Doctor's Notes on Gallstones
Gallstones form when substances in the bile fluid harden and form stones in the gallbladder or bile ducts. Cholesterol stones and pigment stones are the most common types of gallstones. Risk factors for developing gallstones include female gender, obesity, increasing age, rapid weight loss, pregnancy, birth control pill or hormone therapy use, and Crohn’s disease.
Gallstones themselves typically do not cause symptoms or signs. Most people who have gallstones are not aware that they have them. When signs and symptoms of gallstones occur, they almost always occur because the gallstones pass into and block the bile ducts. This leads to a condition known as biliary colic or “gallbladder attack.” Symptoms of biliary colic include a severe, constant pain that may come on suddenly that is located in the middle of the upper abdomen. Nausea can be an associated symptom. The pain of biliary colic lasts until the stone has passed through the bile duct into the small intestine, typically a few hours.
Most people with gallstones have no symptoms. In fact, they are usually unaware that they have gallstones unless symptoms occur. These "silent gallstones" usually require no treatment.
Symptoms usually occur as complications develop. The most common symptom is pain in the right upper part of the abdomen. Because the pain comes in episodes, it is often referred to as an "attack."
- Attacks may occur every few days, weeks, or months; they may even be separated by years.
- The pain usually starts within 30 minutes after a fatty or greasy meal.
- The pain is usually severe, dull, and constant, and can last from one to five hours.
- It may radiate to the right shoulder or back.
- It occurs frequently at night and may awaken the person from sleep.
- The pain may make the person want to move around to seek relief, but many patients prefer to lay still and wait for the attack to subside.
Other common symptoms of gallstones include the following:
- nausea and vomiting,
- indigestion, belching, bloating,
- intolerance for fatty or greasy foods, and
- jaundice (yellowing of the skin or the whites of the eyes).
Warning signs of a serious problem are fever, jaundice, and persistent pain.
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.
The abdomen is an anatomical area that is bounded by the lower margin of the ribs and diaphragm above, the pelvic bone (pubic ramus) below, and the flanks on each side. Although abdominal pain can arise from the tissues of the abdominal wall that surround the abdominal cavity (such as the skin and abdominal wall muscles), the term abdominal pain generally is used to describe pain originating from organs within the abdominal cavity. Organs of the abdomen include the stomach, small intestine, colon, liver, gallbladder, spleen, and pancreas. Abdominal pain can range in intensity from a mild stomach ache to severe acute pain. The pain is often nonspecific and can be caused by a variety of conditions.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.