Gallstones & Gallbladder Disease Care | Symptoms & Treatment

A patient talks to a MedStar Health doctor about abdominal pain.

What are gallstones?

Gallstones are small, hard deposits that slowly form in the gallbladder, a pear-shaped organ that lies under the liver on the right side of the abdomen. They are usually composed of bile fluid, which the liver produces to aid in the digestion of fat and cholesterol. Also called cholelithiasis, gallstones can range in size and are the most common cause of gallbladder disease.

Many people with gallstones never experience symptoms and don’t need treatment. However, they can become painful, especially if they grow or block the biliary tract. Because this can lead to serious complications, symptomatic stones require treatment.

At MedStar Health, you’ll find advanced endoscopists who use the latest techniques for gallstone treatment, using endoscopic retrograde cholangiopancreatography (ERCP) and experienced hepatobiliary surgeons. Our experts work together to care for patients with all types of gallbladder disease, from simple to the most complex cases, ranging across Washington D.C., Baltimore, Maryland, and northern Virginia.

How gallstones form and what causes gallbladder disease

Watch the video below to learn how the gallbladder works, how gallstones form, and what causes gallbladder disease. Our experts explain common symptoms, risk factors, and when treatment may be needed to help you find relief.

Gallbladder disease and gallstones symptoms

Oftentimes, gallstones don’t cause any symptoms. Some people may not even realize they have them until they show up incidentally on imaging for other problems. Asymptomatic gallstones don’t require treatment.

Early signs vs. advanced symptoms

Some early signs or warnings of a possible gallstone attack include the following:

Location of pain: Upper right abdomen, center of the abdomen, or radiating pain to the back (between shoulder blades) or right shoulder.
Type of pain: Steady, sharp, crampy, or severe, sometimes taking your breath away.
Additional symptoms: Nausea, vomiting, bloating, and fullness

Biliary colic

If gallstones become larger or clog the bile duct, they can cause more advanced symptoms and serious complications. The most common symptom of gallbladder disease is pain that occurs in the upper right side of the abdomen near the rib cage. This is often called biliary colic, and gallstones are the most common reason for this type of pain.

This kind of gallbladder attack is sometimes accompanied by nausea and vomiting.
The attacks may be triggered by large or fatty meals, often waking patients up during the night.
They may occur frequently, but not more than once a week.

Acute cholecystitis

The symptoms of acute cholecystitis (gallbladder inflammation) are similar to biliary colic but more painful and longer-lasting. Cholecystitis is also most frequently caused by gallstones that block the biliary duct from properly draining. Symptoms may include:

Pain in the upper right or mid abdomen that is severe and constant. It may last for days. Pain frequently increases when drawing a breath.
Pain may also radiate to the back or occur under the shoulder blades, behind the breastbone, or on the left side.
About a third of patients have fever and chills.
Nausea and vomiting may occur.

What causes gallstones or increases my risk?

Researchers believe gallstones can form from excessive amounts of cholesterol, bile salts, or bilirubin.

In addition, several factors can increase an individual’s risk, including:

Age: As we get older, we become more prone to gallstones
Gender: Women tend to have more stones than men
Weight: People who have a BMI in the overweight or obese range may have more stones present than others
Family history: Having relatives who have been diagnosed can increase your risk
Rapid weight loss: Losing weight quickly can elevate your risk
Certain medical conditions: such as pregnancy, diabetes, and high cholesterol raise your risk

How to prevent gallstones

You can’t always prevent gallstones or gallbladder disease, but making healthy lifestyle changes to help you achieve and maintain a healthy weight may lower your risk. It’s important to lose weight slowly in a sustainable manner, as losing weight too quickly can increase your gallstone risk.

Gallstones diagnosis & what to expect during your appointment

If you have gallbladder disease symptoms, your healthcare provider will begin your visit with a physical exam and discuss your medical history. If your provider suspects gallstones, an abdominal ultrasound is generally the first diagnostic test they will use to visualize your digestive tract.

If your gastroenterologist needs to further evaluate your gallbladder and biliary tract, they may perform the following:

An endoscopic ultrasound or other imaging tests, such as an MRI or an ERCP, which allows your doctor to remove stones at the same time
Or blood tests can also help to identify signs of infection, jaundice, or other potential complications

Gallstones treatment

Treatment varies based on your medical history, the severity of your gallstones, and your risk for complications. The three primary approaches to treating this condition include:

1. Non-surgical management

The majority of patients whose gallbladder disease is asymptomatic do not need treatment. Your doctor will advise you on what signs or complications to watch out for and when you may need to come back for treatment, using a 'wait & see' method.

Exceptions to this recommendation include people disposed to gallbladder cancer, members of ethnic groups particularly at risk for gallstones, or those patients whose gallstones are larger than three centimeters in diameter.
2. Gallbladder surgery (Cholecystectomy)
Candidates for gallbladder removal or surgery typically have, or have had, one of the following:

A very severe gallstone attack

Several less severe gallstone attacks

Cholecystitis (gallbladder inflammation)

Pancreatitis, or inflammation of the pancreas, secondary to gallstones

High risk for gallbladder cancer

Chronic acalculous gallbladder disease (also called biliary dyskinesia), in which the gallbladder does not empty well, and causes biliary colic even though there are no gallstones present

Gallstone surgery is usually performed using laparoscopic or robotic surgery. Because these are minimally invasive approaches, most patients can expect fewer risks of complications, less blood loss and pain, and faster recovery than open surgery.

Each procedure has its risks, but the removal of the gallbladder should remove all symptoms of the disease. Other procedures may be recommended for patients with acalculous gallbladder disease.
3. Endoscopic management

People with gallbladder stones that travel to the common bile duct may need further evaluation using endoscopic retrograde cholangiopancreatography (ERCP). During this advanced procedure, our experts can perform endoscopic sphincterotomy to treat common bile duct stones. It’s an outpatient procedure and most patients can resume normal activity the next day.