancreas frequently becomes inflamed too.
This inflammation can cause destruction of the pancreas, resulting in severe abdominal pain.
Untreated gallstone disease can become life-threatening, particularly if the gallbladder becomes infected or if the pancreas becomes severely inflamed.
The most common symptom of uncomplicated gallstone disease is a type of abdominal pain known as biliary colic.
Biliary colic is a sudden, intense pain that usually lasts between one and five hours (although sometimes it can last up to eight hours). The pain can be located in:
the centre of your abdomen, below your breastbone and above your umbilicus (bellybutton)
the upper right of your abdomen, with the pain radiating towards your shoulder blade
You will usually find that the pain of biliary colic is brought on by eating fatty foods. The pain may also wake you up during the night.
Biliary colic is usually an infrequent symptom of gallstone disease. After an episode of pain, it may be several weeks or months before you experience another episode.
In addition to the pain associated with biliary colic, a number of people also experience:
nausea
vomiting
excessive sweating
The three most common complications that can arise from complicated gallstone disease are:
inflammation of the gall bladder (acute cholecystitis)
inflammation of the bile ducts (acute cholangitis)
inflammation of the pancreas (acute pancreatitis)
Acute cholecystitis can develop when one of your bile ducts becomes blocked by gallstones. The blockage causes the gallbladder to become swollen, irritated and inflamed.
Symptoms of acute cholecystitis include:
pain in your upper abdomen that radiates towards your shoulder blade (unlike biliary colic, the pain usually lasts longer than five hours)
a high temperature (fever) of 38C (100.4F) or above
a rapid heartbeat
An estimated 15% of people with acute cholecystitis will also have symptoms of jaundice.
If the bile ducts become blocked, they are vulnerable to infection by bacteria. Infected bile ducts may become inflamed.
Symptoms of acute cholangitis include:
pain in your upper abdomen that radiates towards your shoulder blade
a high temperature
jaundice (yellowing of the skin and whites of the eyes)
chills
mental confusion
itchy skin
a general sense of feeling unwell
Acute pancreatitis may develop when a gallstone moves out of the gallbladder and blocks the opening (duct) of the pancreas, causing it to become inflamed.
The main symptom of acute pancreatitis is the sudden onset of pain in the centre of your upper abdomen.
The pain of acute pancreatitis often gets steadily worse until it reaches a constant ache. The ache can be severe and may travel from your abdomen and along your back. The pain may feel worse after you have eaten.
Leaning forward or curling up into a ball may help relieve the pain to some extent.
Other symptoms of acute pancreatitis can include:
nausea
vomiting
diarrhoea
loss of appetite
a high temperature (fever) of 38C (100.4F) or above
tenderness of the abdomen
less commonly, jaundice (yellowing of the skin and whites of the eyes)
Gallstones that don't cause signs and symptoms, such as those detected during an ultrasound or CT scan done for some other condition, typically don't require treatment.
Your doctor may recommend you be alert for symptoms of gallstone complications, such as intensifying pain in your upper right abdomen. If gallstone signs and symptoms occur in the future, you can have treatment. But most people with gallstones that don't cause symptoms will never need treatment.
Treatment options for gallstones include:
Surgery to remove the gallbladder (cholecystectomy). Your doctor may recommend surgery to remove your gallbladder, since gallstones frequently recur. Once your gallbladder is removed, bile flows directly from your liver into your small intestine, rather than being stored in your gallbladder. You don't need your gallbladder to live, and gallbladder removal doesn't affect your ability to digest food, but it can cause diarrhea, which is usually temporary.
Medications to dissolve gallstones. Medications you take by mouth may help dissolve gallstones. But it may take months or years of treatment to dissolve your gallstones in this way. Medications for gallstones aren't commonly used and are reserved for people who can't undergo surgery.