Overview
Gallstones are hard, pebble-like deposits of cholesterol or bilirubin that form in the gallbladder, ranging in size from a grain of sand to a golf ball, and while many cause no symptoms, they can lead to sudden, severe abdominal pain if they block a bile duct.
Disease Summary
- Category
- Non-Communicable Disease
- Cause
- Hardened deposits of cholesterol or bilirubin that form in the gallbladder
- Transmission
- Not applicable; gallstones are not contagious and cannot be spread between people
- Body System
- Digestive System
- Preventable
- Yes
- Curable
- Yes
Symptoms
Common Symptoms
Most gallstones cause no symptoms; the following occur when a stone blocks a duct.
Sudden Upper Abdominal Pain
Rapidly intensifying pain in the upper right abdomen or center of the abdomen, often after eating.
Pain Spreading to the Back or Shoulder
Pain from a gallbladder attack can radiate to the back or right shoulder blade.
Nausea and Vomiting
Often accompanies the pain of a gallbladder attack.
Bloating
A feeling of fullness or bloating, particularly after fatty meals.
Danger Signs
Seek emergency medical care if any of the following develop.
Intense, Unrelenting Pain
Pain so severe you cannot sit still or find a comfortable position needs emergency care.
Yellowing of the Skin or Eyes (Jaundice)
May indicate a blocked bile duct and needs urgent evaluation.
Fever and Chills
Can indicate infection of the gallbladder or bile ducts.
Rapid Heartbeat with Low Blood Pressure
May indicate a serious infection and requires emergency care.
Diagnosis
Clinical Assessment
Diagnosis begins with reviewing symptoms and examining the abdomen for tenderness.
Imaging
Abdominal ultrasound is usually the first test used to detect gallstones.
Blood Tests
Help detect inflammation, infection, or jaundice, and offer clues about which organs are affected.
Laboratory Tests
Abdominal Ultrasound
The primary test used to detect gallstones in and around the gallbladder.
Liver Function Tests
Can reveal signs of a blocked bile duct or liver involvement.
Complete Blood Count (CBC)
Helps detect infection or inflammation related to gallstones.
Endoscopic Ultrasound or ERCP
Used when a gallstone is suspected to be stuck outside the gallbladder, in the bile ducts.
Treatment
Gallbladder Removal Surgery (Cholecystectomy)
The usual and most effective treatment for symptomatic gallstones, since the gallbladder is not essential for digestion.
Oral Dissolution Therapy
Medications containing bile acids can dissolve small cholesterol stones, though this is used far less often than surgery.
Prevention
Maintain a healthy weight
Being overweight increases the risk of gallstones, so maintaining a healthy weight through gradual, steady changes helps lower risk.
Avoid rapid weight loss
Losing weight too quickly can actually increase the risk of gallstones; gradual weight loss is safer.
Eat a fibre-rich diet
Diets higher in fibre and healthy fats, with fewer refined carbohydrates, are associated with a lower risk of gallstones.
Stay physically active
Regular physical activity is linked to a lower risk of developing gallstones.
Risk Factors
High Risk
These factors substantially increase the likelihood of developing gallstones.
- Obesity
- Rapid weight loss
- Female sex, particularly during and after pregnancy
Increased Risk
These factors are associated with a moderately higher risk of gallstones.
- Family history of gallstones
- Age over 40
- Diets high in fat or cholesterol
Additional Contributing Factors
Other factors linked with an increased likelihood of gallstones.
- Certain digestive diseases affecting bile
- Diabetes
- Certain medications, including some hormone therapies
Complications
Cholecystitis
Inflammation and infection of the gallbladder caused by a blocked bile duct.
Blocked Bile Duct (Choledocholithiasis)
A gallstone lodged in the bile duct can cause jaundice and requires prompt treatment.
Pancreatitis
A gallstone blocking the pancreatic duct can cause inflammation of the pancreas, a serious complication.
When to Seek Medical Care
Intense Abdominal Pain
Pain so severe you cannot sit still needs immediate medical attention.
Yellowing of the Skin or Eyes
May indicate a blocked bile duct and needs urgent evaluation.
Fever with Abdominal Pain
Combined fever and abdominal pain suggests a possible infection.
Dark Urine or Pale Stools
Can indicate a blocked bile duct and should be assessed by a healthcare provider.
Prognosis
Excellent After Gallbladder Removal
Most people recover fully and can live normally without a gallbladder.
Silent Gallstones Often Need No Treatment
Gallstones that cause no symptoms typically don’t require treatment and may never cause problems.
Risk of Recurrent Symptoms Without Treatment
Gallstone symptoms often return if the gallbladder is not removed.
Differential Diagnosis
Peptic Ulcer Disease
Can cause similar upper abdominal pain, particularly after eating.
Appendicitis
Can cause abdominal pain, though typically located in the lower right abdomen rather than the upper right.
Pancreatitis
Can cause similar upper abdominal pain and may occur together with gallstones.
Gastroenteritis
Causes nausea, vomiting, and abdominal discomfort but usually lacks the localized pain pattern of a gallbladder attack.
References
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
NIH guidance on the causes, types, and symptoms of gallstones.
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Treatment
NIH guidance on treating and preventing gallstones.
Mayo Clinic
Patient-focused overview of gallstone symptoms and causes.
Frequently Asked Questions
Do all gallstones need treatment?
No. Gallstones that don’t cause symptoms, sometimes called silent gallstones, usually don’t need treatment.
Can you live without a gallbladder?
Yes. The gallbladder is not essential, and most people digest food normally after it is removed.
Can gallstones be dissolved without surgery?
In some cases, medication can dissolve small cholesterol stones, though this method is used far less often than surgery and can take months or years.
Are gallstones the same as kidney stones?
No. Gallstones form in the gallbladder and travel through the bile ducts, while kidney stones form in the kidneys and travel through the urinary tract.