What Are Gallstones?

Gallstones are small, hard deposits that form in the gallbladder—a small organ located beneath the liver. The gallbladder's main function is to store bile, which is a digestive fluid that your liver produces. Eventually, bile becomes released into your small intestine and helps break down fats as your body digests food.1

However, if there is an imbalance in the substances that make up bile (e.g., cholesterol, bilirubin, and calcium), gallstones may develop. This happens when these substances become too concentrated or when the gallbladder doesn't empty properly. As a result, the substances can crystallize and form gallstones.2

Your gallstones can vary in size, ranging from as small as a grain of sand to as large as a golf ball. Some people may have only one stone, while others may have multiple stones. Gallstones do not usually cause any symptoms and can often go unnoticed. However, they can lead to complications if they block the bile ducts, leading to symptoms such as extreme stomach pain, jaundice, and inflammation of the gallbladder.1

Types of Gallstones

There are two main types of gallstones: cholesterol gallstones and pigment gallstones. Sometimes people have a mixture of both types of stones. The type of gallstone you have can also affect the type of treatment you need.

Cholesterol Gallstones

Cholesterol gallstones are the most common type, accounting for about 75% of gallstones. These type of gallstones are primarily made up of cholesterol—a fatty substance found in your bile. They form when there is an excess of cholesterol in the bile or when the gallbladder doesn't empty properly. Generally, these gallstones are yellow-green in color and can vary in size.2

Pigment Gallstones

Pigment gallstones are less common and account for the remaining 20% to 25% of all gallstone cases. These stones are made up of bilirubin—a pigment that forms when red blood cells break down.3

Pigment gallstones are usually smaller and darker in color, ranging from brown to black. These type of gallstones commonly occur in people with medical conditions such as cirrhosis, hemolytic anemia, or certain infections.

Symptoms 

Not everyone with gallstones will experience symptoms. Silent gallstones, which do not cause any noticeable symptoms, are common. Generally, your healthcare provider might only discover silent gallstones when you’re undergoing certain medical tests or procedures for a different condition.1

If you do develop gallstone symptoms, you may experience:3

• Sharp or cramp-like pain in the your abdomen, back, and right shoulder
• Nausea and vomiting
• Jaundice
• Fever and chills
• Bloating and indigestion, especially after eating high-fat foods
• Changes in bowel movements, such as diarrhea or clay-colored stools
• Shoulder or back pain
• Chest pain

If you suspect you have gallstones or are experiencing any concerning symptoms, it's best to consult your healthcare provider for an accurate diagnosis and appropriate treatment.

Causes

Gallstones form when there is an imbalance in the substances that make up bile, a digestive fluid produced by the liver. The exact cause of gallstone formation is not fully understood by researchers. But, experts do have some theories as to why gallstones can occur.3

These theories include:4

• Gallbladder motility: When the gallbladder does not contract and empty bile as it should, substances in the bile can become overconcentrated and cause stones.
• Obesity: Obesity can contribute to higher cholesterol levels and decrease gallbladder motility. 
• Rapid weight loss: Losing weight too quickly can disrupt the balance of your bile’s substances.

Risk Factors

Some factors can also increase your risk of developing stones. You may have a higher likelihood of experiencing symptoms if you:352

• Are over the age of 40
• Were assigned female at birth 
• Have a family history of gallstones 
• Live with an underlying medical condition such as liver cirrhosis, hemolytic anemia, and diabetes 

It's important to note that while these risk factors may contribute to gallstone formation, not everyone with risk factors will develop gallstones—and some people without apparent risk factors can still develop them. However, being aware of these risk factors may help you take preventive measures to reduce your chances of developing gallstones and their related complications.

Diagnosis

If you suspect you have symptoms of gallstones, it’s best to see your healthcare provider for proper testing. During your diagnostic process, your healthcare provider will likely start by collecting information about your symptoms, obtaining a medical history, and reviewing any potential risk factors. They may also conduct a physical examination to check for symptoms such as stomach pain or swelling. 

If your provider thinks you may have gallstones, they can confirm a diagnosis by using the following diagnostic tests:3

• Abdominal ultrasound: This is the most common diagnostic imaging test used to diagnose gallstones. This test utilizes sound waves to generate detailed images of the gallbladder, which allows your provider to detect the presence of stones in your body and view them on a screen.
• Blood tests: These tests assess liver function and check for signs of infection or inflammation in your gallbladder. Elevated levels of liver enzymes or bilirubin can indicate that your gallstones are blocking your bile ducts.6
• Computed tomography (CT) scan: A CT scan provides detailed images of the gallbladder, bile ducts, and surrounding structures. This type of medical scan helps identify the presence and location of gallstones, as well as any complications you might be experiencing.
• Hepatobiliary iminodiacetic acid (HIDA) scan: This scan involves injecting a radioactive tracer into your vein and up your liver. Once this happens, the tracer passes into the bile, which helps your provider track its flow through your bile ducts. As a result, this test can help determine if gallstones are blocking the bile ducts.
• Endoscopic retrograde cholangiopancreatography (ERCP): This procedure uses a thin, flexible tube with a camera to create images of your bile ducts. Your healthcare provider will insert the tube through the mouth and down into the small intestine and then inject contrast dye into your bile ducts, which makes the bile ducts more visible on X-ray images.7 Providers can also use magnetic resonance cholangiopancreatography (MRCP), which is just like the ERCP, but uses MRI technology.

These diagnostic methods help healthcare providers determine the presence, size, location, and potential complications of gallstones. If you receive a diagnosis for gallstones, your provider will work with you to figure out next steps for treatment.

Treatment

Generally, your healthcare provider will only recommend treatment for gallstones if you are displaying symptoms. Your exact treatment plan will depend on the type of gallstones you have, the symptoms you’re experiencing, and if you have any complications. 

Surgery

A cholecystectomy—or the surgical removal of your gallbladder—is the most common treatment for gallstones. Your healthcare provider can recommend surgery if you have painful symptoms, are experiencing complications, or may be at a high risk of developing gallstones again.  

A surgeon can perform a cholecystectomy through traditional open surgery or minimally invasive laparoscopic surgery. Keep in mind: laparscopic surgery is much more common today.  During a laparoscopic cholecystectomy, a surgeon will make severall small incisions (cuts) in to your skin and insert a tiny camera and surgical instruments to remove the gallbladder.8

Medications

If surgery is not an option, your healthcare provider may prescribe certain medications. The purpose of the medicines is to help dissolve gallstones. However, medications typically work better for cholesterol gallstones than pigment ones. The most common medicines for gallstones are Actigall (ursodiol) and Chenix (chenodiol). 

Something to note: this treatment option is typically only effective for small stones and may take months or even years to achieve results. Medications aren’t suitable for everyone and requires careful monitoring from your healthcare provider.

How to Prevent Gallstones

While it is not possible to completely prevent gallstones, there are certain lifestyle choices that you can incorporate to help you reduce your risk of developing stones. Some examples of preventative strategies include:149

• Maintaining a healthy weight that is right for your
• Limiting high-fat and cholesterol-rich foods 
• Drinking enough water each day 
• Avoiding drastic weight loss measures 
• Eating smaller, more frequent meals throughout the day

It's important to note that while these preventive measures may help reduce the risk of gallstone formation, they cannot guarantee complete prevention. If you have specific concerns or a family history of gallstones, consult with your healthcare provider for personalized advice and guidance.3

Complications 

Gallstones can lead to several complications, particularly if they block the bile ducts or cause inflammation. Potential complications associated with gallstones include: 

• Cholecystitis: When a gallstone blocks the cystic duct and causes inflammation in the gallbladder, you can experience severe abdominal pain, fever, nausea, and vomiting. If left untreated, this condition can lead to complications such as infection, abscess formation, or perforation (holes in the gallbladder).10
• Choledocholithiasis: If a gallstone passes from the gallbladder into the common bile duct, it can obstruct the flow of bile from the liver and gallbladder to the small intestine. This condition can cause symptoms such as jaundice (yellowing of the skin and eyes), dark urine, pale stools, and abdominal pain.11
• Cholangitis: If your gallstones block the bile duct, you can experience a bile duct infection, leading to a variety of symptoms including fever, chills, jaundice, and intense abdominal pain. If cholangitis is left untreated, it can cause potentially life-threatening complications.12
• Pancreatitis: In some cases, gallstones can migrate from the gallbladder and block the pancreatic duct, leading to inflammation of the pancreas. This condition can cause severe abdominal pain, nausea, and vomiting, and requires immediate medical attention.13

If you experience symptoms such as severe abdominal pain, jaundice, fever, or other signs of complications, it is important to contact your healthcare provider for proper diagnosis and treatment. Early intervention can help prevent further complications and ensure appropriate management of gallstone-related conditions.

Living With Gallstones

Living with gallstones means making lifestyle changes to manage symptoms and prevent complications. Most people with gallstones can lead long and normal lives without major limitations. If you have gallstones, you may consider:

• Keeping in touch with your healthcare provider to update them on the status of your symptoms 
• Planning gallbladder-friendly meals
• Practicing stress reduction activities such as meditation, yoga, or journaling 
• Meeting with a support group who understands your condition
• Taking any medications or treatments your healthcare provider recommends 

Overall, with management and proactive measures, people with gallstones can lead fulfilling lives while minimizing symptoms and complications.