Gallstones

What are gallstones?

Gallstones are lumps of solid material that form in your gallbladder. They are also called cholelithiasis. They are made when the digestive juice called bile turns hard and stone-like.

The gallbladder is a small organ under your liver. It stores bile made by the liver. Bile is made of several things such as cholesterol, bile salts, and a yellowish pigment (bilirubin).

Gallstones can be as small as a grain of sand or as big as a golf ball. Your gallbladder may form a single large stone, hundreds of tiny stones, or both sizes at the same time. In some cases, gallstones block the tubes that carry bile (bile ducts). This can lead to a life-threatening infections of the bile ducts, pancreas, or liver. Once you have had gallstones, you are at risk of having more.

There are 2 types of gallstones: cholesterol and pigment. 

Cholesterol stones

These stones are:

  • Most common type of stone
  • Often a yellow-green color
  • Made mainly of hardened cholesterol

Pigment stones

These stones are:

  • Less common
  • Dark color
  • Made of a yellowish pigment called bilirubin

What causes gallstones?

Cholesterol stones form when your gallbladder doesn’t empty the way it should. They also form when bile has:

  • Too much cholesterol
  • Too much of a yellowish pigment called bilirubin
  • Not enough bile salts

Health experts don’t know what causes pigment stones to form. But pigment stones are more common in people who have:

  • A liver disease (cirrhosis) where scar tissue replaces healthy liver tissue
  • An infection in the vessels that transport bile (biliary tract infection)
  • Blood
    disorders that are passed from parent to child (hereditary) such as sickle cell
    anemia

Who is at risk for gallstones?

Some people have a higher risk for gallstones. These include:

  • Native
    Americans.
    They have the highest rates of gallstones in the U.S. This may be
    genetic as they have very high levels of cholesterol in their bile.
  • Mexican
    Americans.
    They have higher than average rates of gallstones.
  • Women.They are twice as likely to have gallstones as men.
  • People over
    age 60.
    Risk for gallstones increases with age.
  • People with a
    family history of gallstones.
    Gallstones seem to run in some families
    (inherited). There may be a genetic link.

Health issues that may raise your risk for gallstones include:

  • Obesity.
    This is a major risk factor, mainly for women.
  • Estrogen. Women may have extra estrogen from pregnancy, hormone replacement
    therapy, or birth control pills. This seems to raise cholesterol levels in bile and
    slow down gallbladder movement. Both can lead to gallstones.
  • Diet.
    Eating a high-fat, high-cholesterol, or low-fiber diet raises your risk. They lead to
    more cholesterol in the bile and reduced gallbladder emptying.
  • Cholesterol-lowering medicines. These medicines can increase the amount of
    cholesterol in bile.
  • Diabetes. People with diabetes often have high levels of fatty acids
    (triglycerides). This raises the risk for gallstones.
  • Very fast
    weight loss.
    As the body processes fat during very fast weight loss, the
    liver sends out extra cholesterol into bile.
  • Not eating
    for a few days (prolonged fasting).
    Fasting slows down gallbladder movement.
    Over time, your bile has too much cholesterol.

What are the symptoms of gallstones?

Some people with gallstones don’t have any symptoms. These stones are called silent stones. They don’t stop the gallbladder, liver, or pancreas from working properly. In most cases they don’t need to be treated. Most gallstones don’t cause symptoms right away.  

Gallstone symptoms (also called a gallbladder attack) may happen very suddenly. They often:  

  • Begin when gallstones get bigger
  • Happen when the stones start to block bile ducts
  • Occur after a fatty meal or at night

Each person’s symptoms may vary. Symptoms may include:

  • Steady, severe pain in your upper belly (abdomen) that quickly gets worse
  • Pain in your back between the shoulder blades
  • Pain in your right shoulder
  • Nausea
  • Vomiting
  • Fever
  • Chills
  • Yellowing of the skin or eyes (jaundice)

See your healthcare provider right away if you have any of these symptoms during or after a gallbladder attack:

  • Pain that lasts more than 5 hours
  • Sweating
  • Chills
  • Low-grade fever
  • Yellowish color of the skin or whites of the eyes
  • Clay-colored stools

The symptoms of gallstones may look like other health problems. Always see your healthcare provider to be sure.

How are gallstones diagnosed?

Many
people have gallstones but don’t know it because they don’t have symptoms. In some
cases, gallstones are found by accident. This may happen if you are being tested for a
different health problem.

But if you have pain that doesn’t go away, your healthcare provider will look at your past health and give you a physical exam. 

You may also have some tests to check for gallstones such as:

  • Ultrasound. This imaging test uses high-frequency sound waves to create
    images of your internal organs on a computer screen. It is used to see the
    gallbladder and gallstones.
  • HIDA scan
    (hepatobiliary scintigraphy or cholescintigraphy).
    This scan checks for any
    abnormal contractions of the gallbladder and blockages in your bile ducts. A
    radioactive chemical or tracer is shot (injected) into your vein. The amount of
    radiation is very small. It is not harmful. It collects in your liver and flows into
    your gallbladder. A special scanner is used to watch the tracer move through your
    organs. You will take a medicine to make your gallbladder contract.
  • Blood
    tests.
    These look for signs of infection, blockage, liver problems, jaundice,
    and pancreatitis.
  • CT scan.
    A CT scan shows detailed images of any part of the body. It can show gallstones. It
    can also show infection or bursting of the gallbladder or bile ducts.
  • MRCP (magnetic resonance cholangiopancreatography).
    This is a special MRI test that creates images using magnetic fields and pulsed
    radiofrequency energy.
  • EUS (endoscopic ultrasound). This internal
    ultrasound is done with a flexible lighted scope. You are given medicine to help you
    relax and then a scope is passed through your mouth. It creates internal images using
    sound waves.
  • ERCP
    (endoscopic retrograde cholangiopancreatography).
    ERCP uses both X-ray and a
    long flexible lighted tube. The tube is put in your mouth and throat. It goes down
    your food pipe (esophagus), through your stomach, and into the first part of your
    small intestine (duodenum). Your healthcare provider can see the inside of these
    organs on a video screen and check for any problems. A dye is put into your bile
    ducts through the tube. The dye lets the bile ducts be seen clearly on the
    X-ray.