Gallstones: Symptoms, Causes, Treatment & Warnings

Introduction

Gallstones are hard deposits that form from substances in bile^[4,6]. Bile is a fluid that helps the body digest fat^[4]. Stones usually form in the gallbladder but can also appear in the bile ducts^[5,7].

Many people have gallstones without knowing it^[1,7]. These silent stones may cause no symptoms for years^[1]. Problems often start when a stone moves and blocks the flow of bile^[1,6].

This guide explains gallstones symptoms causes treatment and warning signs in clear terms. It covers gallbladder attack symptoms, risk factors, diagnosis, and gallstone treatment. It also explains when abdominal pain may signal an emergency.

Overview: What Gallstones Are and How They Form

The gallbladder, bile, and bile ducts

The gallbladder is a small, pear-shaped organ under the liver^[4,8]. It stores bile made by the liver^[4]. During a meal, the gallbladder squeezes bile into the small intestine^[4,8].

Bile travels through small tubes called bile ducts^[4]. The common bile duct links the liver and gallbladder to the small intestine^[4]. A stone can block one of these tubes and stop normal bile flow^[7,9].

Gallstones form when substances in bile harden into stone-like pieces^[4,9]. They can be as small as sand or as large as a golf ball^[3,6]. One person may have one large stone or hundreds of tiny stones^[6].

Gallstones in the gallbladder are called cholelithiasis^[9]. Stones in the bile ducts are called choledocholithiasis^[9]. Stones in either place can cause problems if they block bile flow^[7,9].

Cholesterol stones versus pigment stones

Gallstones are commonly made from cholesterol or bilirubin^[3,6]. Bilirubin is a pigment made when the body breaks down red blood cells^[3]. Cholesterol stones are the most common type^[3].

Blood cholesterol levels do not directly show whether someone has cholesterol stones^[3]. In fact, these stones are not linked in a simple way to blood cholesterol^[3].

Pigment stones are made mainly from bilirubin^[3,9]. They can form when bile contains too much bilirubin^[3,9]. Some blood disorders, liver disease, and bile duct infections can raise this risk^[3,9].

Why some gallstones cause no symptoms

Many stones stay inside the gallbladder without blocking bile flow^[1,7]. Doctors call these silent or asymptomatic gallstones. Stones that do not block a bile duct usually cause no symptoms^[1].

Symptoms can begin when a stone moves into a duct and gets stuck^[6,7]. Bile may then collect behind the blockage^[1]. This pressure can lead to pain and swelling^[1].

A lasting blockage can harm nearby organs^[5,9]. It may affect the gallbladder, bile ducts, liver, or pancreas^[5,9]. This is why certain gallstone warning signs need quick care.

Symptoms: Gallstone Symptoms and Gallbladder Attacks

Common symptoms of biliary colic

A gallbladder attack is also called biliary colic^[1,6]. It starts when a stone blocks normal bile flow^[1]. The blockage may be brief, but the pain can be strong^[1].

Biliary colic often causes steady pain in the upper-right abdomen^[1,5]. Some people feel pain in the upper-middle abdomen instead^[5,8]. Pain may last from several minutes to several hours^[1,7].

The word “colic” may suggest pain that comes in waves. However, biliary colic can feel steady rather than come and go^[5].

Common gallbladder attack symptoms include:

• Steady pain under the ribs on the right side^[1,5].
• Steady pain in the upper-middle abdomen^[5,8].
• Pain that moves into the back or right shoulder^[7,8].
• Nausea with upper abdominal pain^[7,8].
• Vomiting during an attack^[7,8].
• Pain after a heavy or greasy meal^[1,5].
• Pain that starts in the evening or at night^[1].
• Pain that makes it hard to get comfortable^[8].

Gallbladder attack symptoms can vary from person to person. Upper abdominal pain can also have other causes. A healthcare professional should assess new or repeated pain.

Pain location, timing, and possible triggers

The gallbladder sits under the liver in the upper-right abdomen^[4,8]. Gallstone pain often starts in this area^[1,5]. It may also start in the upper-middle part of the abdomen^[5,8].

Pain can spread toward the back^[7,8]. It can also move below the right shoulder blade^[7,8]. Nausea or vomiting may occur at the same time^[7,8].

Gallbladder attacks often follow heavy or high-fat meals^[1,5]. Eating causes the gallbladder to squeeze and release bile^[8]. A stone near the outlet can block that flow and cause pain^[5].

Attacks often happen during the evening or at night^[1]. The pain may stop when the stone moves away from the duct^[1]. Pain relief does not mean the stones are gone.

Silent gallstones and recurring attacks

Silent gallstones do not cause typical gallbladder attack symptoms^[1,7]. Doctors may find them during an imaging test done for another reason^[5]. Many silent stones never need treatment^[2,7].

The outlook changes after the first painful attack. Additional attacks are likely after someone has had one gallbladder attack^[1]. Pain can return when another stone blocks a duct^[1,2].

A person should seek medical advice for recurring upper abdominal pain^[2]. A clinician can look for gallstones and signs of a blocked duct. Testing also helps guide the right gallstone treatment.

Causes and Risk Factors for Gallstones

Changes in bile and poor gallbladder emptying

Gallstones can form because of changes in bile^[5,9]. Cholesterol stones may form when bile contains too much cholesterol^[9]. Low levels of bile salts may also play a part^[9].

Poor gallbladder emptying can increase the chance of stone formation^[5,9]. Bile stays in the gallbladder longer when the organ does not empty well^[5,9]. Substances in the bile may then form crystals and stones^[5].

Pigment stones are linked to excess bilirubin in bile^[3,9]. Cirrhosis, which is severe liver scarring, can raise the risk of pigment stones^[9]. Bile duct infections can also raise the risk^[9].

Some inherited blood disorders can cause pigment stones^[9]. One example is sickle cell disease^[9]. Fast breakdown of red blood cells can increase bilirubin levels^[3].

Personal and medical risk factors

A risk factor raises the chance of developing a disease. It does not mean that the disease will occur.

Gallstones are more common in females than in males^[3,7]. They are also more common after age 40^[3]. People with excess body weight have a higher risk^[3].

A family history of gallstones can raise a person’s risk^[3]. Pregnancy is another known risk factor^[3,8]. Rapid weight loss can also make stones more likely^[3,8].

Some liver, blood, and bile duct disorders raise gallstone risk^[3,9]. A person may have several risk factors at once. However, risk factors do not show whether symptoms will occur.

Someone with several risks may never have an attack. Another person may develop symptoms without knowing their risks. Symptoms and medical tests are more useful than risk factors alone.

Can gallstones be prevented?

Not every case of gallstones can be prevented. People cannot change their age, sex, or family history. They may also have health problems that raise their risk^[3,8].

Avoiding rapid weight loss may reduce one known risk^[3,8]. Gradual weight control and regular physical activity may also help lower risk^[8]. A balanced diet with fiber and healthy fats may be helpful^[8].

People planning major weight loss should speak with a healthcare professional. They can ask how to lose weight at a steady pace.

Prevention steps cannot remove stones that have already formed. Food changes may reduce meal-related symptoms for some people. They do not replace medical care for repeated attacks or gallstone warning signs.

When to See a Doctor: Gallstone Warning Signs and Complications

Contact a healthcare professional after symptoms of a gallbladder attack^[2]. This is important when upper abdominal pain returns. Medical care can help find a blocked duct or other cause.

A blockage that lasts more than a few hours can cause serious problems^[1]. These problems may include swelling, organ injury, or infection^[5,9].

Symptoms that require urgent medical care

Seek urgent medical care for these gallstone warning signs:

• Severe or lasting upper abdominal pain^[1,8].
• Pain that prevents you from getting comfortable^[8].
• Fever or chills with abdominal pain^[1].
• Yellow skin or eyes, called jaundice^[1].
• Dark urine or pale stools^[1].
• Repeated vomiting or trouble keeping fluids down^[1].
• Severe pain that spreads into the back^[5].
• Confusion, fainting, or signs of severe illness.

Fever, chills, and jaundice can point to a serious blockage or infection^[1,9]. Dark urine and pale stools can also occur when bile flow is blocked^[1]. Repeated vomiting with severe pain needs urgent assessment^[1].

Do not treat severe pain, fever, or jaundice as a minor stomach problem^[1,9]. A blocked bile duct can lead to a life-threatening infection^[9].

Acute cholecystitis

Acute cholecystitis is sudden swelling of the gallbladder^[5]. It can happen when a stone blocks the cystic duct. This duct carries bile out of the gallbladder.

Unlike brief biliary colic, the pain may not go away^[1,5]. Fever or other signs of swelling may occur^[1,5]. This condition needs medical treatment.

Choledocholithiasis and cholangitis

Choledocholithiasis means a gallstone is inside the common bile duct^[9]. The stone can block bile from draining normally^[9]. This blockage may lead to jaundice^[1,9].

Cholangitis is a serious infection of the bile ducts^[5,9]. It can develop when bile builds up behind a blockage^[5,9]. Signs may include fever, chills, abdominal pain, and jaundice^[1,9].

Bile duct infections can become life-threatening^[9]. People with these gallstone warning signs need urgent care.

Gallstone pancreatitis

The pancreas has a duct near the common bile duct. A gallstone can block drainage in this area^[5,9]. The blockage can inflame the pancreas and cause gallstone pancreatitis^[5,9].

Pancreatitis may cause severe upper abdominal pain^[5]. The pain may spread into the back^[5]. Vomiting can also occur during a severe gallstone attack^[1,7].

Gallstone complications include acute cholecystitis and choledocholithiasis^[5,9]. They also include cholangitis and gallstone pancreatitis^[5,9]. Medical tests help doctors find the blockage and check for organ injury^[10].

Diagnosis and Treatment of Gallstones

Medical history and examination

A clinician will ask about the pain and its location. They may ask how long it lasts and whether it follows meals. They will also ask about past attacks.

The clinician may check for fever, vomiting, or jaundice. They may press gently on the abdomen to find tender areas. Tests are often needed because many problems can cause upper abdominal pain.

Blood tests and imaging

Abdominal ultrasound is often the first imaging test for suspected gallstones^[10]. It uses sound waves to make pictures inside the abdomen^[10]. The test can show many stones inside the gallbladder^[3,10].

Cholesterol stones may not appear on a CT scan^[3]. However, they are often visible on an abdominal ultrasound^[3].

Very small stones can be harder to find. Endoscopic ultrasound may detect stones missed by a standard ultrasound^[10]. This test uses a thin tube with a small ultrasound tool^[10].

The clinician passes the tube through the mouth and digestive tract^[10]. The device then makes detailed pictures of nearby organs^[10].

Other imaging tests can study bile flow or search for duct stones^[10]. The doctor chooses tests based on symptoms and earlier results.

Blood tests can show infection, swelling, or organ injury. They may help assess the liver or pancreas. Imaging is often needed to locate stones and blocked ducts^[10].

When observation is appropriate

Asymptomatic gallstones usually do not need treatment^[2,5]. An exception may apply in certain high-risk situations^[2,5]. Many silent stones never cause symptoms or need treatment^[7].

Observation avoids treatment when the stones are not causing problems. However, people with silent stones should know the main gallstone warning signs.

New pain, fever, jaundice, or vomiting should lead to medical advice^[1,2]. Gallbladder attacks are likely to return after the first attack^[1].

Surgery for symptomatic gallstones

Laparoscopic cholecystectomy is the standard treatment for most symptomatic gallstones^[2,5]. Cholecystectomy means surgery to remove the gallbladder. Laparoscopic surgery uses small cuts, a camera, and special tools.

The gallbladder is not needed for normal life^[2]. After surgery, bile still flows from the liver into the small intestine^[4]. Most people can live normally without a gallbladder^[2].

Surgery removes the organ where most gallstones form. It is often used when attacks return or complications occur^[2,5]. A surgeon can explain the possible benefits and risks.

Endoscopic treatment for duct stones

Doctors may use an endoscopic procedure to remove stones from the common bile duct. Endoscopy uses a flexible tube passed through the mouth. The clinician guides the tube through the digestive tract.

This method can reach a blocked bile duct and remove a stone. However, it does not remove stones that remain in the gallbladder.

Some people may also need gallbladder removal. The plan depends on the stone’s location and any complications. A person’s overall health also guides treatment.

Nonsurgical dissolution treatment

Doctors sometimes use nonsurgical treatment for cholesterol stones^[2]. These treatments are only suitable for selected people^[2]. Pigment stones usually need surgery when treatment is required^[2].

Dissolution medicines slowly break down certain cholesterol stones^[2]. Treatment may take months or years^[2]. Gallstones can return after the medicine is stopped^[2].

These limits make medicine less useful for many symptomatic patients. Nonsurgical treatment mainly applies to selected cholesterol stones^[2]. A healthcare professional must decide whether it is a suitable option.

Conclusion

Understanding gallstones symptoms causes treatment and warning signs can support safer choices. Silent stones often need no treatment^[1,2]. Stones that block bile flow can cause pain or serious harm^[1,5].

A gallbladder attack often causes steady pain in the upper abdomen^[1,5]. The pain may begin after a heavy or high-fat meal^[1,5]. Later attacks are likely after a first painful episode^[1].

Seek medical advice for pain that keeps returning^[2]. Get urgent help for severe pain, fever, chills, or jaundice^[1,9]. Dark urine, pale stools, or repeated vomiting are also gallstone warning signs^[1].

Abdominal ultrasound often starts the diagnostic process^[10]. Laparoscopic gallbladder removal is the standard treatment for most symptomatic stones^[2,5]. Prompt care can help doctors find and treat serious gallstone complications.