Gallstones


Definition

Gallstones are hard deposits that form inside the gallbladder. Gallstones may be as small as a grain of sand or as large as a golf ball.

Alternative Names

Cholelithiasis; Gallbladder attack; Biliary colic; Gallstone attack; Biliary calculus: chenodeoxycholic acids (CDCA); Ursodeoxycholic acid (UDCA, ursodiol); Endoscopic retrograde cholangiopancreatography (ERCP) - gallstones

Causes

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The cause of gallstones varies. There are two main types of gallstones:

Gallstones are more common in women, native Americans, Hispanics, people over age 40, and people who are overweight. Gallstones may also run in families.

The following factors also make you more likely to develop gallstones:

Symptoms

Many people with gallstones do not have any symptoms. The gallstones are often found during a routine x-ray, abdominal surgery, or other medical procedure.

However, if a large stone blocks a tube or duct that drains the gallbladder, you may have a cramping pain in the middle to right upper abdomen. This is known as biliary colic. The pain goes away if the stone passes into the first part of the small intestine.

Symptoms that may occur include:

Other symptoms may include:

Exams and Tests

Tests used to detect gallstones or gallbladder inflammation include:

Your health care provider may order the following blood tests:

Treatment

SURGERY

Most of the time, surgery is not needed unless symptoms begin. However, people planning weight loss surgery may need to have gallstones removed before undergoing the procedure. In general, people who have symptoms will need surgery right away or soon after the stone is found.

Endoscopic retrograde cholangiopancreatography (ERCP) and a procedure called a sphincterotomy may be done to find or treat gallstones in the common bile duct.

MEDICINES

Medicines may be given in pill form to dissolve cholesterol gallstones. However, these drugs may take 2 years or longer to work, and the stones may return after treatment ends.

Rarely, chemicals are passed into the gallbladder through a catheter. The chemical rapidly dissolves cholesterol stones. This treatment is hard to perform, so it is not done very often. The chemicals used can be toxic, and the gallstones may return.

LITHOTRIPSY

Shock wave lithotripsy (ESWL) of the gallbladder has also been used for people who cannot have surgery. This treatment is not used as often as it once was because gallstones often come back.

Outlook (Prognosis)

You may need to be on a liquid diet or take other steps to give your gallbladder a rest after you are treated. Your health care provider will give you instructions when you leave the hospital.

The chance of symptoms or complications from gallstones surgery is low. Nearly all people who have gallbladder surgery do not have their symptoms return.

Possible Complications

Blockage by gallstones may cause swelling or infection in the:

When to Contact a Medical Professional

Call your provider if you have:

Prevention

In most people, gallstones can't be prevented. In people who are obese, avoiding rapid weight loss may help prevent gallstones.

References

Fogel EL, Sherman S. Diseases of the gallbladder and bile ducts. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 155.

Jackson PG, Evans SRT. Biliary system. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 20th ed. Philadelphia, PA: Elsevier; 2017:chap 54.

Wang D Q-H, Afdhal NH. Gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 65.

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