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.
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:
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.
Although there is not an exact cause for gallstones, a number of factors are known to contribute to their formation:
How likely are you to get gallstones? Anyone can develop gallstones, but some are more susceptible than others. These include:
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:
If these complications do develop, and are left untreated, they can be fatal.
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.
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.
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.
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.
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.
American Liver Foundation
National Institute of Diabetes and Digestive and Kidney Diseases
Abraham S, Rivero HG, Erlickh IV, Griffith LF, Konndamudi VK. Surgical and nonsurgical anagement of gallstones. Am Fam Physician. 2014;89(10):795-802.
Gallstones. American Gastroenterological Association website. Available at: http://www.gastro.org/patient-care/conditions-diseases/gallstones. Accessed April 18, 2017.
Gallstones. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114033/Gallstones. Updated July 22, 2016. Accessed April 18, 2017.
Gallstones. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/gallstones. Updated November 27, 2013. Accessed April 18, 2017.
Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver. 2012;6(2):172-187.
Last reviewed April 2017 by Michael Woods, MD, FAAP
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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