Gallstones are solid particles made from bile in the gallbladder. Bile is a substance made by the liver to help you digest fats. The bile is stored in the gallbladder. The gallbladder is a small sac that lies under the liver and is part of the digestive system. Bile ducts are small tubes that drain bile from the liver into the gallbladder and small intestine. Gallstones may stay in the gallbladder or they may move into the bile ducts. If they block the outlet of the gallbladder or a duct, they can cause a lot of pain.
The formation of gallstones in the gallbladder is called cholelithiasis. Gallstones can be any size--from a grain of sand to as large as a golf ball.
Bile can contain cholesterol or other substances from the breakdown of old blood cells (bilirubin). If there is too much cholesterol or bilirubin in the bile, the bile can turn into a solid form called a gallstone.
You are more likely to have gallstones if:
Gallstones often do not cause any symptoms and do not need treatment. When they do cause symptoms, they may include:
Biliary colic is the medical term for the pain caused by gallstones. It happens when the gallbladder tries to empty and a stone is in the way. The pain may be mild or severe. It may last a few minutes or an hour or more. You may have nausea and vomiting with the pain. The pain may spread from your chest or abdomen to your right shoulder or back.
It's possible for stones to move into the main duct and clog it, causing you to turn yellow (jaundice). The stones can also cause pancreatitis, an inflammatory reaction in the pancreas that can be life threatening. The main symptom of pancreatitis is severe pain in the middle of the upper abdomen.
Your healthcare provider will review your symptoms, ask about your medical history, and examine you. He or she may use the following tests:
Not all gallstones show up on regular X-rays. Ultrasound can most often show whether stones are present.
A nuclear gallbladder scan uses an injection of radioactive dye and can show whether the gallbladder is blocked and inflamed. It can also show if the gallbladder is working properly. Your provider will check to see if your symptoms happen again when the scan shows the gallbladder emptying during the test.
Usually gallstones that cause symptoms are treated with surgery to remove the gallbladder. In most cases the gallbladder and stones can be removed with a laparoscope and several small cuts rather than open surgery with a large incision. A laparoscope is a thin metal tube with a light and tiny camera. Your provider can put the scope and tools into your abdominal cavity through the small cuts. Open surgery through a large incision is necessary when the gallbladder disease is more serious or there is severe infection. It may also be necessary if you are very obese or pregnant. Removal of the gallbladder should cause few, if any, long-term problems because the digestive system can function normally without it. Some people have looser bowel movements after its removal.
In some cases, especially if you are not well enough to have surgery, other treatments may be tried. For example, if you have only a couple of very tiny stones, your healthcare provider may try to dissolve the stones with medicine. The stones may come back, so the best treatment is usually removal of the gallbladder.
If you are extremely overweight and need to follow a very low calorie diet for quick weight loss, your healthcare provider may prescribe the medicine ursodiol, which may help prevent gallstones. The weight loss medicine orlistat may also help protect against stone formation during weight loss. Ask your provider if either of these medicines would be appropriate.
The pain caused by gallstones usually keeps coming back until the stones are removed. If the pain lasts over a few hours, you should seek care from your healthcare provider. Gallstones that are not removed can cause an infection in the gallbladder or slide into the bile duct and block bile flow. Both of these conditions need emergency care.
To take care of yourself during and after treatment, follow these guidelines:
Call your healthcare provider right away if:
To prevent gallstones, follow these guidelines: