Updated 21 October 2021 | Approved By Dr. Umberto Russo
What are Gallstones?Gallstones (also known as gallbladder stones or cholelithiasis) are hardened rock-like structures that build up from the digestive fluids (bile) leftover in the gallbladder and bile ducts. People can develop any number of gallstones ranging from the size of a sand particle to a golf ball . Most people living with gallstones will experience no symptoms and are found coincidentally during other assessments, such as ultrasounds . In Australia, approximately 25-30% of people over 50 will have issues with gallstones.
What does the gallbladder do?The gallbladder functions as a part of the biliary system, including ducts, structures and organs (e.g. liver, pancreas, small intestines, etc.). A thick digestive fluid called bile is produced, stored and released by the biliary system to break down fats and vitamins from consumed foods . The gallbladder can be found underneath the liver and serves to store excess bile after digestion of food. A structure called the bile duct helps to transport bile from the liver to the gallbladder.
What Causes Gallstones?As noted in the first section, gallstones form due to an accumulation of excess bile found in the gallbladder. These leftover reserves can be described as a ‘biliary sludge’, which comprises proteins, calcium and cholesterol. This sludge can either disappear over time or build up into gallstones. One analogy describing this process is the build of sugar crystals at the bottom of syrup . Especially in Western populations, most gallbladder stones are caused by excessive cholesterol found in bile . High levels of cholesterol and low concentrations of bile salts are some reasons why this can occur.
Gallstone Risk FactorsSome people are more prone to developing pain from gallbladder stones. A list of characteristics or conditions that can lead to increased gallstone formation are as follows :
- Being overweight or obese
- Genetic conditions (e.g. cystic fibrosis, etc.)
- Female gender (especially those taking oral contraceptives)
- Sudden weight changes
- Older ages, especially over 50 years
- Certain ethnicities
Gallstones SymptomsThe majority of people with gallstones will not experience any symptoms. However, symptoms can occur during a gallstone attack or biliary colic. During these episodes, the pain will occur due to the gallbladder contracting as a gallstone(s) attempts to travel through an opening . Symptoms from these episodes usually commence after a meal and can last anywhere from a few minutes to hour . For most, these symptoms will resolve over a few hours but can recur over days or months. However, some people may continuously experience ongoing discomfort over several days, which can indicate a stuck or impacted gallstone. In these situations, a GP must be consulted as soon as possible to ensure proper care. Examples of gallstone symptoms (particularly during an attack) include :
- Pain located around the upper right abdominal region
- Pain shooting into the interscapular area (i.e. between the shoulder blades)
- Diaphoresis or excessive sweating
Tests and DiagnosisA diagnosis from a GP can be made after performing a thorough medical examination and appropriate testing. Examples of tests that may be requested include :
- Blood tests
- Ultrasound imaging is generally the first line of testing and has up to a 95% accuracy in identifying stones.
- CT scans
- Magnetic resonance cholangiopancreatography (MCRP) - MRI
- Nuclear medicine biliary scanning
Gallstones TreatmentPeople who have gallstones should seek GP support regardless if they have symptoms. Those who are asymptomatic should discuss strategies and/or treatments to help prevent discomfort. Individuals who have symptoms or ongoing problems should consult a GP as soon as possible for better outcomes.
Asymptomatic ManagementThe primary purpose of seeking GP support is to exclude any other diagnosis and ensure positive long term outcomes . Importantly, strategies can be offered about how to prevent gallstone pain and symptoms. Examples of treatments that GPs can offer include:
- Offering dietary advice about foods to avoid or reduce. High-fat diets (e.g. deep-fried foods, red meat, etc.) have been associated with gallstone development . Some GPs may also refer you to a dietitian or nutritionist for additional support.
- Managing conditions that can lead to an increased risk of developing gallstones, such as obesity and diabetes.
- Education about biliary colic or gallstone attacks and when to seek medical attention.
Symptomatic TreatmentWhether symptoms from gallstones are temporary or recurring, consulting a GP is recommended. If pain or discomfort have been persistent for more than several hours or days, immediate medical attention is required. Examples of treatments include :
- Medications such as anti-inflammatories and anti-spasm drugs to help relieve pain, inflammation and discomfort.
- Dietary and lifestyle strategies to prevent symptomatic episodes
- Referral for extracorporeal shockwave lithroscopy (ESWL) which is a procedure that might be appropriate for those with smaller gallstones and are not eligible for surgery. Shockwaves are produced non-operatively through a device outside the body to break these stones into smaller pieces.
- A cholecystectomy (surgical removal of the gallbladder) may be required for individuals with complications, infections or more severe conditions. Refers to specialists, such as a gastroenterologist may be necessary.
- Referrals to the emergency department may be required if the GP feels that immediate treatment is needed.
RecoveryIn most circumstances, most people with gallstones will remain asymptomatic or will make an eventual recovery from symptoms. Lifestyle strategies can be implemented to help prevent future episodes . Those requiring gallbladder removal surgery will usually also recover well, as the body can function well without this organ. It can take up to 6 weeks for digestion (e.g. gas, loose stools, etc.) symptoms to settle after surgery . Severe complications after elective surgery are uncommon.
ComplicationsComplications can occur in individuals with persistent and severe symptoms that do not seek immediate medical treatment. These complications can be prevented and treated well when GP support is sought early. Examples include :
- Acute cholecystitis
- Common bile duct stones
- Gallbladder necrosis or tissue death
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- Crawford, M. (2013). Biliary pain: work-up and management in general practice. Australian family physician, 42(7), 458-461.
- Tanaja, J., Lopez, R. A., & Meer, J. M. (2017). Cholelithiasis.
- Park, Y., Kim, D., Lee, J. S., Kim, Y. N., Jeong, Y. K., Lee, K. G., & Choi, D. (2017). Association between diet and gallstones of cholesterol and pigment among patients with cholecystectomy: a case-control study in Korea. Journal of Health, Population and Nutrition, 36(1), 1-7.
- Abraham, S., Rivero, H. G., Erlikh, I. V., Griffith, L. F., & Kondamudi, V. K. (2014). Surgical and nonsurgical management of gallstones. American family physician, 89(10), 795-802.