Gallstones
Also called: Cholelithiasis, Biliary colic, Cholecystitis
Hard deposits of cholesterol or pigment form in the gallbladder. Most never cause symptoms, but a stone blocking the outlet causes severe pain (biliary colic) and can inflame the gallbladder or pancreas.
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10–15% of adults in Western countries have gallstones.
What happens in the body
Bile supersaturated with cholesterol, poor gallbladder emptying and nucleating factors lead to crystal formation and stone growth.
Causes
- Cholesterol supersaturation of bile
- Pigment stones in haemolytic anaemias and cirrhosis
Risk factors
- Female sex, pregnancy, oestrogen
- Obesity and rapid weight loss
- Age over 40
- Family history
- Diabetes
- Crohn's disease
Symptoms
- Severe steady pain in the upper right or central abdomen lasting 30 minutes to hours, often after a fatty meal
- Pain radiating to the right shoulder blade
- Nausea and vomiting
- Cholecystitis: fever and persistent pain
- Jaundice if a stone blocks the bile duct
Diagnosis — tests and examinations
- Abdominal ultrasound
- Liver function tests and lipase
- MRCP or endoscopic ultrasound for bile duct stones
Treatment
Medicines and medical treatment
- Pain relief (NSAIDs are effective for colic)
- Antibiotics for cholecystitis or cholangitis
Operations and procedures
- Laparoscopic cholecystectomy (gallbladder removal) — definitive
- ERCP to remove bile duct stones
- Percutaneous cholecystostomy for very unwell patients
Self-care, home remedies and lifestyle
- Healthy weight loss (avoid crash diets)
- Lower-fat meals may reduce attacks while awaiting surgery
Possible complications
- Acute cholecystitis
- Obstructive jaundice and cholangitis
- Acute pancreatitis
- Gallstone ileus
- Gallbladder cancer (rare)
Prevention
- Maintaining a healthy weight and avoiding very rapid weight loss
Outlook
Excellent after cholecystectomy; life without a gallbladder is normal.
When to see a doctor
Seek urgent care for abdominal pain with fever, yellow eyes or skin, or pain lasting more than a few hours.
Sources and further reading
These sources cover this condition. They have not been checked against every statement on this page.
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