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Gallstones

(Biliary Colic; Calculus of Gallbladder; Cholangitis; Cholelithiasis; Cholecystitis; Cholecystolithiasis; Choledocholithiasis)

Definition

Gallstones are pieces of stone-like material that collect in the gallbladder. The gallbladder sits under the liver and stores a fluid called bile. Gallstones may be as small as a grain of sand or as large as a golf ball. A person may have one large stone, many tiny stones, or both.

Causes

Gallbladders store fluid from the liver. The fluid is sent to the small intestine to help break down food. Gallstones may be caused by a problem with fluids from the liver such as:

  • Too much cholesterol in the bile
  • Too much bilirubin in the bile
  • Not enough bile salts
  • Problems that make it hard for the gallbladder to empty, such as a blockage

Blockages in the gallbladder can also trap bile and may lead to stones.

Risk Factors

Things that may raise the risk of gallstones are:

  • Having other family members who had gallstones
  • Obesity
  • Rapid weight loss or frequent changes in weight
  • History of intestinal problems
  • Being on IV nutrition
  • A high fat diet
  • Lack of physical activity
  • Smoking
  • Taking certain medicines, such as estrogen, cholesterol-lowering drugs, and thiazide diuretics
  • Problems with the liver, such as cirrhosis
  • Crohn disease

Symptoms

Most people do not have symptoms. Those who do may have pain in the upper right side of the belly. It may last 30 minutes to several hours. Other problems may be:

  • Sudden pain after heavy meals
  • Nausea and vomiting
  • Bloating
  • Burping
  • Gas
  • Fever or chills
  • Yellowing of the skin or the whites of the eyes
  • Clay-colored stool

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done. Blood tests to look for possible causes or rule out other problems. Urine tests may be also be done.

Gallstones can be seen with:

Treatment

Gallstones that do not cause symptoms do not need to be treated. Stones that are causing symptoms or blockages may be treated with:

  • Medicine, such as:
    • Pain relievers
    • Bile salt tablets to dissolve the gallstones
  • Shock wave lithotripsy—device sends energy through skin to break up the gallstones
  • ERCP—scope is passed through the mouth and into the stomach; gallstones can be removed
  • Surgery to remove the gallbladder—cholecystectomy

Prevention

This risk of gallstones may be lowered by:

RESOURCES:

American Liver Foundation
https://www.liverfoundation.org

National Institute of Diabetes and Digestive and Kidney Diseases
https://www.niddk.nih.gov

CANADIAN RESOURCES:

Canadian Liver Foundation
https://www.liver.ca

Health Canada
https://www.canada.ca

REFERENCES:

Demehri FR, Alam HB. Evidence-Based Management of Common Gallstone-Related Emergencies. J Intensive Care Med. 2016 Jan;31(1):3-13.

Gallstones. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/gallstones. Accessed February 9, 2021.

Gallstones. Family Doctor—American Academy of Family Physicians website. Available at: https://familydoctor.org/condition/gallstones. Accessed February 9, 2021.

Gallstones. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/gallstones. Accessed February 9, 2021.

Last reviewed February 2021 by EBSCO Medical Review Board James P. Cornell, MD  Last Updated: 2/9/2021