Abdominal Pain: Gallstones

Gallstones are pieces of solid material that form in the body from special digestive fluids. They affect a small but important area of the body—the gallbladder. The gallbladder’s primary purpose is to store bile—a fluid that aids in the digestion process. Gallstones come in varying sizes and can result in a number of complications including blockage, inflammation and, in rare cases, cancer.

Types of Gallstones

There are two primary kinds of gallstones:

1. Cholesterol stones: These make up about 80 percent of all gallstones, and are typically a yellow-green color.
2. Pigment stones: These are smaller, darker stones that form from bilirubin, a chemical in bile.

Causes and Risk Factors

Gallstones typically form due to three main reasons:

1. Excess bilirubin in bile: Bilirubin is produced when your body recycles old red blood cells into new red blood cells, but too much bilirubin being recycled at once can lead to gallstone formation.
2. Too much cholesterol in bile: If your liver excretes more cholesterol than can be dissolved in bile, crystals that eventually develop into stones can form.
3. Abnormal emptying of gallbladder: If your gallbladder doesn’t empty itself of bile as often or as completely as it should, meaning bile sits too long in your gallbladder.

There are also several factors that may increase your risk of forming gallstones:

Diet: Eating a high-fat, low-fiber and high-cholesterol diet can contribute to gallstone formation.
Ethnicity: Native Americans and Mexican-Americans have a higher risk of developing gallstones. The exact reason for this is unknown
Age: Those above 60 years of age are at a higher risk.
Gender: Women tend to form gallstones more frequently than men.
Medications: Hormones, cholesterol-lowering medications and estrogen can lead to gallstone formation.
Pregnancy
Obesity
Family history of gallstones
Rapid weight loss
Diabetes

Symptoms

Most gallstones never cause problems. Roughly 90 percent of gallstones are tiny, don’t lead to any symptoms and are nothing to worry about. If a gallstone leads to a blockage, either of the gallbladder or the tubing system that connects the liver and the gallbladder to the small intestines, symptoms can develop. These symptoms may include:

Abdominal pain of the upper right or upper middle of the abdomen
Nausea or vomiting, or both
Pain between the shoulders, or in right shoulder
Heartburn, bloating and other digestive problems

Possible Complications

In some cases, gallstones can lead to additional complications including:

Inflammation of gallbladder: Known as cholecystitis, this inflammation can cause pain and fever.
Blockage of pancreas: This can cause inflammation in the pancreas, which usually leads to severe pain, nausea and vomiting, and frequently requires hospitalization.
Blockage of bile duct: This blocks bile from flowing to the small intestine, and can result in jaundice (a yellowish discoloration of the skin and eyes) and severe infections.
Cancer: Cancer of the gallbladder can occur in people who have a history of severe gallstones problems; however, this is an incredibly rare complication.

Treatment and Prevention

Doctors use various tests to determine if symptoms are related to gallstones. Again, most gallstones are innocent bystanders and are nothing to worry about. Gallbladder problems, however, are common problems. If you have abdominal pain, nausea or other symptoms that may be due to gallstones, your doctor may use blood tests, special x-rays, ultrasounds, CT scans or other similar diagnostic tests to further evaluate your symptoms.

If treatment is necessary, the following are possible approaches to gallstone problems:

Cholecystectomy: Since gallstones frequently recur, surgically removing the gallbladder may be necessary. This procedure is called a cholecystectomy and is one of the most common surgeries performed.
ERCP: This special procedure can help remove gallstones from the tubes that connect the liver and gallbladder to the intestines. It involves using special cameras and equipment to remove gallstones. A cholecystectomy is usually also performed to prevent long-term recurrence of gallstone problems.
Medications: Medications are rarely used, as they are often ineffective, to dissolve gallstones.These are used mostly in minor cases or for people who aren’t able to undergo surgery. This treatment can sometimes take months or years to fully dissolve gallstones.

The following may help lower your risk of gallstone-related problems:

Lose weight safely and slowly—rapid weight loss can increase the likelihood of gallstones forming.
Avoid skipping meals—fasting can increase your risk of gallstones. Stick to regular, smaller meals.
Maintain a healthy weight—obesity is a major risk factor for gallstone issues.

If you’re concerned you might have problems related to your gallbladder or gallstones, speak to your doctor about your treatment options.

I grew up in Utah County and graduated from Brigham Young University. I received my medical degree from the University of Virginia, and I finished my residency in internal medicine at the University of Utah where I also served as chief medical resident. As a doctor, I recognize the tremendous trust my patients place in me, and I do my best to help them understand not only their medical issues but also the plan—the how and why—behind helping them feel better. I love the challenge posed by all gastrointestinal disorders but especially enjoy the challenges and intricacies of Crohn’s disease and Ulcerative Colitis.