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Gallstones


Alternative Names:

Cholelithiasis; Gallbladder attack; Biliary colic; Gallstone attack; Biliary calculus: chenodeoxycholic acids (CDCA); Ursodeoxycholic acid (UDCA, ursodiol); Endoscopic retrograde cholangiopancreatography (ERCP)-gallstones

Causes:

The cause of gallstones varies. There are two main types of gallstones:

  • Stones made of cholesterol. This is the most common type. Cholesterol gallstones are not related to cholesterol levels in the blood.
  • Stones made of bilirubin. These are called pigment stones. They occur when red blood cells are destroyed and too much bilirubin is in the bile.

Gallstones are more common in women, Native Americans, Hispanics, people over age 40, and people who are overweight. Gallstones may also run in families.

The following factors also make you more likely to develop gallstones:

  • Bone marrow or solid organ transplant
  • Diabetes
  • Failure of the gallbladder to empty bile properly (this is more likely to happen during pregnancy)
  • Liver cirrhosis and biliary tract infections (pigmented stones)
  • Medical conditions that cause too many red blood cells to be destroyed
  • Rapid weight loss from eating a very low-calorie diet, or after weight loss surgery
  • Receiving nutrition through a vein for a long period of time (intravenous feedings)
  • Taking birth control pills
Exams and Tests:

Tests used to detect gallstones or gallbladder inflammation include:

Your doctor may order the following blood tests:

Treatment:

SURGERY

Most of the time, surgery is not needed unless symptoms begin. However, people planning weight loss surgery may need to have gallstones removed before undergoing the procedure. In general, patients who have symptoms will need surgery right away or soon after the stone is found.

  • A technique called laparoscopic cholecystectomy is most commonly used. This procedure uses small surgical cuts, which allow for a faster recovery. Patients can often go home from the hospital within 1 day of surgery.
  • In the past, open cholecystectomy (gallbladder removal) was most often done. However, this technique is less common now.

Endoscopic retrograde cholangiopancreatography (ERCP) and a procedure called a sphincterotomy may be done to find or treat gallstones in the common bile duct.

MEDICINES

Medicines may be given in pill form to dissolve cholesterol gallstones. However, these drugs may take 2 years or longer to work, and the stones may return after treatment ends.

Rarely, chemicals are passed into the gallbladder through a catheter. The chemical rapidly dissolves cholesterol stones. This treatment is hard to perform, so it is not done very often. The chemicals used can be toxic, and the gallstones may return.

LITHOTRIPSY

Shock wave lithotripsy (ESWL) of the gallbladder has also been used for people who cannot have surgery. This treatment is not used as often as it once was because gallstones often come back.

Outlook (Prognosis):

You may need to be on a liquid diet or take other steps to give your gallbladder a rest after you are treated. Your health care provider will give you instructions when you leave the hospital.

The chance of symptoms or complications from gallstones is low. Nearly all patients who have gallbladder surgery do not have their symptoms return.

Possible Complications:

Blockage by gallstones may cause swelling or infection in the:

  • Gallbladder (cholecystitis)
  • Tube that carries bile from the liver to the gallbladder and intestines (cholangitis)
  • Pancreas (pancreatitis)
When to Contact a Medical Professional:

Call your health care provider if you have:

  • Pain in the upper part of your abdomen
  • Yellowing of the skin or whites of the eyes
Prevention:

In most people, gallstones cannot be prevented. In people who are obese, avoiding rapid weight loss could prevent gallstones.

References:

Jackson PG, Evans SRT. Biliary system. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 55.

Wang DQH, Afdhal NH. Gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 65.

Glasgow RE, Mulvihill SJ. Treatment of gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 66.


Review Date: 7/18/2013
Reviewed By: George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2002 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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