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Gallstones


Expert reviewer, Dr Yiannis Kallis, Consultant Hepatologist and Gastroenterologist
Next review due January 2023

Gallstones are stones that develop in your gallbladder. For most people, they don’t give any symptoms and won’t need treatment.

Gallstones sometimes cause problems such as abdominal (tummy) pain and inflammation of your gallbladder. The usual treatment for gallstones when they cause problems is surgery.


A doctor is showing the patient some leaflets

About gallstones

Your gallbladder is a small, pear-shaped pouch in the upper right part of your tummy (abdomen). Between meals, your gallbladder stores bile, a fluid that’s produced by your liver. When you eat, your gallbladder releases bile into your bowel through a channel called the bile duct. Bile helps your body break down food, especially fats.

Gallstones develop if the chemicals that make up your bile become imbalanced and form lumps which then harden. You might form one stone, several or many. Gallstones can vary in size from as small as grains of sand to as big as a golf ball.

If you have gallstones, they may stay in your gallbladder and cause no problems. Small gallstones may occasionally just break up and be passed out. But if gallstones begin to block the flow of bile they can cause pain and inflammation. See our section on symptoms below for more information.

Types of gallstone

There are three main types of gallstone.

  • Cholesterol gallstones form if you have too much cholesterol in your bile. These are the most common type.
  • Pigmented gallstones form when there’s too much calcium and bilirubin in your bile. Bilirubin is a waste product that’s produced when your body breaks down red blood cells. These stones mostly happen in people who have inherited red blood cell disorders like sickle cell anaemia.
  • Mixed gallstones are a combination of cholesterol and pigmented stones. These are also common.
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Symptoms of gallstones

Most people with gallstones don’t have any symptoms. Sometimes, gallstones are found if you have a scan to investigate something else.

Abdominal pain (biliary colic)

The most common symptom of gallstones is pain in the middle or right side of your upper abdomen, just under your ribs. This is known as biliary colic. It can happen when a gallstone blocks the flow of bile out of the gallbladder.

The pain may be severe, and is constant – it doesn’t come and go. It may spread to the centre of your back and the tip of your right shoulder blade. You may develop this pain after a heavy meal, especially in the evening or during the night. The pain usually lasts for at least 30 minutes and may go on for up to eight hours. You may also sweat, feel sick and vomit.

Sometimes an episode of biliary colic leaves you with a dull ache or discomfort over the gallbladder area for several days afterwards.

Other less common symptoms

Gallstones may block the flow of bile for a long time, or leave the gallbladder to cause problems in the bile duct and nearby pancreas. See our section on complications below for more information about what can happen. Symptoms may then include the following.

  • A high temperature, perhaps with shivering and ‘chills’ or shaking (rigors).
  • Pain that doesn’t go away.
  • Yellow skin and a yellowing of the whites of your eyes (jaundice).
  • Dark urine and very pale poo.
  • Itchy skin.

Diagnosis of gallstones

You may only discover you have gallstones when you have a test such as an ultrasound of your abdomen for some other reason.

If you do have symptoms, your GP will ask about these and about your medical history. This will help to identify possible causes and any other conditions. They’ll feel your tummy area to see if it’s tender or swollen.

You might have blood tests to check for any inflammation or infection, a problem with your liver or a blocked bile duct.

Your GP may refer you to your local hospital for more tests, some of which are described below. If your GP thinks you have complications that need immediate treatment, you may have to go to hospital straightaway.

  • An ultrasound scan– this uses sound waves to produce an image of the inside of your body. Gallstones usually show up well on this type of scan, but very small stones may be missed. See our FAQ further down the page: Do negative tests mean I don't have gallstones?
  • A type of MRI scan, called a magnetic resonance cholangiopancreatography (MRCP) – this can produce images of the inside of your body, including your pancreatic and bile ducts.
  • An endoscopic ultrasound scan – this may be recommended if you can’t have an MRCP for some reason. A narrow, flexible, tube-like telescopic camera called an endoscope goes into and through your stomach via your mouth. It can spot small gallstones which lie in the bile duct.
  • A CT scan – this can produce detailed images of your bile ducts, liver and pancreas. Gallstones can be missed on CT scan, unless they contain a lot of calcium.

Treatment of gallstones

If gallstones aren’t giving you any symptoms, your GP may suggest leaving them alone. If your gallstones start to cause problems, your GP may refer you for further investigations and treatment.

Medicines

You may be able to manage your symptoms by taking over-the-counter painkillers painkillers like paracetamol or ibuprofen. Your GP may prescribe stronger painkillers if you need them.

If your gallstones have caused an infection, your doctor may prescribe antibiotics. These may be given intravenously (into a vein) in hospital.

Always read the patient leaflet that comes with your medicine and if you have any questions, ask your pharmacist.

Diet

There is no special diet for gallstones, but your GP may advise you to avoid any food or drinks that you notice make your pain worse. For more information, see our FAQ: Should I change my diet if I have gallstones? below.

Surgery

The main treatment for gallstones which give symptoms is an operation to remove your gallbladder. Your gallbladder isn’t essential, and most people don’t notice any difference without it.

The decision to remove your gallbladder may depend on how often you get symptoms, how severe they are and what problems your gallstones are causing. Your decision should also take into account your age and general health. Your doctor or surgeon can explain your options and answer any questions you may have.

An operation to remove the gallbladder is called a cholecystectomy. There are two main ways this can be done.

  • Laparoscopic cholecystectomy (keyhole surgery). Your surgeon will remove your gallbladder through small cuts in your tummy (abdomen). This is the most common way to have your gallbladder removed.
  • Open cholecystectomy. Your surgeon will make one large cut to remove your gallbladder. This technique is used less often but you may have it if keyhole surgery isn’t suitable for you.

Non-surgical treatments

If your doctor thinks you might have gallstones in your bile duct, they may suggest having an endoscopic retrograde cholangiopancreatography (ERCP). This uses a combination of endoscopy and X-rays to find and treat your gallstones. Your doctor passes an endoscope through your mouth down to where the bile duct opens into your intestine. They can then widen the end of the bile duct and take out the gallstones.

If an ERCP isn’t possible, your doctor may recommend a procedure called a percutaneous transhepatic cholangiogram (PTC). In a PTC, the gallstones in the bile duct are removed by passing a tube through the skin below your ribs, and into the liver.

Most people will still need to have an operation afterwards to remove their gallbladder because there may be more gallstones in it.

Causes of gallstones

Your chance of getting gallstones increases as you get older, especially once you’re over 40.

You’re also more likely to get gallstones if you:

  • are female – women are more than twice as likely to get gallstones as men
  • are overweight
  • have high cholesterol
  • have someone in your family who has had them
  • have lost weight quickly – through weight loss surgery, for example
  • eat a lot of fat and refined carbohydrates but not much fibre
  • have a health condition that affects your blood, such as sickle cell anaemia
  • have diabetes
  • have Crohn’s disease
  • take hormone replacement therapy (HRT) or the pill (oral contraceptive)
  • take certain medicines

Complications of gallstones

Most gallstones stay in your gallbladder; occasionally they can pass out of your system without any problems. But sometimes they can move and cause complications. They may block ducts to your internal organs, like your gallbladder, liver, pancreas and small intestine and cause inflammation, swelling or infection.

Some of the most common complications are as follows.

  • Biliary colic. This is the most common complication. If gallstones move, your gallbladder or duct (connecting tube) could tighten around them causing pain. See our section on symptoms above for more information about biliary colic.
  • Cholecystitis. This is an inflamed gallbladder and is the second most common problem. It can lead to a severe infection, and damage to your gallbladder. If you have an infection, you’ll need antibiotics, usually given intravenously (into a vein) in hospital.

Other complications, including those listed here, are much less common but can be more harmful.

  • Jaundice. If gallstones pass out of your gallbladder and block your bile duct, the flow of bile may stop. This will make your skin and eyes look yellow.
  • Pancreatitis. Gallstones may travel down your bile duct and block the opening of the pancreatic duct. This causes inflammation in your pancreas, which is a serious medical condition.
  • Cholangitis. If a gallstone obstructs your bile duct, the duct may become infected. Severe cholangitis can lead to kidney, heart, breathing and liver problems.
  • Gallstone ileus. If large gallstones (over 2.5cm) pass out of your gallbladder, there is a chance that they may get stuck and block your bowel.
  • Gallbladder cancer. Rarely, gallstones can lead to gallbladder cancer.

If you have one of the complications of gallstones, your doctor will explain any tests and treatments they recommend.

Frequently asked questions

  • If you have gallstones, you don’t need to follow a special diet unless you identify any foods that trigger symptoms. If so, avoid or cut back on those. Some people find avoiding spicy and fatty foods, caffeine and dairy products helpful. Large and heavy meals may also bring on biliary colic, so you may choose to avoid these.

    Being overweight can increase the risk of developing more gallstones but if you need to lose weight, do it gradually. You’re more likely to get gallstones if you fast for long periods or follow a liquid-only or low-calorie diet.

    Try to eat a healthy balanced diet. Generally, this means:

    • plenty of fruit and vegetables
    • plenty of high-fibre foods like brown rice
    • eating regular, balanced meals
    • avoiding salty foods and those high in saturated fat

    Doing more physical activity can help you to stay a healthy weight and is good for your general health.

  • Not necessarily. You may still have gallstones even if your blood tests and ultrasound scan come back normal.

    It depends on the type and size of the stones, and where they’re causing problems. An ultrasound scan may not spot very small gallstones, or those that are in the bile duct. You may need another sort of scan that will show if small stones are inside your bile duct.

    Your doctor will explain what’s involved with any tests they recommend, and how they might help in finding the cause of your symptoms.



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Related information

Tools and calculators

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    • Gallstones. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised June 2019
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    • Personal communication, Dr Yiannis Kallis, Consultant Hepatologist and Gastroenterologist, January 2020
  • Reviewed by Dr Kristina Routh, Freelance Health Editor, Bupa Health Content Team, January 2020
    Expert reviewer, Dr Yiannis Kallis, Consultant Hepatologist and Gastroenterologist
    Next review due January 2023

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