What is a Gallstone?
A gallstone is a hardened (stone-like) mass which forms in the gallbladder. It can be composed of two different substances, either cholesterol or bilirubin (which comes from bile produced by the liver).
Gallstones have been present in human bodies for millennia and have even been found in gallbladders of Egyptian mummies. (1)
About six percent of males and nine percent of females across all age groups in the US develop a gallstone. However, only about two percent will experience symptoms and these can take many years to manifest. (2)
The gallbladder is located under the liver. Shaped like a small pouch, its primary function is to store and increase the concentration of bile.
Bile is a fluid which contains both cholesterol and bilirubin. It is produced in the liver, and then passes from the liver to the gallbladder via small tubes called bile ducts. The main function of bile is to help the body digest fats.
Eating a meal high in fat and cholesterol prompts the gallbladder to contract and supply bile to the small intestine. This where it helps the digestive process. (3)
There are three types of gallstones: some form mainly out of cholesterol, others from bilirubin and those that are a mix of both.
Bile usually stores cholesterol in liquid form. However, when concentration of cholesterol gets too high crystals form, and these crystals will eventually come together to form a gallstone.
Likewise (but less common) an excess of waste from the destruction of red blood cells increases bilirubin, resulting in the formation of a gallstone. (4)
A gallstone retained within the gallbladder often causes no issues. Yet, there are occasions when it can travel and block a bile duct or prevent bile leaving the gallbladder. Also, when there are many of them, or they become large, symptoms will present which include:
Sometimes referred to as biliary colic, pain can be felt in the upper right hand side of the abdomen. It can also radiate towards the shoulder blades or the side of the body.
This happens when the gallbladder contracts and forces a stone into the opening of a bile duct. When the gallbladder relaxes again, the gallstone can return to the gallbladder and pain will subside.
Consequently, this type of pain is intermittent and lasts up to about five hours.
Triggers are often the consumption of a meal high in fats and also happen most often at night. When the pain subsides it might be some time before it is felt again, possibly days, weeks or even months. (5, 6)
If the pain lasts more than eight hours, there could be complications which will present with other symptoms like fever, nausea, vomiting and inflammation. This generally happens when a dislodged stone does not return to the gallbladder (acute cholecystitis).
Pain might sometimes be constant and felt in the upper central region of the abdomen radiating to the back. Some relief might be felt when bending forward.
When accompanied by profuse vomiting, it is likely caused by a blockage in the duct between the pancreas and gallbladder (pancreatitis). (7)
When the bile duct is partially or fully obstructed by a gallstone, bilirubin cannot be processed efficiently by the liver. Skin and eyes might have a yellow hue and urine will be dark while stools will be pale.
This most often happens if blockage is caused by a gallstone in the neck of the gallbladder or in the ducts which transport bile from the liver. (8)
Nausea and Sickness
If the bile duct is blocked by a gallstone then the biliary system can become infected and inflamed (ascending cholangitis) due to excess bacteria, such infection may cause a fever. Jaundice and pain often accompany this symptom. (10)
Excess sweating, particularly at night, is another symptom that can present with this condition. (11)
Depending on where the blockage by a gallstone occurs, the result can be swelling in the abdominal area. This is usually associated with pancreatitis or a gallstone obstructing the bowel (gallstone ileus). (12)
Constipation or Diarrhea
There are no specific stages associated with a gallstone, however, there are various clinical aspects that can be assessed. (14)
Sometimes referred to as silent gallstones, this is considered a condition which is present yet produces no symptoms. Up to 80 percent of people in the US with a gallstone will not know they have them (asymptomatic colelithiasis).
There are risk factors associated with this condition. Large stones or many small stones are more likely to cause gallbladder cancer. Organ transplants, abdominal surgery and sickle cell disease can contribute to the formation of gallstones.
When a gallstone begins to show symptoms it is classified as symptomatic. This is indicated by the presence of biliary pain, happening at night and lasting longer than 30 minutes.
The pain will be severe and steady and felt in the upper abdomen. There will generally also be other symptoms like nausea and vomiting. (15)
Most gallstones, as we have mentioned, don’t cause issues and therefore require no treatment other than a “watch and wait” approach.
When a gallstone becomes symptomatic there are surgical and non surgical treatment options. (16)
Painkillers might be prescribed to alleviate the symptoms of pain and/or inflammation of the gallbladder (cholecystitis).
There are also types of medication which can help dissolve or prevent further formation of additional gallstones.
Percutaneous cholecystostomy involves a catheter being placed into the gallbladder under guidance from an imaging source. This enables drainage of infection from the gallbladder and might be used prior to surgery. (17)
Extracorporeal shockwave lithotripsy (ESWL) uses a device which produces shock waves to break up any gallstones. The smaller particles can pass from the gallbladder without causing obstruction. (18)
Removal of the gallbladder (cholecystectomy) is an option when a gallstone causes a lot of pain or is blocking a duct. We are able to live and function without a gallbladder, as bile is secreted by the liver directly to the digestive system.
This procedure can be carried out by either laparoscopic or traditional open surgery.
When there doesn’t appear to be complications, laparoscopic removal of the gallbladder can be done. A surgeon will make small cuts in the abdomen and insert hollow tubes into the incisions. A camera and light as well as surgical tools can then be used to locate and remove the gallbladder.
Carbon dioxide gas will be used to inflate the abdomen so the internal organs can be seen more clearly.
There are occasions when this procedure may be started but then changed to open surgery, if circumstances dictate.
Open surgery involves an incision being made in the abdomen to allow access to the gallbladder. Following removal the site will be sutured and there may be a drain in place.
Each procedure takes about one to two hours, however the hospital stay will be shorter following a laparoscopic procedure. (19)
What is a gallstone? A gallstone is a hardened form of a fluid called bile and is found in the gallbladder. It can be composed of two different deposits, cholesterol or bilirubin.
What are the signs of a gallstone? Many people will have gallstones and experience no symptoms. When they do occur they include pain, usually in the upper right abdomen, which is severe and lasts longer than 30 minutes. Other symptoms are nausea and sickness, fever, sweating and jaundice.
How do you develop a gallstone? A gallstone is formed from excess cholesterol or bilirubin in the gallbladder. It can also form when the gallbladder doesn’t empty properly and stores too much bile. There are factors that can predispose someone to the formation of a gallstone. These include genetics, age and family history of gallstones. Other factors are gender, (women are more likely to get gallstones than men), high fat diets, obesity and birth control pills. Losing weight quickly, a sedentary lifestyle and diabetes are other predisposing influences. (20)
How are you diagnosed for a gallstone? An ultrasound scan is the most effective way of detecting the presence of a gallstone. (21)
What is the best treatment for a gallstone? Whether a gallstone produces symptoms or not, and the severity of the symptoms, will determine treatment. There are times when your physician may choose a “watch and wait” approach. Other treatment options will be discussed with you to determine the best course of action.
What are the long term complications of a gallstone? Untreated, a gallstone can cause inflammation of the gallbladder, jaundice, infection of the bile ducts, pancreatitis, cancer or bowel issues. (22)
Is a gallstone considered a disability? A gallstone is not considered a disability, however resulting gallbladder cancer is. (23)
Is there a cure for a gallstone? There is no cure for this condition, however there are treatments that can help manage it and if necessary, the gallbladder can be removed.
Is a gallstone life threatening? Untreated this condition can lead to infection, or the gallbladder may burst. It could also result in cancer of the gallbladder. These instances can be life threatening. (24)
A gallstone is a hardened form of a fluid called bile and is found in the gallbladder. Formed from either cholesterol or bilirubin, these stones are often asymptomatic, needing no treatment.
If treatment is required there are options available to either manage or disperse the gallstone, or to remove the gallbladder.
While there is no cure, fortunately we can live without a gallbladder.