Gallstones (Cholelithiasis)

Gallstones occur when bile builds up and hardens in your gallbladder or bile duct. They can be tiny or as big as golf balls. You can get one or several at once.

Gallstones are common in the United States. Doctors don't know what causes them in all cases.

Causes can include:

  • Too much cholesterol in your bile
  • Too much bilirubin (a chemical your body makes) in your bile; can be the result of liver cirrhosis, biliary tract infections and some blood disorders
  • Too much bile in your gallbladder

You will probably need to have your gallbladder removed if you have gallstones that cause symptoms.

You Are at Risk for Gallstones if You:

  • Are female
  • Are age 40 or older
  • Are overweight or obese
  • Have family history of gallstones
  • Eat a high-fat diet
  • Eat a high-cholesterol diet
  • Eat a low-fiber diet
  • Have diabetes
  • Take cholesterol medication
  • Take estrogen medication
  • Are pregnant
  • Are American Indian
  • Are Mexican-American
  • Have certain intestinal disorders or diseases
  • Have lost weight quickly

Symptoms

You can have gallstones with no symptoms. These usually don't require treatment, but if your gallstones are in your bile duct, they'll need to be removed even if you don't have symptoms.

A gallstone can cause symptoms including:

  • Bloating
  • Nausea
  • Vomiting
  • Sweating
  • Fever
  • Pain in your upper right or center of your abdomen that gets worse; can last from minutes to hours
  • Pain in your right shoulder; can last from minutes to hours
  • Pain between your shoulder blades; can last from minutes to hours
  • Pain that happens soon after eating a heavy meal, in the evening or at night
  • Jaundice (yellowing of your skin and eyes)

See a doctor if you have pain or other symptoms that worry you, especially if you have abdominal pain that lasts longer than a few hours.

Sometimes the pain can become severe or you can develop a fever and chills. You might notice your skin and eyes turning a yellowish color. If any of the symptoms occur, see a doctor right away.

Diagnosis

Gallstone symptoms can be similar to those for other conditions, such as appendicitis, pancreatitis, gastroesophageal reflux disease (GERD) and ulcers. Your doctor will rule out other causes for your symptoms.

You might have some of these tests:

  • Blood tests
  • Liver function tests
  • Abdominal ultrasound – Your doctor moves a device over your abdomen to create pictures from sound waves
  • Computed tomography (CT) scan
  • Hepatobiliary iminodiacetic acid (HIDA) scan (cholescintigraphy) – You receive a radioactive material through an IV that allows your doctor to see pictures of your biliary system
  • Magnetic resonance cholangiopancreatography (MRCP) – Your doctor looks at your bile ducts with magnetic resonance imaging (MRI)
  • Endoscopic retrograde cholangiopancreatography (ERCP) – A tube with a light and camera is inserted down your throat and into your stomach and small intestine. A dye is injected to make your bile ducts show up. Gallstones can be removed during this test.
  • Endoscopic ultrasound (EUS) – A small ultrasound device in a tube is inserted down your throat. Sound waves from the ultrasound create pictures for your doctor to review.

Treatment

Gallstones that cause symptoms are treated with medication or surgery.

  • Medication – You might be able to take medication (by mouth) to dissolve your gallstones, but this can take a long time. Surgery is a much more common and effective treatment.
  • Surgery – The operation to remove the gallbladder is called cholecystectomy. Usually, surgery to remove the gallbladder is minimally invasive (laparoscopic cholecystectomy). This means you only need a few small incisions instead of a large one.

One reason to remove the gallbladder is that gallstones often come back. The removal procedure is called endoscopic retrograde cholangiopancreatography (ERCP).

Without your gallbladder, you are still able to digest food. Bile flows from your liver to your small intestine instead of to your gallbladder.

How to Prevent Gallstones

You can reduce your risk of getting gallstones by:

  • Maintaining a healthy weight
  • Eating a healthy diet including regular meals (skipping meals and fasting can increase your risk)
  • Exercising at least two to three hours a week
  • Losing weight slowly; rapid weight loss can increase your risk of gallstones

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