Gallstones are a common medical condition affecting millions of people worldwide. They are solid particles that form in the gallbladder, a small organ located beneath the liver that helps with the digestion and storage of bile. Gallstones can be made of cholesterol or pigment, and their size can range from small grains to large golf balls. While some people with gallstones may not experience any symptoms, others may experience severe pain, nausea, and other complications that can significantly impact their quality of life.1
There are several risk factors associated with gallstones, including age, gender, obesity, genetics, and certain medical conditions. Although there is no guaranteed way to prevent gallstones, however, maintaining a healthy weight, eating a balanced diet, and staying physically active may help reduce the risk.1 Treatment options for gallstones range from surgery to medications or lifestyle changes, depending on the severity of the condition.
In this context, it is important to understand the signs and symptoms of gallstones, as well as their diagnosis, management, and potential complications. Hence, this article will explore these areas.
Types of gallstones
Gallstones are solid deposits that form in the gallbladder, which is a small organ located in the upper right portion of the abdomen. These stones can vary in size and composition, with two primary types being cholesterol and pigment stones.1
- Cholesterol stones: they are the most common type of gallstone, accounting for around 80% of cases. They are made up of hardened cholesterol that forms when the bile in the gallbladder contains too much cholesterol or not enough bile salts. Risk factors for cholesterol stones include obesity, rapid weight loss, a diet high in fat and cholesterol, and certain medical conditions such as diabetes1
- Pigment stones: they are less common and account for around 20% of gallstones. Pigment stones result from abnormal bilirubin metabolism, which is a waste product formed when the liver breaks down red blood cells. Pigment stones are more common in people with liver disease, infections of the bile ducts, and certain blood disorders such as sickle cell anaemia3
Causes of gallstones
Gallstones occur when there is an imbalance in the chemical components that make up bile, a digestive fluid produced by the liver and stored in the gallbladder. Bile contains cholesterol, bile salts, and waste products such as bilirubin. When the balance of these substances is disrupted, gallstones can form.4
The exact cause of gallstones is not fully understood, but there are several known risk factors. One of the primary risk factors is a diet high in fat and cholesterol, as this can cause an increase in cholesterol levels in the bile. Obesity, rapid weight loss, and pregnancy can also increase the risk of gallstones.2 Hormonal changes during pregnancy can affect the way the gallbladder functions, while rapid weight loss can cause the liver to secrete extra cholesterol into the bile.1
Other risk factors for gallstones include certain medical conditions such as diabetes, liver disease, and inflammatory bowel disease. Genetic factors may also play a role in the development of gallstones.
Signs and symptoms of gallstones
Although gallstones are often asymptomatic, they can cause acute and intense abdominal pain, referred to as biliary colic, if they obstruct any of the bile ducts.5 However, common symptoms can include:
- Abdominal pain, especially in the upper right portion of the abdomen
- Nausea and vomiting
- Indigestion or bloating
- Back pain
- Fever or chills
- A high temperature
In some cases, gallstones can cause more serious complications such as inflammation of the gallbladder or blockage of the bile ducts, which can lead to jaundice or pancreatitis.5 Hence, if you are experiencing any of these symptoms, it is important to seek medical attention to determine the cause and receive appropriate treatment.
Management and treatment for gallstones
The management and treatment of gallstones depend on the severity of symptoms and the underlying cause. If gallstones are not causing any symptoms, no treatment may be necessary, and the stones can be monitored for changes. However, if symptoms are present, treatment options may include:
- Medications: Medications can be prescribed to dissolve cholesterol gallstones over time
- Surgery: Surgery is the most common treatment for gallstones. A cholecystectomy is a surgical procedure that removes the gallbladder, eliminating the risk of future gallstone formation
- Endoscopic treatment: Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that can remove gallstones from the bile ducts
- Shock wave lithotripsy: This non-invasive procedure uses shock waves to break up gallstones, making them easier to pass through the bile ducts
Lifestyle changes can also be helpful in managing gallstones, such as maintaining a healthy weight, eating a diet low in fat and cholesterol, and avoiding rapid weight loss.
It is important to consult with a healthcare provider to determine the best course of treatment for individual cases of gallstones.
Diagnosis of gallstones
The diagnosis of gallstones typically involves a combination of physical examination, medical history, and diagnostic tests. The most common diagnostic tests as recommended by NHS include:
- Abdominal ultrasound: This imaging test uses sound waves to create images of the gallbladder, liver, and bile ducts, which can detect the presence of gallstones
- CT scan: A CT scan can create detailed images of the gallbladder and surrounding structures to help identify gallstones and complications
- Magnetic resonance cholangiopancreatography (MRCP): This imaging test uses magnetic fields and radio waves to create images of the bile ducts and pancreatic duct, which can help diagnose gallstones and other conditions
- Blood tests: Blood tests can be used to check for signs of infection, inflammation, or liver function
If gallstones are detected, further tests may be needed to determine the severity of the condition and the best course of treatment.
Risks factors and complications
Risk factors include: 1,5
- Age: Gallstones are more common in people over the age of 40
- Gender: Women are more likely to develop gallstones than men
- Obesity: Being overweight or obese increases the risk of developing gallstones
- Genetics: A family history of gallstones can increase the risk of developing them
- Pregnancy: Pregnant women are more likely to develop gallstones due to hormonal changes
Complications of gallstones can include: 1,4
- Acute cholecystitis: Inflammation of the gallbladder can occur when a gallstone blocks the flow of bile
- Choledocholithiasis: A gallstone can become lodged in the bile duct, leading to infection and inflammation
- Pancreatitis: Inflammation of the pancreas can occur when a gallstone blocks the pancreatic duct
- Biliary colic: Severe pain can occur when a gallstone blocks the cystic duct
- Gallbladder cancer: Although rare, long-term inflammation of the gallbladder can increase the risk of developing gallbladder cancer
It is important to consult with a healthcare provider to determine the best course of action for managing gallstones and reducing the risk of complications.
How common are gallstones?
Gallstones are a common medical condition in the United Kingdom, with an estimated 10-15% of adults developing them at some point in their life. Women are more likely to develop gallstones than men, and the risk increases with age and certain medical conditions.
How can I prevent gallstones?
While there is no guaranteed way to prevent gallstones, there are several lifestyle changes that may reduce the risk. These include maintaining a healthy weight, eating a balanced diet rich in fruits, vegetables, and whole grains, and staying physically active. Avoiding rapid weight loss or fasting, limiting alcohol intake, and managing any underlying medical conditions can also help reduce the risk of gallstones.
How long is the recovery after gallstone surgery?
Recovery time after gallstone surgery can vary depending on the type of surgery performed and individual factors. In general, patients can expect to stay in the hospital for one or two days after laparoscopic surgery and up to a week after open surgery. Full recovery may take several weeks, during which time patients should avoid strenuous activity and follow any specific instructions provided by their healthcare provider.
When should I see a doctor?
It is important to see a doctor if you experience symptoms such as severe abdominal pain, nausea, vomiting, fever, or yellowing of the skin or eyes. These may be signs of gallstones or other medical conditions that require prompt attention. Additionally, if you have risk factors for gallstones or a family history of gallbladder disease, it may be advisable to discuss preventive measures with a healthcare provider.
Gallstones are solid particles that form in the gallbladder and can affect millions of people worldwide. They consist of two types which are cholesterol or pigment and range in size from small grains to large golf balls. Gallstones can cause severe pain, nausea, and other complications that can significantly impact a person's quality of life. Certain risk factors increase the likelihood of developing gallstones, including age, gender, obesity, genetics, and certain medical conditions. While there is no guaranteed way to prevent gallstones, lifestyle changes, such as maintaining a healthy weight, eating a balanced diet, and staying physically active, may help reduce the risk. Treatment options for gallstones vary depending on the severity of the condition, with some cases requiring surgery and others manageable with medications or lifestyle changes. Understanding the signs and symptoms of gallstones, as well as their diagnosis, management, and potential complications, is essential to making informed decisions about care and reducing the impact of gallstones on daily life.
- Di Ciaula A, Garruti G, Frühbeck G, De Angelis M, De Bari O, Wang DQH, et al. The role of diet in the pathogenesis of cholesterol gallstones. CMC [Internet]. 2019 Sep 12 [cited 2023 Apr 13];26(19):3620–38. Available from: http://www.eurekaselect.com/152765/article
- Gutt C, Schläfer S, Lammert F. The treatment of gallstone disease. Deutsches Ärzteblatt international [Internet]. 2020 Feb 28 [cited 2023 Apr 13]; Available from: https://www.aerzteblatt.de/10.3238/arztebl.2020.0148
- Lammert F, Gurusamy K, Ko CW, Miquel JF, Méndez-Sánchez N, Portincasa P, et al. Gallstones. Nat Rev Dis Primers [Internet]. 2016 Apr 28 [cited 2023 Apr 13];2(1):16024. Available from: https://www.nature.com/articles/nrdp201624
- Njeze GE. Gallstones. Niger J Surg [Internet]. 2013 [cited 2023 Apr 14];19(2):49–55. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3899548/
- National Institute of Diabetes and Digestive and Kidney Diseases. Gallstone [internet]. NIDDK; [cited 2023 Apr 14]. Available from: https://www.niddk.nih.gov/health-information/digestive-diseases/gallstones