Gallstone
Stone formed in gallbladder from precipitated bile components.
A gallstone is a solid mass that forms inside the gallbladder when components of bile, such as cholesterol, bile salts, and bilirubin, precipitate out of solution. The medical term cholelithiasis can describe either the presence of these stones or any illness they cause. When a stone moves into the bile ducts, the condition is called choledocholithiasis. Roughly 80% of people with gallstones have no symptoms. However, if a stone blocks a bile duct, it can trigger a sudden, severe cramping pain in the upper right abdomen known as biliary colic, often called a gallbladder attack. About 1–4% of individuals with gallstones experience such an attack each year. Potential complications include inflammation of the gallbladder (cholecystitis), inflammation of the pancreas (pancreatitis), obstructive jaundice, and infection of the bile ducts (cholangitis). Signs of these complications include pain lasting longer than five hours, fever, yellowish skin, vomiting, dark urine, and pale stools.
Risk factors include birth control pills, pregnancy, a family history of gallstones, obesity, diabetes, liver disease, and rapid weight loss. Gallstones are primarily classified as cholesterol stones, formed mainly from cholesterol, or pigment stones, formed mainly from bilirubin. Diagnosis is typically suspected based on symptoms and confirmed with an ultrasound; blood tests can help detect complications. To lower the risk, maintaining a healthy weight through exercise and diet is recommended. Asymptomatic gallstones usually require no treatment. For those experiencing gallbladder attacks, surgical removal of the gallbladder is often advised, performed either through several small incisions or one larger incision under general anesthesia. In rare cases where surgery isn't possible, medication may dissolve the stones or lithotripsy may break them apart.
In developed nations, 10–15% of adults have gallstones. Gallbladder and biliary diseases affected about 104 million people globally in 2013, resulting in 106,000 deaths. Women are more likely than men to develop gallstones, and the condition becomes more common after age 40. Rates also vary significantly by ethnicity: for instance, 48% of Native Americans experience gallstones, while in many parts of Africa the rate is as low as 3. After gallbladder removal, outcomes are generally positive.
Quick Facts
- Field
- Gastroenterology; General surgery
- Symptoms
- None, crampy pain in the right upper abdomen
- Complications
- Inflammation of the gallbladder
- inflammation of the pancreas
- liver inflammation
- Onset
- After 40 years old
- Risks
- Birth control pills
- pregnancy
- family history
- obesity
- diabetes
- liver disease
- rapid weight loss
- Diagnosis
- Based on symptoms and physical examination, confirmed by ultrasound
- Prevention
- Healthy weight
- diet high in fiber
- diet low in simple carbohydrates
- Treatment
- Asymptomatic: none, ursodeoxycholic acid (UDCA) and Chenodeoxycholic acid; Pain: surgery ERCP, Cholecystectomy
Facts from the source article.
Lore & Background
Gallstones are solid deposits that form within the gallbladder from precipitated components of bile, primarily cholesterol, bile salts, and bilirubin. Stones composed mainly of cholesterol are termed cholesterol stones, while those formed predominantly from bilirubin are called pigment stones. The condition of having gallstones in the gallbladder is known as cholelithiasis; when stones migrate into the bile ducts, it is called choledocholithiasis. Most people with gallstones—about 80%—remain asymptomatic, with these "silent stones" often requiring no treatment. However, if a stone obstructs a bile duct, it can cause acute cholestasis and a reflexive smooth muscle spasm, leading to an intense, cramp-like visceral pain in the right upper abdomen known as biliary colic, which typically peaks within an hour and resolves within five hours. This occurs in 1–4% of those with gallstones annually. Complications may include inflammation of the gallbladder (cholecystitis), pancreatitis, obstructive jaundice, or bile duct infection (cholangitis), with symptoms such as prolonged pain, fever, yellowish skin, vomiting, dark urine, and pale stools. Gallstones are more common in women and after age 40, with significant ethnic variation: 48% of Native Americans experience them, while rates in parts of Africa are as low as 3%. Risk factors include birth control pills, pregnancy, family history, obesity, diabetes, liver disease, and rapid weight loss. Diagnosis is typically confirmed by ultrasound, and treatment—usually gallbladder removal—is recommended for symptomatic cases.
Reader's Guide
Gallstone disease is significant because it is a common condition that can lead to serious complications. While most people with gallstones are asymptomatic, about 1–4% per year experience biliary colic when a stone obstructs the bile duct. Complications include cholecystitis (inflammation of the gallbladder), pancreatitis, obstructive jaundice, and cholangitis (bile duct infection). Diagnosis is typically confirmed by ultrasound, and treatment for symptomatic cases often involves surgical removal of the gallbladder. The risk of gallstones may be decreased by maintaining a healthy weight with exercise and diet. Once the gallbladder is removed, outcomes are generally positive. The condition's high prevalence and potential for severe complications make it a major focus in gastroenterology and surgery.
Frequently Asked Questions
Do Gallstones always cause pain?
About four out of five people who have gallstones never experience any symptoms at all, a phenomenon often called the silent gallstone. The classic cramping, visceral pain of biliary colic typically appears only when a stone shifts and partially or fully blocks a bile duct.
What's the difference between a Gallstone and a choledocholith?
A gallstone refers to a stone sitting in the gallbladder itself, while choledocholithiasis is the term used when a stone has migrated down into the common bile duct. Both can cause obstruction, but the location changes which ducts are affected and how the symptoms present.
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