Gallstones are hard, pebble-like deposits that form inside the gallbladder. [br]Gallstones may be as small as a grain of sand or as large as a golf ball.
Causes, incidence, and risk factors
The cause of gallstones varies. There are two main types of gallstones:
- Stones made of cholesterol, which are by far the most common type. [br]Cholesterol gallstones have nothing to do with cholesterol levels in the blood.
- Stones made of bilirubin, which can occur when red blood cells are being destroyed (hemolysis). This leads to too much bilirubin in the bile. These stones are called pigment stones.
Gallstones are more common in women, Native Americans, Hispanics, and people over age 40. Gallstones may also run in families.
The following also make you more likely to develop gallstones:
- Bone marrow or solid organ transplant
- Failure of the gallbladder to empty bile properly (this is more likely to happen during pregnancy)
- Liver cirrhosis and biliary tract infections (pigmented stones)
- Medical conditions that cause the liver to make too much bilirubin, such as chronic hemolytic anemia, including sickle cell anemia
- Rapid weight loss from eating a very low-calorie diet, or after bariatric surgery
- Receiving nutrition through a vein for a long period of time (intravenous feedings)
Many people with gallstones have never had any symptoms. The gallstones are often found during a routine x-ray, abdominal surgery, or other medical procedure.
However, if a large stone blocks either the cystic duct or common bile duct (called choledocholithiasis), 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 (the duodenum).
Symptoms that may occur include:
- Pain in the right upper or middle upper abdomen:
- May be constant
- May be sharp, cramping, or dull
- May spread to the back or below the right shoulder blade
- Yellowing of skin and whites of the eyes (jaundice)
Other symptoms that may occur with this disease include:
- Clay-colored stools
- Nausea and vomiting
Signs and tests
Tests used to detect gallstones or gallbladder inflammation include:
- Abdominal ultrasound – initial best test to diagnose gallstones
- Abdominal CT scan
- Endoscopic retrograde cholangiopancreatography (ERCP)
- Gallbladder radionuclide scan (HIDA scan)
- Endoscopic ultrasound
- Magnetic resonance cholangiopancreatography (MRCP)
Your doctor may order the following blood tests:
Some people have gallstones and have never had any symptoms. The gallstones may not be found until an ultrasound is done for another reason. Surgery is usually not needed unless symptoms begin. One exception is in patients who have weight-loss surgery.
In general, patients who have symptoms will need surgery either right away, or after a short period of time.
A technique called laparoscopic cholecystectomy is most commonly used now. This procedure uses smaller surgical cuts, which allow for a faster recovery. Patients are often sent home from the hospital on the same day as surgery, or the next morning.
Endoscopic retrograde cholangiopancreatography (ERCP) and a procedure called a sphincterotomy may be done to find or treat gallstones in the common bile duct.
One of our surgical colleagues will perform the Laparoscopic Cholecystectomy if necessary. Our practice performs ERCP when necessary for our patients at Greenwich Hospital. Not all gastroenterologists are adequately trained to perform ERCP. Two physicians within our practice, Dr. Neda Khaghan and Dr. Neal Schamberg routinely perform ERCP and have received specialized training in this highly skilled procedure.
Gallstones develop in many people without causing symptoms. The chance of symptoms or complications from gallstones is low. When symptoms arise from gallstones, the risk of complications requiring possible emergency care and hospitalization markedly increases. Surgery is indicated for symptomatic gallstones.
Nearly all patients who have gallbladder surgery do not have their symptoms return (if the symptoms were actually caused by gallstones).
Blockage of the cystic duct or common bile duct by gallstones may cause the following problems:
- Acute cholecystitis
- Chronic cholecystitis
- Gallstones (biliary) pancreatitis