This article will review the causes, symptoms, and management of gallstones. Gallstones are small, pebble-like composites of materials that deposit in the gallbladder, an organ that sits adjacent to the liver and is responsible for storing bile. Gallstones can present in people a variety of ways from acute, severe pain to a chronic condition without any discomfort.
What are gallstones?
Gallstones are small, round deposits found in the gallbladder, the organ where bile is stored. Gallstones can be subclassified a number of ways. Oftentimes, gallstones will be referred to as either cholesterol stones or pigment stones depending on the makeup of the gallstone.
Gallstones can also be classified as asymptomatic or symptomatic, which determines how the condition is managed. Presenting symptoms may include pain in the upper right quadrant of the abdomen, nausea, vomiting, and abdominal bloating.
Treatment for symptomatic gallstones primarily involves the removal of the gallbladder.
You should visit your primary care physician to speak about your pain. Your doctor would perform an ultrasound to recognize something going on in your gallbladder.
When to see a doctor for gallstones
If you are experiencing sudden-onset right upper quadrant pain you should consult your physician. People with right upper quadrant pain and fever may be experiencing a dangerous complication of gallstones and should seek care immediately.
Gallstones are a , affecting approximately six percent of men and nine percent of women in the United States. The majority of cases of gallstones are and are found during imaging tests for other medical conditions. The presence of gallstones in the gallbladder is not considered a disease process until these stones cause symptoms. The gallbladder stores bile, a substance in our bodies that helps us break down fats after meals. Hormones in the body that are released when we eat signal the gallbladder to contract to emit bile.
Symptoms of gallstones generally occur when the stone obstructs the outflow of bile from the gallbladder, causing a backup and leading to pain.
- : The right upper quadrant is the upper, right aspect of the abdomen, where the liver and gallbladder are found. As discussed above, the gallbladder stores bile, which flows out of the bile duct to our intestines when we eat. When a gallstone stone obstructs the bile duct, bile builds up in the gallbladder and causes distension of the organ, leading to pain.
- Biliary colic: This describes the pattern of the right upper quadrant pain often associated with gallstones. Biliary colic is fluctuating right upper quadrant pain that occurs when the gallbladder contracts and forces the stone into the bile duct thus producing pain. This pain fluctuates because when the gallbladder stops contracting and the stone dislodges from the duct, the individual may return to being asymptomatic.
There are other symptoms of gallstones that are less common than right upper quadrant pain, nausea, and vomiting.
- Abdominal bloating
- Early satiety
- Clay-colored stools
While most people with gallstones are asymptomatic, gallstones can cause a number of serious complications in addition to pain with meals.
- Cholecystitis: Cholecystitis is acute inflammation of the gallbladder that most commonly occurs as a complication of gallstones. Cholecystitis is characterized by the triad of right upper quadrant pain, fever, and elevated white blood cell count.
- Choledocholithiasis: Choledocholithiasis presents similarly to cholecystitis with fever, right upper quadrant pain, and elevated white blood cell count but is due to an obstruction from a stone in a different portion of the bile duct.
- Gallstone pancreatitis: Gallstones have the potential to cause acute inflammation of the pancreas by obstructing outflow of pancreatic enzymes from the pancreatic duct. These enzymes that are produced by the pancreas are intended to help break down fats in digestion. When the pancreatic duct is obstructed, these enzymes can lead to a process called autodigestion of the pancreatic tissue, resulting in pancreatitis.
As previously discussed, gallstones can be classified as either cholesterol stones or pigment stones. While rates vary across the literature, cholesterol gallstones have been cited to cause as high as 90 percent of all cases of gallstones. Gallstones more commonly present in women, which is thought to be associated with .
Cholesterol-rich stones are more commonly seen in people with high fat and carbohydrate diets. Other risk factors for cholesterol stones include experiencing rapid weight loss, being of Native American ethnicity, and having Crohn’s disease or cirrhosis.
Pigment stones are composed of red blood cell breakdown products and are seen in people with the blood disorders sickle cell disease and hereditary spherocytosis.
A workup for gallstones should be pursued if an individual presents with the symptoms detailed above. Lab tests in a person with asymptomatic gallstones or with biliary colic, the waxing and waning pain associated with periodic duct obstruction, will usually be normal. Abnormal results on tests specific to the gallbladder including liver enzymes (AST, ALT), gamma-glutamate transferase, and alkaline phosphatase suggests one of the complications of gallstones listed above. The most commonly used test for diagnosing gallstones is a right upper quadrant ultrasound. Gallstones are best visualized on ultrasound if the individual has been fasting for at least eight hours. Ultrasound as a diagnostic test for gallstones has a .
Gallstones Treatments and Prevention
Most people with gallstones are asymptomatic and do not require treatment. If gallstones are found incidentally on imaging but do not cause any problems, it is not recommended to pursue further treatment.
- Cholecystectomy: People who have biliary colic or complications of gallstones can be managed with the removal of the gallbladder.
- NSAIDs followed by an outpatient cholecystectomy: Anyone with biliary colic who presents to the emergency department will usually be treated with non-steroidal anti-inflammatory medications such as ibuprofen for pain control and will be instructed to follow-up as an outpatient for cholecystectomy.
- Procedure type: as opposed to an open incision due to reduced post-operative pain and length of hospital stay associated with the former.
Many of the factors that predispose people to gallstones, including age, gender, and ethnic background, are not within a person’s control. However, you can modify your diet to reduce foods high in cholesterol and fat and consequently reduce your risk of gallstones.
Questions Your Doctor May Ask to Determine Gallstones
- Is your abdominal pain getting better or worse?
- Is your abdominal pain constant or come-and-go?
- Have you lost your appetite recently?
- How long has your abdominal pain been going on?
- Any fever today or during the last week?
Self-diagnose with our free if you answer yes on any of these questions.
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