What are gallstones?
Gallstones are lumps of solid material that form in your gallbladder. They are also
called cholelithiasis. They are made when the digestive juice called bile turns hard
The gallbladder is a small organ under your liver. It stores bile made by the liver.
Bile is made of several things such as cholesterol, bile salts, and a yellowish pigment
Gallstones can be as small as a grain of sand or as big as a golf ball. Your gallbladder
may form a single large stone, hundreds of tiny stones, or both sizes at the same
time. Gallstones often don't cause any symptoms. But in some cases, gallstones block
the tubes that carry bile (bile ducts). This can lead to a life-threatening infections
of the bile ducts, pancreas, or liver. Once you have had gallstones, you are at risk
of having more.
There are two types of gallstones: cholesterol and pigment.
These stones are:
Most common type of stone
Often a yellow-green color
Made mainly of hardened cholesterol
These stones are:
What causes gallstones?
Cholesterol stones form when your gallbladder doesn’t empty the way it should. They
also form when bile has:
Health experts don’t know what causes pigment stones to form. But pigment stones are
more common in people who have:
A liver disease (cirrhosis) where scar tissue replaces healthy liver tissue
An infection in the vessels that transport bile (biliary tract infection)
Blood disorders that are passed from parent to child (hereditary) such as sickle cell
Who is at risk for gallstones?
Some people have a higher risk for gallstones. These include:
Native Americans. They have the highest rates of gallstones in the U.S. This may be genetic as they
have very high levels of cholesterol in their bile.
Mexican Americans. They have higher than average rates of gallstones.
Women.They are twice as likely to have gallstones as men.
People over age 60. Risk for gallstones increases with age.
People with a family history of gallstones. Gallstones seem to run in some families (inherited). There may be a genetic link.
Health issues that may raise your risk for gallstones include:
Obesity. This is a major risk factor, mainly for women.
Estrogen. Women may have extra estrogen from pregnancy, hormone replacement therapy, or birth
control pills. This seems to raise cholesterol levels in bile and slow down gallbladder
movement. Both can lead to gallstones.
Diet. Eating a high-fat, high-cholesterol, or low-fiber diet raises your risk. They lead
to more cholesterol in the bile and reduced gallbladder emptying.
Cholesterol-lowering medicines. These medicines can increase the amount of cholesterol in bile.
Diabetes. People with diabetes often have high levels of fatty acids (triglycerides). This
raises the risk for gallstones.
Very fast weight loss. As the body processes fat during very fast weight loss, the liver sends out extra
cholesterol into bile.
Not eating for a few days (prolonged fasting). Fasting slows down gallbladder movement. Over time, your bile has too much cholesterol.
What are the symptoms of gallstones?
Some people with gallstones don't have any symptoms. These stones are called silent
stones. They don't stop the gallbladder, liver, or pancreas from working properly.
In most cases they don't need to be treated. Most gallstones don’t cause symptoms
Gallstone symptoms (also called a gallbladder attack) may happen very suddenly. They
Begin when gallstones get bigger
Happen when the stones start to block bile ducts
Occur after a fatty meal or at night
Each person’s symptoms may vary. Symptoms may include:
Steady, severe pain in your upper belly (abdomen) that quickly gets worse
Pain in your back between the shoulder blades
Pain in your right shoulder
Yellowing of the skin or eyes (jaundice)
See your healthcare provider right away if you have any of these symptoms during or
after a gallbladder attack:
The symptoms of gallstones may look like other health problems. Always see your healthcare
provider to be sure.
How are gallstones diagnosed?
Many people have gallstones but don’t know it because they don’t have symptoms. In
some cases, gallstones are found by accident. This may happen if you are being tested
for a different health problem.
But if you have pain that doesn’t go away, your healthcare provider will look at your
past health and give you a physical exam.
You may also have some tests to check for gallstones such as:
Ultrasound. This imaging test uses high-frequency sound waves to create images of your internal
organs on a computer screen. It is used to see the gallbladder and gallstones.
HIDA or PIPIDA scan (hepatobiliary scintigraphy or cholescintigraphy). This scan checks for any abnormal contractions of the gallbladder and blockages in
your bile ducts. A radioactive chemical or tracer is shot (injected) into your vein.
The amount of radiation is very small. It is not harmful. It collects in your liver
and flows into your gallbladder. A special scanner is used to watch the tracer move
through your organs. You will take a medicine to make your gallbladder contract.
Blood tests. These look for signs of infection, blockage, liver problems, jaundice, and inflammation
of the pancreas (pancreatitis).
CT scan. A CT scan is an imaging test that uses X-rays and a computer to make detailed pictures
of any part of the body. It can show gallstones. It can also show infection or bursting
of the gallbladder or bile ducts.
MRCP (magnetic resonance cholangiopancreatography). This is a special MRI test that creates images using magnetic fields and pulsed radio
EUS (endoscopic ultrasound). This internal ultrasound (sonogram) is done with a flexible lighted scope. You are
given medicine to help you relax and then a scope is passed through your mouth. It
creates internal images using sound waves.
ERCP (endoscopic retrograde cholangiopancreatography). ERCP uses both X-ray and a long flexible lighted tube with a camera near the end
(catheter).. While you are sedated, the tube is put in your mouth and throat. It goes
down your food pipe (esophagus), through your stomach, and into the first part of
your small intestine (duodenum). Your healthcare provider can see the inside of these
organs on a video screen and check for any problems. A dye is put into your bile ducts
through the tube. The dye lets the bile ducts be seen clearly on the X-ray.
How are gallstones treated?
If your gallstones don’t cause any symptoms, you often don’t need treatment.
Gallstones that do cause symptoms should be treated right away. They may lead to damage
or infection if your bile ducts are blocked for a long time.
If your symptoms don’t go away, your treatment may include:
ERCP (endoscopic retrograde cholangiopancreatography). ERCP uses both X-ray and a long flexible lighted tube (endoscope). While you are
sedated, the tube is put into your mouth and throat. It goes down your food pipe (esophagus),
through your stomach, and into the first part of your small intestine (duodenum).
A dye is put into your bile ducts through the tube. The dye lets the bile ducts be
seen clearly on X-rays. Small stones can be taken out through the scope.
Sphincterotomy. This can also be done through the tube during an ERCP. Tight rings of muscle (called
sphincters) are around the openings of the bile ducts. They can block gallstones.
Cutting these rings lets the ducts open wider so that stones can pass into your intestine.
Gallbladder removal (cholecystectomy). If stones are in your gallbladder, your gallbladder must be removed. These stones
cannot be taken out with ERCP. Gallbladder removal is a common surgery. Your body
will work well without your gallbladder. It is not essential for a healthy life.
Percutaneous drainage/cholecystostomy. If stones in your gallbladder cause a blockage of bile acid and subsequent infection,
your gallbladder will have to be removed. But if you are too sick to have surgery
or there are other complications, a drainage tube may be inserted into your gallbladder
through the skin of your abdomen. This will temporarily bypass the blockage and drain
Oral dissolution therapy. The stones are dissolved using medicines made from bile acid. But, it can take a
couple of years to completely dissolve the stones. They also tend to come back when
the medicine is stopped.
Methyl-tert-butyl ether. This solution or a similar chemical can be shot (injected) through the skin into
your gallbladder to dissolve stones. This is an uncommon procedure.
Most people respond very well once their stones are dissolved or taken out.
Key points about gallstones
Gallstones are lumps of solid material that form in your gallbladder.
They are made when the digestive juice called bile gets hard and stone-like.
If your gallstones cause no symptoms, treatment is often not needed.
If symptoms don’t go away, you will need treatment to remove the gallstones.
If stones are in your gallbladder, the gallbladder must generally be removed. This
is a common surgery.
Tips to help you get the most from a visit to your health care provider:
Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells
At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also
know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that
Know how you can contact your provider if you have questions.