Overview
Gallstones are hardened deposits of digestive fluid that form in the gallbladder. Most are made of cholesterol. Many people have gallstones without symptoms. However, when a stone passes into the bile duct or blocks the gallbladder outlet, it causes severe pain known as biliary colic.
How common is it?
Gallstones affect about 1 in 10 adults in Western countries. They are more common in women, particularly those who have been pregnant.
Causes and risk factors
Gallstones form when bile contains too much cholesterol, bilirubin, or too little bile salts, allowing crystals to form and grow. The gallbladder not emptying completely also promotes stone formation.
Common risk factors
- Female sex
- Age over 40
- Obesity
- Pregnancy (multiple pregnancies increase risk)
- Rapid weight loss or prolonged fasting
- High-fat, low-fibre diet
- Family history of gallstones
- Diabetes
- Taking certain medications (oestrogens, clofibrate)
Symptoms
- Many people have no symptoms (silent gallstones)
- Biliary colic: sudden severe pain in the upper right abdomen, often after a fatty meal, lasting 30 minutes to 5 hours
- Pain radiating to the right shoulder
- Nausea and vomiting during an attack
- Jaundice (yellowing skin) if a stone blocks the common bile duct
- Fever and rigors (shaking chills) if the bile duct becomes infected (cholangitis)
When to see a doctor
Seek emergency care for severe right upper abdominal pain with fever and yellowing skin, as infected bile duct (cholangitis) is life-threatening. See a doctor for any episode of biliary colic for further assessment.
Diagnosis
Abdominal ultrasound is the first-line investigation and detects gallstones with over 95% accuracy. MRCP (magnetic resonance cholangiopancreatography) visualises the bile ducts. Blood tests assess liver function and look for infection.
Treatments
Laparoscopic cholecystectomy
Keyhole surgical removal of the gallbladder. The definitive treatment for symptomatic gallstones. Most people go home the same day and recover within 1 to 2 weeks.
ERCP
Endoscopic retrograde cholangiopancreatography removes stones from the common bile duct using a flexible camera passed through the mouth. Usually done before or alongside cholecystectomy for duct stones.
Conservative management
Asymptomatic gallstones rarely need treatment. A low-fat diet can reduce the frequency of biliary colic episodes while awaiting surgery.
Self-care and lifestyle
- Follow a low-fat diet to reduce biliary colic attacks while waiting for surgery
- Maintain a healthy weight (but avoid rapid weight loss, which promotes stone formation)
- Regular physical activity reduces gallstone risk
- Do not fast for long periods
Prevention
Maintaining a healthy weight, losing weight gradually rather than rapidly, eating a balanced diet with adequate fibre, and staying physically active all reduce gallstone risk.