Gallstones

Medical Author:

Jerry R. Balentine, DO, FACEP

Jerry R. Balentine, DO, FACEP

Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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• Gallstones Overview
• Gallstones Causes
• Gallstones and Diet
• Gallstones Symptoms
• When to Seek Medical Care
• Gallstones Diagnosis
• Gallstones Treatment
• Gallstones Self-Care at Home
• Gallstones Medical Treatment
• Gallstone Surgery (Cholecystectomy)
• Gallstones Follow-up
• Gallstones Prevention Diet
• Gallstones Prognosis
• Synonyms and Keywords
• Author and Editor
• Read more on Gallstones from Healthwise
• Viewer Comments: Gallstones - Causes
• Viewer Comments: Gallstones - Symptoms Experienced

Gallstones Overview

Gallstones (commonly misspelled gall stones or gall stone) are solid particles that form from bile in the gallbladder.

• The gallbladder is a small saclike organ in the upper right part of the abdomen. It is located under the liver, just below the front rib cage on the right side.
  
  
• The gallbladder is part of the biliary system, which includes the liver and the pancreas.
  
  
• The biliary system, among other functions, produces bile and digestive enzymes.

Bile is a fluid made by the liver to help in the digestion of fats.

• It contains several different substances, including cholesterol and bilirubin, a waste product of normal breakdown of blood cells in the liver.
  
  
• Bile is stored in the gallbladder until needed.
  
  
• When we eat a high-fat, high-cholesterol meal, the gallbladder contracts and injects bile into the small intestine via a small tube called the common bile duct. The bile then assists in the digestive process.

There are two types of gallstones: 1) cholesterol stones and 2) pigment stones.

1. Patients with cholesterol stones are more common in the United States; cholesterol stones make  up approximately 80% of all gallstones. They form when there is too much cholesterol in the bile.
   
   
2. Pigment stones form when there is excess bilirubin in the bile.

Gallstones can be any size, from tiny as a grain of sand to large as a golf ball.

• Although it is common to have many smaller stones, a single larger stone or any combination of sizes is possible.
  
  
• If stones are very small, they may form a sludge or slurry.
  
  
• Whether gallstones cause symptoms depends partly on their size and their number, although no combination of number and size can predict whether symptoms will occur or the severity of the symptoms.

Gallstones within the gallbladder often cause no problems. If there are many or they are large, they may cause pain when the gallbladder responds to a fatty meal. They also may cause problems if they move out of the gallbladder.

• If their movement leads to blockage of any of the ducts connecting the gallbladder, liver, or pancreas with the intestine, serious complications may result.
  
  
• Blockage of a duct can cause bile or digestive enzymes to be trapped in the duct.
  
  
• This can cause inflammation and ultimately severe pain, infection, and organ damage.
  
  
• If these conditions go untreated, they can even cause death.

Up to 20% of adults in the United States may have gallstones, yet only 1% to 3% develop symptoms.

• Hispanics, Native Americans, and Caucasians of Northern European descent are most likely to be at risk for gallstones. African Americans are at lower risk.
  
  
• Gallstones are most common among overweight, middle-aged women, but the elderly and men are more likely to experience more serious complications from gallstones.
  
  
• Women who have been pregnant are more likely to develop gallstones. The same is true for women taking birth control pills or on hormone/estrogen therapy as this can mimic pregnancy in terms of hormone levels.

Gallstones Causes

Gallstones occur when bile forms solid particles (stones) in the gallbladder.

• The stones form when the amount of cholesterol or bilirubin in the bile is high.
  
  
• Other substances in the bile may promote the formation of stones.
  
  
• Pigment stones form most often in people with liver disease or blood disease, who have high levels of bilirubin.
  
  
• Poor muscle tone may keep the gallbladder from emptying completely. The presence of residual bile may promote the formation of gallstones.

Risk factors for the formation of cholesterol gallstones include the following:

• female gender,
  
  
• being overweight,
  
  
• losing a lot of weight quickly on a "crash" or starvation diet, or
  
  
• taking certain medications such as birth control pills or cholesterol lowering drugs.

Gallstones are the most common cause of gallbladder disease.

• As the stones mix with liquid bile, they can block the outflow of bile from the gallbladder. They can also block the outflow of digestive enzymes from the pancreas.
  
  
• If the blockage persists, these organs can become inflamed. Inflammation of the gallbladder is called cholecystitis. Inflammation of the pancreas is called pancreatitis.
  
  
• Contraction of the blocked gallbladder causes increased pressure, swelling, and, at times, infection of the gallbladder.

When the gallbladder or gallbladder ducts become inflamed or infected as the result of stones, the pancreas frequently becomes inflamed too.

• This inflammation can cause destruction of the pancreas, resulting in severe abdominal pain.
  
  
• Untreated gallstone disease can become life-threatening, particularly if the gallbladder becomes infected or if the pancreas becomes severely inflamed.