If you have a gallstone that is blocking your common bile duct (the one that runs from the gallbladder to the small intestine), your doctor may recommend endoscopic retrograde cholangiopancreatography (ERCP). This procedure may be used both to diagnose your condition and to treat it immediately.
During ERCP, an endoscope (a long, thin tube) containing a tiny camera is passed down your throat and into your bile ducts. Your doctor may then use additional tubes or tiny tools to remove gallstones from the area.
If your doctor discovers during ERCP that there are gallstones in the gallbladder itself, surgery may be necessary. (3)
If you have gallbladder cancer, in addition to having your gallbladder removed, your doctor may recommend additional treatments such as chemotherapy or radiation therapy. (5)
Doctors are also learning more about how and when to treat gallstones during pregnancy. Recent research has shown that while most pregnant women with gallstones don’t undergo gallbladder surgery during pregnancy, having the operation is associated with an almost 60 percent lower risk of hospital readmission (and gallstones during pregnancy increase the risks of preterm birth and health problems in both mothers and newborn babies). (8)
Gallbladder Surgery
The most common surgical procedure related to the gallbladder is removing it completely. Known as cholecystectomy, gallbladder removal is most often performed to resolve pain caused by gallstones.
There are two methods of gallbladder removal. Laparoscopy, which is almost always the preferred method, involves making several small incisions through which surgical tools and a tiny video camera are inserted.
Open surgery, using a large incision, may be required if your surgeon discovers during a laparoscopic procedure that your gallbladder is infected or has hardened. This happens in 5 to 10 percent of laparoscopic gallbladder surgeries. (9) Open surgery may also be the first choice if your gallbladder disease is severe. (4)
Learn More About Gallbladder Surgery
Medication Options
Medications may be used to help reverse gallstones, but usually only when surgery isn’t an option. A drug called ursodiol may be taken to slowly dissolve the cholesterol in gallstones. But this treatment can take months, and gallstones may return once the drug is no longer being taken. (3)
Alternative and Complementary Therapies
Dietary changes are often recommended following gallbladder surgery.
When your gallbladder is removed, your body is no longer able to store bile there. As a result, your liver must adapt to releasing bile directly into your small intestine to aid in digestion. Before your body adapts to this new reality, it can be more difficult to digest certain fatty and high-fiber foods.
It’s best to reintroduce those kinds of harder-to-digest foods slowly after your surgery, rather than jump back into your normal diet. It may also be helpful to eat smaller meals more frequently, since this reduces your small intestine’s demand for bile at any given time. (10)
Learn More About Your Diet After Gallbladder Removal
Prevention of Gallbladder Problems
While there’s no proven way to prevent gallstones, there are some steps that may be helpful, including:
- Eating three balanced meals each day
- Maintaining a healthy weight
- Getting regular exercise
- Drinking alcohol in moderation (9,11)
It’s also important to manage any health conditions that may raise your risk of developing gallstones, including diabetes and high cholesterol.
Overview
Gallstones are hardened deposits of digestive fluid that can form in your gallbladder. Your gallbladder is a small, pear-shaped organ on the right side of your abdomen, just beneath your liver. The gallbladder holds a digestive fluid called bile that's released into your small intestine.
Gallstones range in size from as small as a grain of sand to as large as a golf ball. Some people develop just one gallstone, while others develop many gallstones at the same time.
People who experience symptoms from their gallstones usually require gallbladder removal surgery. Gallstones that don't cause any signs and symptoms typically don't need treatment.
Symptoms
Gallstones may cause no signs or symptoms. If a gallstone lodges in a duct and causes a blockage, the resulting signs and symptoms may include:
- Sudden and rapidly intensifying pain in the upper right portion of your abdomen
- Sudden and rapidly intensifying pain in the center of your abdomen, just below your breastbone
- Back pain between your shoulder blades
- Pain in your right shoulder
- Nausea or vomiting
Gallstone pain may last several minutes to a few hours.
When to see a doctor
Make an appointment with your doctor if you have any signs or symptoms that worry you.
Seek immediate care if you develop signs and symptoms of a serious gallstone complication, such as:
- Abdominal pain so intense that you can't sit still or find a comfortable position
- Yellowing of your skin and the whites of your eyes (jaundice)
- High fever with chills
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Causes
It's not clear what causes gallstones to form. Doctors think gallstones may result when:
- Your bile contains too much cholesterol. Normally, your bile contains enough chemicals to dissolve the cholesterol excreted by your liver. But if your liver excretes more cholesterol than your bile can dissolve, the excess cholesterol may form into crystals and eventually into stones.
- Your bile contains too much bilirubin. Bilirubin is a chemical that's produced when your body breaks down red blood cells. Certain conditions cause your liver to make too much bilirubin, including liver cirrhosis, biliary tract infections and certain blood disorders. The excess bilirubin contributes to gallstone formation.
- Your gallbladder doesn't empty correctly. If your gallbladder doesn't empty completely or often enough, bile may become very concentrated, contributing to the formation of gallstones.
Types of gallstones
Types of gallstones that can form in the gallbladder include:
- Cholesterol gallstones. The most common type of gallstone, called a cholesterol gallstone, often appears yellow in color. These gallstones are composed mainly of undissolved cholesterol, but may contain other components.
- Pigment gallstones. These dark brown or black stones form when your bile contains too much bilirubin.
Risk factors
Factors that may increase your risk of gallstones include:
- Being female
- Being age 40 or older
- Being a Native American
- Being a Hispanic of Mexican origin
- Being overweight or obese
- Being sedentary
- Being pregnant
- Eating a high-fat diet
- Eating a high-cholesterol diet
- Eating a low-fiber diet
- Having a family history of gallstones
- Having diabetes
- Having certain blood disorders, such as sickle cell anemia or leukemia
- Losing weight very quickly
- Taking medications that contain estrogen, such as oral contraceptives or hormone therapy drugs
- Having liver disease
Complications
Complications of gallstones may include:
- Inflammation of the gallbladder. A gallstone that becomes lodged in the neck of the gallbladder can cause inflammation of the gallbladder (cholecystitis). Cholecystitis can cause severe pain and fever.
- Blockage of the common bile duct. Gallstones can block the tubes (ducts) through which bile flows from your gallbladder or liver to your small intestine. Severe pain, jaundice and bile duct infection can result.
Blockage of the pancreatic duct. The pancreatic duct is a tube that runs from the pancreas and connects to the common bile duct just before entering the duodenum. Pancreatic juices, which aid in digestion, flow through the pancreatic duct.
A gallstone can cause a blockage in the pancreatic duct, which can lead to inflammation of the pancreas (pancreatitis). Pancreatitis causes intense, constant abdominal pain and usually requires hospitalization.
- Gallbladder cancer. People with a history of gallstones have an increased risk of gallbladder cancer. But gallbladder cancer is very rare, so even though the risk of cancer is elevated, the likelihood of gallbladder cancer is still very small.
Prevention
You can reduce your risk of gallstones if you:
- Don't skip meals. Try to stick to your usual mealtimes each day. Skipping meals or fasting can increase the risk of gallstones.
- Lose weight slowly. If you need to lose weight, go slow. Rapid weight loss can increase the risk of gallstones. Aim to lose 1 or 2 pounds (about 0.5 to 1 kilogram) a week.
- Eat more high-fiber foods. Include more fiber-rich foods in your diet, such as fruits, vegetables and whole grains.
- Maintain a healthy weight. Obesity and being overweight increase the risk of gallstones. Work to achieve a healthy weight by reducing the number of calories you eat and increasing the amount of physical activity you get. Once you achieve a healthy weight, work to maintain that weight by continuing your healthy diet and continuing to exercise.
Aug. 20, 2021
- Cholelithiasis. Merck Manual Professional Version. //www.merckmanuals.com/professional/hepatic-and-biliary-disorders/gallbladder-and-bile-duct-disorders/cholelithiasis. Accessed June 16, 2021.
- Gallstones. National Institute of Diabetes and Digestive and Kidney Diseases. //www.niddk.nih.gov/health-information/digestive-diseases/gallstones?dkrd=hispt0204. Accessed June 16, 2021.
- Gallstones. American Gastroenterological Association. //gastro.org/practice-guidance/gi-patient-center/topic/gallstones/. Accessed June 16, 2021.
- Feldman M, et al., eds. Gallstone disease. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 11th ed. Elsevier; 2021.//www.clinicalkey.com. Accessed June 16, 2021.
- Rajan E (expert opinion). Mayo Clinic, Rochester, Minn. July 22, 2019.