Gallstones

Gallstones form when the gallbladder does not empty properly or when bile components are imbalanced. Bile is a fluid produced by the liver and stored in the gallbladder until it is needed. It helps break down food for digestion, especially fat. When you eat high-fat or high-cholesterol foods, bile travels through the common bile duct to the duodenum, or the first part of the small intestine, where food is digested.

Bile is composed of cholesterol, bilirubin, bile salts, and other substances. This condition may form if bile contains too much cholesterol, too much bilirubin, or not enough bile salts, although most stones develop from an excess of cholesterol. Gallstones may also develop if the gallbladder does not empty completely or often enough.

You can have this condition and not even know it, because it often does not cause symptoms. However, if gallstones block the bile ducts, pressure increases in the gallbladder, causing a gallbladder attack. When this happens, you will feel a constant, severe, and dull pain in your right upper abdomen.

Gallbladder attacks usually begin shortly after eating a high-fat meal and typically occur at night. The pain can last from one hour to several hours. Gallbladder attacks usually stop when gallstones move and no longer block the bile ducts.

If you experience nausea, vomiting, fever, chills, jaundice (yellowing of the eyes and skin), light-colored stools, or abdominal pain that lasts for more than 5 hours, you should go to the emergency room.

To diagnose gallstones, your doctor will first review your medical history and conduct a physical exam. Be sure to tell your doctor about your symptoms and risk factors. Your doctor may conduct one or more imaging tests to identify the presence of gallstones or inflammation, including:

• Abdominal ultrasound
• CT scan
• MRI
• Gallbladder radionuclide scan, known as cholescintigraphy, HIDA (hydroxyl iminodiacetic acid) scan, or hepatobiliary scan
• ERCP (endoscopic retrograde cholangiopancreatography)

Your doctor may also test your blood and urine to check for signs of infection or inflammation of the bile ducts, gallbladder, pancreas, or liver.

Many people with gallstones do not have symptoms and do not need treatment. However, if you have abdominal pain that lasts for more than 5 hours or any other symptoms, you will likely need surgery to remove the gallbladder and the gallstones. The most common surgery is laparoscopic (minimally invasive) cholecystectomy.

If a person with cholesterol stones cannot undergo surgery, nonsurgical treatments such as medication and/or electrohydraulic shock wave lithotripsy (ESWL) may be used to dissolve cholesterol gallstones.