The gallbladder is located under the liver and near the stomach. Gallstones form when cholesterol or bile stored in the gallbladder hardens into pieces of stone-like material. Gallstones are made of cholesterol salts or bilirubin salts. Gallstones can be as small as a grain of sand or as large as a golf ball. The gallbladder can develop just one large stone, hundreds of tiny stones, or almost any combination.

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Gallstones are caused when bile or cholesterol crystalizes into gallstones.

Gallstones can form under the following conditions:

Too much cholesterol in the bile Too much bilirubin in the bile Not enough bile salts When the gallbladder does not empty completely or often enough due to blockage or poor contraction
Risk Factors

People who are older than 60 are at increased risk for gallstones. Women between 20-60 years old and those with high estrogen levels are also at increased risk. People of Native American, Mexican American, and Northern European descent are also at increased risk.

Other factors that may increase your risk of gallstones include:

Problems that affect the gallbladder such as: Inflammation of the lining of the gallbladderPoor gallbladder functionDiseases of the gallbladder and ductsPrevious gallstones Dietary factors such as a: ObesityRapid weight loss and fastingHigh fat diet Certain conditions such as diabetes or Crohn's disease Blockage in the biliary tract History of intestinal problems Blood diseases that increase breakdown of hemoglobin and therefore bile production, including sickle cell anemia Gastric bypass surgery Liver disease, such as cirrhosis Metabolic syndrome Lack of physical activity Heredity

Certain medications can increase your risk of gallstones, including:

Thiazide diuretics Cholesterol-lowering drugs—fibrates Ceftriaxone Octreotide Somastatin

Many people have gallstones without symptoms, called silent gallstones. In some cases, these are treated.

Gallstones may cause pain in the upper abdomen. This is sometimes called an attack because it begins suddenly, often after a fatty meal. The pain is severe and may last for 30 minutes or several hours.

Other symptoms include:

Intermittent pain on the right, below the rib cage; the pain may spread Bloating, nausea, and vomiting Belching, gas, and indigestion

If you have the following symptoms, see your doctor right away:

Abdominal pain Sweating Chills Low-grade fever Yellowish color of the skin or whites of the eyes Clay-colored stools

You will be asked about your symptoms and medical history. A physical exam will be done.

Your bodily fluids may be tested. This can be done with blood tests.

Images may be taken of your bodily structures. This can be done with:

Abdominal ultrasound Magnetic resonance cholangiopancreatography (MRCP) Hepatobiliary scintigraphy (HIDA) scan Abdominal CT scan Endoscopic retrograde cholangiopancreatography (ERCP) Cholecystogram

Talk to your doctor about the best treatment plan for you.

Options include:

Surgical Treatments

Laparoscopic cholecystectomy—the removal of the gallbladder through several small incisions in the abdomen. To view the gallbladder, a small, lighted tube with a camera is inserted into one of the incisions. Surgical instruments are used to remove the gallbladder through one of the other incisions. Open cholecystectomy—the removal of the gallbladder through a large incision in the abdomen. This is necessary if there is an infection in the abdomen or a great deal of scar tissue.


You may be prescribed:

Over-the-counter or prescription medication to control pain Bile salt tablets to dissolve gallstones; these medications may need to be taken for months or years until the stones are dissolved

Other Treatments

Shock wave lithotripsy—machine called a lithotripter generates shock waves that pass through the body to break the gallstone into smaller pieces

Another procedure that may be used to treat gallstones is called endoscopic retrograde cholangiopancreatography (ERCP). ERCP uses a combination of endoscopy and x-rays to locate and remove gallstones before or during gallbladder surgery.


To reduce your chance of getting gallstones:

Maintain a healthy weight. Avoid rapid weight loss diets. Exercise regularly. Eat a diet low in saturated fat. Eat plenty of fruits, vegetables, and whole grain foods.
Michael Woods, MD 201511 20141220