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Gallstones: Know the Symptoms & When to Treat

Treatment can be a wait-and-see approach or immediate surgery.

What are gallstones?

Gallstones are tiny masses that can cause intense abdominal pain. They form in the gallbladder, a small, pear-shaped pouch just below the liver. The gallbladder stores bile, a greenish-yellow liquid produced by the liver that helps with digestion.

Gallstones can block the gallbladder’s drainage system, called bile ducts, which can be dangerous. Stones may form without an apparent cause or from excess cholesterol.

They are very common, and many people don’t even know they have them. In some, it causes issues.

Common symptoms

Upper abdominal pain (in the center or right side) is the most common sign of gallstones. The pain is caused by the stones preventing the gallbladder from draining completely. Often the obstruction is temporary. So pain will come and go.

If the stone doesn’t ”pass” (resolve) on its own, the pain in the upper abdomen will be constant. If the stone passes and resolves on its own, it won’t cause any other problems. But, future stones in the same person may (some people are “stone formers”).

Other symptoms you may have

  • Nausea
  • Vomiting
  • Fever and chills
  • Yellowing of skin and whites of eyes
  • Dark urine
  • Clay-colored stools

Pro Tip

Gallstones can recur, even if your gallbladder is removed. Your liver produces bile that your gallbladder stores. So while the gallbladder coming out removes the “reservoir” of bile, it does not mean you will never get gallstones again. —Dr. Shria Kumar

Causes of gallstones

Normally, the gallbladder stores bile produced by the liver and ultimately releases it. When bile in the gallbladder hardens into a small crystallized stone, either on its own or mixed with cholesterol, it’s called a gallstone.

If the stone is big enough, it can block drainage and lead to a variety of symptoms.

Sometimes, gallstones happen without a clear reason. But there are risk factors. Obesity is a big risk factor. If you’re very overweight, talk to your doctor about how to lose weight safely.

Factors that increase your risk of gallstones include:

  • Obesity
  • Older age (especially above ages 40 to 50)
  • Being female
  • Pregnancy
  • Rapid weight loss, such as after a bariatric surgery procedure
  • Family history
  • Diabetes
  • Post-surgery, if you have a certain part of your small intestine removed

Can gallstones go away without surgery?

Gallstones require treatment based on severity of symptoms. If you have no signs of an infection but are having off-and-on-pain, you will still likely need surgery, but sometimes you can take a wait and see approach. However, you may eventually need surgery as more stones form.

If your gallbladder is infected, you will be prescribed antibiotics to reduce the infection and help your gallbladder “cool off.” You’ll have surgery soon after—in about a week—to have it taken out.

If gallstones are only in an area called the biliary tree, they have moved out of the gallbladder into the normal drainage path (“the bile duct”) that ends in the intestine. If a stone gets stuck here, the treatment is a little different.

You will still be given antibiotics. You will get an endoscopic procedure (an ERCP) within a few days to remove the stones from the biliary tree. This endoscope (a camera that goes through your mouth when you’re under anesthesia) goes from your intestine into your biliary tree to remove the stone. A week or so later, you will have surgery to remove your gallbladder.

Pro Tip

Surgery to remove your gallbladder is a relatively quick and simple operation. Patients can often go home the same day. —Dr. Kumar

Are gallstones serious?

When stones do not pass, you can get an infection, which can lead to serious health issues and hospitalization. Gallstones can also lead to inflammation of the pancreas (pancreatitis), an organ that helps with digestion and regulating blood sugar.

Symptoms of pancreatitis are abdominal pain, fevers, and chills. Mild pancreatitis can get better without treatment. But a severe case can become life-threatening. If you have pancreatitis, your pancreatitis will be treated first and then you will have your gallbladder surgically removed.

If you have severe abdominal pain plus fevers and chills, go to the nearest ER. For milder abdominal pain without signs of an infection like fevers or chills, call your doctor.

Dr. Rx

Patients who undergo bariatric surgery are at increased risk of gallstones after their surgery and weight loss. So often, with the bariatric surgery, the gallbladder is removed to minimize the chance of this occurring. It doesn’t make it impossible, but much less likely. —Dr. Kumar

What happens if gallstones are left untreated?

Gallstones that are causing symptoms always need treatment. Infections are treated with antibiotics, given orally if you aren’t in the hospital or through an IV if you are. If you don’t treat gallstones that are causing symptoms, you can get severe infections requiring you stay in the hospital and may cause liver damage from severe inflammation.

Depending on your diagnosis and symptoms, you may need an endoscopic procedure to clear stones or a surgical procedure to remove your gallbladder, or maybe both.

Gallbladder removal is common and usually done laparoscopically without any big cuts. Patients can often go home the same day, but will take a week or two to fully recover.

Be aware that gallstones can recur, even if your gallbladder is removed, because your liver still produces bile. So while you no longer have a gallbladder, it does not mean you will never form these stones again. They may form and get stuck in the biliary tree (bile ducts), and you may still need treatment. However, this is less likely once your gallbladder has been removed.

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