Gallstones

Gallbladder issues can come up suddenly and unexpectedly.When you learn you have gallstones, you need experts to help you on your road to recovery.

The gallbladder is a small, pear-shaped organ that sits under your liver in the right upper side of your abdomen. The gallbladder is a small storage vessel for bile. Bile is a greenish liquid that is made in the liver, and it is stored in the gallbladder. When you eat a meal, your gallbladder squeezes out the bile to help digest and break down your food, particularly fat.

Anatomy of the gallbladder

The gallbladder (shown in green) is a small, pear-shaped organ that is tucked under the liver. It stores bile, a fluid that is made in the liver and helps the body break down fat. When you eat a meal that has fat in it, your gallbladder empties the bile into a tube called the "bile duct." The bile duct carries the bile into the small intestine to help with digestion.

Reproduced with permission from: Zakko SF. Patient Information: Gallstones (Beyond the Basics). In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA 2012. Copyright © 2012 UpToDate, Inc. For more information visit www.uptodate.com.

Gallstones are small crystal-like stones that form inside the gallbladder, usually from cholesterol deposits. They come in many sizes, shapes, colors, and chemical composition. They can be as small as grains of sand or gravel (called "gallbladder sludge") or as big as the entire gallbladder, which can be up to 6 inches long.

About 10-20% of the U.S. population will have gallstones at some point in their lifetime. Many people can have stones for years without causing any symptoms. In other people, gallstones can cause symptoms when they move around and irritate the inside of the gallbladder, or when then become stuck and block the outlet of the gallbladder (called the cystic duct), or they move out of the gallbladder and block the tubes (called ducts) that connect the gallbladder to the liver and the intestines (called the common bile duct).

Gallstone complications

• Infection of the gallbladder (called Cholecystitis)
• Gallbladder ruptures, which can lead to severe infection and death
• Jaundice (yellowing of the skin and eyes) due to blockage of the ducts that drain the liver (called the common bile duct)
• Pancreatitis (inflammation of the pancreas) due to blockage of the common bile duct which shares a drainage system with the pancreas

Symptoms of gallstones

In many cases, gallstones do not cause any symptoms. When they do cause symptoms, gallstones can cause:

• Abdominal pain – often on the right side just under the rib cage or across top portion of the abdomen; this pain is usually after a large or fatty meal
• Pain in the back or right shoulder, or between the shoulder blades
• Nausea and vomiting
• Indigestion
• Fever, usually associated with abdominal pain

If you know that you have gallstones but have no symptoms, you probably will not need treatment. But if you start having symptoms, you should get treated. The symptoms can come and go, but they often get worse over time, and can cause serious complications as above.

Testing for gallstones

The most common test for gallstones is an ultrasound of the abdomen. An ultrasound is a painless test done in the radiology department. An ultrasound technician will perform the study, using a small plastic wand, and gently moves it around your upper abdomen, creating a picture of the organs inside using sound waves.

Even if tests show that you have gallstones, that does not mean they are causing symptoms. Your doctor might need to do other tests to make sure your stones and your symptoms are related. Many other conditions of the digestive system have similar symptoms as those caused by gallstones.

Treatment for gallstones

• For people without symptoms - The best option is no treatment. The stones generally will not go away, and symptoms may develop at a later time, and treatment can be considered if they start having symptoms.
• For People with symptoms - The most common treatment is surgery to remove the gallbladder and the stones (Called Cholecystectomy) and is one of the most common surgeries performed in the United States. It is, however, still major surgery involving anesthesia and has risks associated with it, just like any other surgery. The surgery does not affect digestion very much. But about half the people who have surgery have mild symptoms afterward, including watery bowel movements, gas, or bloating. These symptoms usually get better a few months after surgery. People who have their gallbladder removed do not need to worry about gallstones coming back.

There is a way to get rid of the gallstones with medication. However this usually takes months to years to work, and may not work for people with severe symptoms or complications from gallstones. Generally the stones will come back when the medication is stopped. This is not a routine treatment option.

For patients that have complications of gallstones, such as the gallstones are obstructing the bile ducts (causing jaundice) or the pancreatic ducts (causing pancreatitis), a special procedure called an ERCP may need to be performed to remove the stones from these ducts.

Ways to prevent gallstones

• Keep yourself at a healthy weight, obesity is big contributing factor to gallbladder problems
• Rapid weight loss can also cause gallstones (such as after pregnancy)
• Eat at least 3 meals per day with a little bit of fat to keep your gallbladder working (but avoid meals high in fat as this can worsen symptoms)
• Eat a balanced diet with fruits, vegetables, low-fat dairy products, and fiber

Learn more about gallstones.