Gallstones (cholelithiasis)

Overview

The gallbladder is a small pouch under the liver that stores bile and releases it into the intestine after eating. Stones form when the components of bile — most often cholesterol, more rarely bile pigments — harden.

Many people have stones without any symptoms and discover them by chance on ultrasound.

Symptoms

Biliary colic — typical symptoms:

• severe, steady pain in the upper right or middle part of the abdomen
• may spread to the back or to the right shoulder
• usually lasts from 30 minutes to several hours, often after a fatty meal or at night
• may come with nausea and vomiting

Bloating, gas and indigestion are non-specific complaints and do not prove that gallstones are the cause.

Complications

• Acute cholecystitis — inflammation of the gallbladder: pain that does not pass, fever.
• Stones in the common bile duct — may cause jaundice.
• Cholangitis — infection of the bile ducts: pain, fever with chills and jaundice.
• Biliary pancreatitis — inflammation of the pancreas: severe pain in the middle of the abdomen that goes through to the back.

Risk factors

Female sex, age over 40, family history, pregnancy, overweight, rapid weight loss (e.g. after drastic diets or bariatric surgery) and some diseases.

Diagnosis

• Abdominal ultrasound — the first and most accurate exam for gallbladder stones.
• Blood tests — when inflammation, infection or obstruction is suspected (blood count, bilirubin, liver enzymes, lipase).
• MRCP (magnetic resonance cholangiography) or endoscopic ultrasound — when stones in the bile duct are suspected.
• ERCP — used mainly for treatment (removing stones from the duct), not as a routine diagnostic exam, because it carries risks.

Treatment

• Stones without symptoms usually do not require intervention.
• Stones with symptoms: laparoscopic cholecystectomy is recommended — removal of the gallbladder through a few small incisions. The hospital stay usually lasts one day.
• Acute cholecystitis requires early assessment in hospital; surgery is often done within the week of diagnosis, when the condition allows.
• Stones in the duct are removed with ERCP, before or after removal of the gallbladder.
• Ursodeoxycholic acid has a limited role in selected patients and does not replace surgery.

Do not treat severe pain that does not pass with painkillers on your own.

After gallbladder removal

Most people live completely normally without a gallbladder. Eating resumes gradually. Some people have diarrhea after eating; if it persists, there is specific treatment.