Gallstone (Cholelithiasis) Symptoms and Causes

Gallstones (also called cholelithiasis) form when there is an imbalance in the composition of bile in the gallbladder. Gallstones are quite common, affecting around 25 million people in the United States.

Gallstones are hard, pebble-like pieces of material usually made of crystallized cholesterol or bilirubin that form in your gallbladder. They can be the size of a golf ball or tiny grains of sand, occurring alone or with a group of stones that can lead to a gallbladder attack.

This article presents an overview of gallstones and their causes. It explains how gallstone pain and other symptoms are diagnosed and treated, including lifestyle changes to improve diet and exercise.

Types of Gallstones

There are two types of gallstones:

• Cholesterol stones: Cholesterol stones result from bile made of too much cholesterol or bilirubin and not enough bile salts. Cholesterol stones may also form when the gallbladder fails to empty during the digestive process. These stones are usually yellow-green and are the most common type.
• Pigment stones: People who develop pigment stones typically have cirrhosis of the liver, biliary tract infections, or hereditary blood disorders, including sickle cell anemia. These conditions cause too much bilirubin to be made and can lead to pigment stones that are dark brown or black.

Gallstone Symptoms

Symptoms are not always present, so anyone can have gallstones and not know it. In fact, most people with gallstones don't have symptoms.

However, when gallstones travel into and block the ducts of your biliary tract, they may cause:

• Sudden, sharp pain in the upper abdomen, on the right side, just under your ribs
• Severe pain that can last a few minutes to several hours
• Referred pain, radiating to your right shoulder or upper back
• Nausea
• Vomiting
• Fever
• Chills
• Jaundice (yellowing of the skin or eyes)
• Abdominal bloating
• Indigestion
• Burping or gas
• Intolerance of fatty foods

The pain that occurs with this blockage is often referred to as biliary colic or a gallbladder attack.

What Causes Gallstones?

The biliary tract is the pathway between your liver and pancreas to the first part of the small intestine. The gallbladder, part of that tract, is a small, pear-shaped organ that sits under your liver on the upper right side of your body between your chest and your hips.

It acts as a storehouse for bile, which is a fluid produced by your liver to help your body digest fat.

Bile helps your body digest fats and fat-soluble vitamins. After eating fats, your gallbladder contracts, pushing the stored bile into the common bile duct, which brings the liquid to your small intestine to aid digestion.

The bile stored in the gallbladder contains water, bile salts, cholesterol, fats, proteins, and bilirubin. Bile salts break up the fat that is consumed in the food we eat. The bilirubin gives the bile a yellowish-green color and our stools their brown color.

Gallstones can form in the gallbladder when bile hardens into a stone-like material, which can happen if there are too much bile salts, cholesterol, or bilirubin in it.

There are a variety of reasons why gallstones may form. These factors have been associated with gallstones:

• Obesity
• Lack of exercise
• High-fat diets and refined carbohydrates
• Tobacco use
• Genetic predisposition

Complications of Gallstones

Although uncommon, the gallbladder can get infected (cholecystitis) when gallstones block the bile duct and bile gets trapped in the gallbladder. A bacterial infection can occur, causing symptoms such as:

• Severe abdominal pain that lasts several hours
• Nausea
• Vomiting
• Fever
• Jaundice—a yellow tone to your skin and whites of the eyes
• Loose, light-colored stools
• Abdominal bloating

If you think you have an infected gallbladder, seek medical attention right away either by contacting your healthcare provider or going to an emergency room.

How Are Gallstones Diagnosed?

There are a number of tests that your healthcare provider may perform to diagnose gallstones. Blood tests may be done to check for infection or inflammation, but not for gallstones themselves.

Imaging tests are used to diagnose gallstones with ultrasound being the first test usually done. Magnetic resonance imaging (MRI) or computerized tomography (CT) scans may also be performed.

How to Get Rid of Gallstones

Treatment for gallstones is only suggested if you have symptoms. If you are having gallbladder attack or other symptoms, contact your healthcare provider because even if symptoms go away, they may come back and need treatment.

Sometimes nonsurgical treatment can be used but the most common treatment for gallstones is surgery to remove the gallbladder.

Surgery

Laparoscopic cholecystectomy. This surgery is minimally invasive because a small incision is made and an instrument called a laparoscope can remove the gallbladder. The surgery is usually done in an outpatient setting and you're able to go home the same day. Recovery is usually about a week.

Open cholecystectomy. If your gallbladder is very inflamed, infected, or scarred, then a large incision in the abdomen is needed to remove the gallbladder. The surgery is done in an operating room and you may need to stay in the hospital for up to a week. Recovery to normal physical activity usually takes about a month.

Once your gallbladder is removed, bile flows directly into the duodenum (the first part of the small intestine), instead of being stored in the gallbladder.

Gallstones Healthcare Provider Discussion Guide

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Nonsurgical Treatments

In some cases, nonsurgical approaches may be used, but they are only considered when surgery is not possible and can only be used to remove or break up cholesterol gallstones (not pigment stones).

Endoscopic retrograde cholangiopancreatography (ERCP). The ERCP procedure combines upper gastrointestinal (GI) endoscopy and x-rays to remove a gallstone that is stuck in the common bile duct.

Oral dissolution therapy. Some medications that contain bile acids are used to break up gallstones but not everyone is a candidate. Actigall (ursodiol) and Chenix (chenodiol) are two medicines used and work best to break up small cholesterol stones. It may take months or years of treatment to break up all the stones.

Shock wave lithotripsy. This shock wave therapy blasts gallstones into tiny pieces of stones that pass out of your body in your urine. This procedure isn't commonly used and is only appropriate for treating cholesterol stones.

Gallstone Prevention and Lifestyle

While you may not be able to prevent gallstones entirely, you can lower your risk of developing gallbladder stones by following a healthy diet and getting regular exercise. 

Your diet should include foods that are high in fiber, such as:

• Fruits and vegetables
• Beans, peas, and lentils
• Whole grains, such as brown rice, oats, whole grain pasta, and whole wheat bread 

Foods to avoid with gallstones include refined carbohydrates, sugar, and unhealthy fats, such as fried foods, processed meats, butter, pastries, and sweets. Instead, include healthy monounsaturated fats, like nuts, seeds, avocado, fatty fish, and olive oil.

Following these guidelines can help your gallbladder contract and empty on a regular basis and prevent the risk of gallstones. 

Summary

Gallstones are hard, pebble-like pieces of material that can form in the gallbladder. The stones can range in size from tiny to golf-ball size. The blocking of the bile duct can lead to pain, digestive symptoms like nausea and vomiting, and other problems like jaundice.

Treatment for gallstones depends on the symptoms and severity. Gallstones will sometimes break up on their own, or you can be treated with medication. Keep in mind, though, that gallbladder surgery is one of the most common surgeries for adults. Be sure to talk to your healthcare provider about any concerns or questions you have.