Anatomy of a Gallstone

Related Media: Cholecystectomy

It is possible to have gallstones and not know it. They can lie dormant for years without causing problems. However, when they become symptomatic, they can cause severe pain. John H., an overweight, 55-year-old accountant, woke up one morning not long ago with terrible pains in his upper abdomen and right shoulder. Positive he was having a heart attack, he rushed off to the emergency room. Fortunately, John's problem was far less dramatic. He had gallstones.

Understanding Gallstones

The gallbladder is a small, pear-shaped organ that is part of the digestive system. It is located on the right side of the abdomen below your liver. The gallbladder stores and secretes bile, which is made by the liver, into the small intestine during digestion. Bile, a yellow-brownish fluid, helps digest fats in food.

Gallstones form when substances in the bile crystallize, or harden. There are 2 types of gallstones:

• Cholesterol gallstones—Made mostly of cholesterol, these yellow-green stones comprise about 80% of gallstones.
• Pigment gallstones—Made mostly of bilirubin and calcium salts, these smaller and darker stones account for the remaining 20% of gallstones.

Gallstones can be as small as a grain of sand, or as large as a golf ball, though smaller gallstones are much more common. In fact, 10%-20% of people in the US typically develop gallstones, though up to 80% of them will not develop symptoms. Symptoms may begin to appear when the stones get too large, or leave the gallbladder and get lodged in a duct.

Factors that Contribute to Gallstones

Although there is not an exact cause for gallstones, a number of factors are known to contribute to their formation:

• Body chemistry—Bile that contains too high a concentration of cholesterol and too low a concentration of bile salts
• Reduced efficiency—Refers to how well your gallbladder is at contracting and flushing bile into the intestine
• Proteins —An improper balance of different types of proteins in the liver or bile.
• Obesity —Excess weight may be linked to a decrease in bile salts and an increase in cholesterol production by the liver. Weight may also affect the efficiency of the gallbladder. This risk is more pronounced in women.
• Rapid weight loss—Causes an increase in cholesterol in the bile. Rapid weight may also impair gallbladder function.

Knowing Your Risk

How likely are you to get gallstones? Anyone can develop gallstones, but some are more susceptible than others. These include:

• People with a family history of gallbadder problems
• Women—high estrogen levels can increase cholesterol levels in bile and decrease gallbladder contractions
• People who are over 40 years old
• Native Americans and Hispanics of Mexican origin
• People with certain health conditions, such as diabetes, cirrhosis of the liver, or Crohn's disease
• People who are obese
• Certain diets, which may cause rapid weight loss

Symptoms and Complications

If you do experience a gallstone attack, the symptoms can be severe, and sometimes dangerous. Usually experienced as severe pain in the upper abdomen, upper back between the shoulder blades, or right shoulder, gallstone attacks can last anywhere from 20 minutes to a number of hours, and are often accompanied by nausea and vomiting. If you have gallbladder symptoms, seek medical help. Often times, gallbladder attacks are recurrent or will not go away on their own.

Although very painful, gallstone attacks are usually not life-threatening as long as the gallstones remain in the gallbladder. However, if the gallstones migrate out of the gallbladder, serious problems can develop:

• Acute cholecystitis—inflammation or gallbladder infection may occur if gallstones migrate and block the duct draining the gallbladder into the small intestine
• Jaundice—yellowing of the skin occurs if gallstones migrate and block the main duct between the liver and the intestine
• Pancreatitis—inflammation of the pancreas

If these complications do develop, and are left untreated, they can be fatal.

Diagnosing Gallstones

If gallstones are suspected, images of the abdomen are taken to confirm the diagnosis. These tests may include abdominal ultrasound, hepatobiliary scintigraphy (HIDA) scan, or magnetic resonance cholangiopancreatography (MRCP).

An endoscopic retrograde cholangiopancreatography (ERCP) combines endoscopy and x-ray. It may also be done to diagnose gallstones. Certain stones can be removed during an ERCP exam.

Gallstone Treatment Options

Keep in mind that gallstones that do not create symptoms are usually not treated. Once gallstones become symptomatic and are diagnosed, they can be treated in a number of ways.

Surgery

One treatment for gallstones is a cholecystectomy, which is surgery to remove the gallbladder. This can be done as an open surgery, where a large incision is made into the abdomen, or as laparoscopic surgery.

For laparoscopic surgery, small incisions are made in the abdomen, and a small camera and surgical tools are then passed through these incisions. Watching on a TV monitor, the surgeon removes the gallbladder, and stitches the internal and external incisions. Like open surgery, a laparoscopic cholecystectomy is done under general anesthesia. The laparoscopic method is less invasive. As a result, the laparoscopy causes much less postoperative pain than open surgery. In addition, recovery takes less time, and it requires a shorter hospital stay.

Nonsurgical Methods

There are also nonsurgical methods available to treat gallstones.

With oral dissolution therapy, you would be asked to take medications made from bile acids to dissolve gallstones. Generally lasting anywhere from a few months to a few years, this therapy is usually only prescribed for those with very small, cholesterol-type gallstones. People that have larger gallstones often have recurring symptoms after this therapy.

Contact dissolution therapy involves introducing and removing a gallstone-dissolving agent into the gallbladder through a catheter that is attached to a pump. Although there has been some success with this treatment, long-term safety and effectiveness of the chemicals used have not been established.

Life Without a Gallbladder

Can you live without your gallbladder? Yes. The gallbladder simply functions as a storage area for bile. Without a gallbladder, bile simply drains directly into the small intestines from the liver at a steady rate all day. Some people may have softer and more frequent stools as a result.

Persons with gallstones that are not causing symptoms need to carefully weigh the risks of gallbladder removal surgery against potential complications that could occur if the gallbladder is not removed. These complications include eventually developing a painful complication of gallstones. Talk with your doctor to learn more.

Revision Information

• Reviewer: Michael Woods, MD, FAAP
• Review Date: 04/2017
• Update Date: 04/18/2017