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. Gallstones are the most common cause of gallbladder disease, which is any condition that affects the gallbladder.
Many people with gallstones never experience symptoms and don’t need treatment. However, gallstones can become painful, especially if they grow or block the biliary tract. Because this can lead to serious complications, symptomatic gallstones require treatment.
At MedStar Health, you’ll find advanced endoscopists who use the latest techniques to treat gallstones using endoscopic retrograde cholangiopancreatography (ERCP) and experienced hepatobiliary surgeons. Our team of experts work together to care for patients with all types of gallbladder disease, from the simple to the most complex.
How do gallstones form?
Watch the video below to learn more about the gallbladder and what causes gallstones and gallbladder disease.
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.
If gallstones become larger or clog the bile duct, they can cause 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.
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?
Researchers believe gallstones can form from excessive amounts of cholesterol, bile salts, or bilirubin.
In addition, several factors can increase an individual’s risk of developing gallstones, 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 gallstones than others
- Family history: Having relatives who had gallstones can increase your risk
- Rapid weight loss: Losing weight quickly can elevate your risk of gallstones
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Certain medical conditions: Pregnancy, diabetes, and high cholesterol raise your risk
Preventing 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.
Diagnosing gallbladder disease
If you have gallbladder disease symptoms, your healthcare provider will begin your visit with a physical exam and discuss your medical history. If your healthcare 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 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. Blood tests can also help to identify signs of infection, jaundice, or other potential complications.
Gallstones treatment
Treatment for gallstones varies based on your medical history, the severity of your gallstones, and your risk for complications. The three primary approaches to treating gallstones include:
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1. Wait and see
The majority of patients whose gallbladder disease is asymptomatic do not need treatment. Your doctor will advise you on what signs of complications to watch out for and when you may need to come back for treatment. 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.
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2. Gallbladder surgery (Cholecystectomy)
Candidates for gallbladder removal 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 recoveries than open surgery. Each procedure has its risks, but removal of the gallbladder should remove all symptoms of the disease. Other procedures may be recommended for patients with acalculous gallbladder disease.
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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.
Our providers
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Fasika Aberra, MD
Gastroenterology
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Ghassan Abdullah Alzayer, MD
Gastroenterology
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Heather Norton Benedetto, FNP
Gastroenterology
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Alyssa Bialek, PA
Gastroenterology
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Aaron Michael Fond, MD
Gastroenterology
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Nadim G Haddad, MD
Gastroenterology
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Denise Marlatte, FNP
Gastroenterology
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Sachin Mohan, MD
Gastroenterology
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Kathryn Peacher, CRNP, NP, C
Gastroenterology
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Meggin A. Sabatino, DNP
Gastroenterology
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Nayan Rasiklal Shah, MD
Gastroenterology
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James Arthur Butler, MD
Gastroenterology
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Roderick Burns Kreisberg, MD
Gastroenterology
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Farzin Rashti, MD
Gastroenterology
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Akriti P Saxena, MD
Gastroenterology
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Michael Scott Schindler, MBBS
Gastroenterology