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Gallstones


Expert reviewer, Dr Yiannis Kallis, Consultant Hepatologist and Gastroenterologist
Next review due September 2020

Gallstones are stones that develop in your gallbladder when chemicals like fats and minerals in your bile (a fluid that helps break down food) harden. Gallstones can vary in size from as small as grains of sand to as big as a pebble.

Gallstones can take years to develop. You might not know you’ve got any unless they show up during tests for something else or move and cause complications.

In the UK, one to two out of every 10 people get gallstones but most people don’t have any symptoms from them.


An image showing a diagram of the upper digestive system

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. Your gallbladder releases bile into your bowel when you eat to help your body break down food.

Gallstones develop if the chemicals that make up your bile become imbalanced and harden. They may also develop if the flow of bile slows down because of a blockage. You might form one stone or several.

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.
  • Mixed gallstones are a combination of cholesterol and pigmented stones.

Symptoms of gallstones

Most people with gallstones don’t have any symptoms. Gallstones can often stay in your gallbladder or pass out of your system without any problems, so you might not know that you have them. Sometimes, gallstones are found if you have a scan to investigate something else and they show up in that.

It’s not clear how many people who have gallstones will go on to develop symptoms or complications from them. It’s estimated to be up to four in every 100 people. You usually only get symptoms from gallstones if they move and get stuck in a duct (connecting tube) inside your gallbladder. They may also block the ducts leading to other internal organs, like your liver, pancreas and small intestine, and cause inflammation or infection. This can cause the following symptoms.

  • The most common symptom of gallstones is pain in the upper right side of your tummy, just under your ribs. This is known as biliary colic. It can range from mild indigestion and general discomfort to severe pain. It may spread to the centre of your back and the tip of your right shoulder blade. You may feel this after eating (particularly after a large or fatty meal) or at night. The pain may last for minutes to hours and usually resolves itself.
  • Feeling sick or vomiting, with a high temperature, shivering and sweating, and tummy pain.
  • Yellow skin and a yellowing of the whites of your eyes, which are signs of jaundice. You may also have dark urine and very pale poo.

Other less common symptoms include:

  • itchy skin
  • a painful and bloated tummy
  • a fast heartbeat
  • confusion

If you have severe pain in your tummy which does not resolve by itself or after taking over-the-counter painkillers, contact your GP.

If you become very unwell and develop a high fever, jaundice or any of the other symptoms listed above, seek medical attention as soon as possible because you may need urgent hospital treatment.

For more information see our section: Complications of gallstones.

Diagnosis of gallstones

Your GP will ask about your symptoms and your medical history. This will help to identify possible causes and any other conditions. He or she will feel your tummy area to see if it’s tender or swollen.

You might have blood and urine tests to check for any inflammation or infection, damage to 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 straight away.

  • 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.
  • 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 and can spot very small gallstones.
  • A CT scan – this can produce detailed images of your bile ducts, liver and pancreas.

Treatment of gallstones

If gallstones aren’t causing any symptoms and were found in a scan that was done for something else, your GP may suggest leaving them alone. They usually don’t cause any problems. Your GP will keep an eye on you and to watch for any later symptoms. If your gallstones start to cause problems, they may refer you for further investigations and treatment.

A gallstone may stay in your gallbladder but sometimes they pass out naturally, go down your bile duct and enter your bowel. You may then pass them out when you go to the toilet. However, if the gallstone gets stuck along the way, it can cause complications. For more information, see our section: Complications of gallstones.

Medicines

You may be able to manage your symptoms by taking over-the-counter painkillers like paracetamol or ibuprofen. Your GP may also prescribe medicines to stop painful muscle spasms in your gallbladder. Always read the patient leaflet that comes with your medicine and if you have any questions, ask your pharmacist or GP.

If your gallstones have caused an infection, your doctor may prescribe antibiotics. You usually have these in hospital as well as painkilling injections if over-the-counter painkillers don’t help. You may also need to have fluids through an intravenous drip if severe symptoms like vomiting make you dehydrated. Painkillers given as suppositories (placed in your back passage) can help if you’re vomiting and struggling to keep down tablets.

Diet

You might find it helps to note down any foods or drinks that make your symptoms worse. Nuts and caffeine can be triggers, for instance. If possible, you could cut these from your diet, or at least consume less of them. Use our food and symptoms diary to help monitor and identify any triggers.

Some people find it helps to eat a low-fat diet; it won’t affect any gallstones you’ve already got but may help reduce pain from biliary colic. A healthy diet and more exercise may reduce the risk of developing symptoms and forming new gallstones. Ask your GP for more information about foods that can affect gallstones and eating healthily, and see our FAQ: Diet and gallstones.

Surgery

Your doctor may advise you to have your gallbladder removed. After surgery, your symptoms should quickly disappear. It can take a couple of weeks to recover from the operation and you may need to take 2–3 weeks off work.

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. You may need surgery very quickly to treat some serious complications. Your decision should also take into account if you’ve had gallstones or complications before, your age and general health. Your doctor or surgeon can explain your options and answer any questions you may have.

Your gallbladder can be removed in an operation called a cholecystectomy. There are two main ways this can be done.

  • Laparoscopic cholecystectomy. Your surgeon will remove your gallbladder through small cuts in your tummy (abdomen). This is called keyhole surgery and is the most common way to have your gallbladder removed. You’ll usually be able to go home on the same day. However, it’s possible that during the surgery, your surgeon may need to convert to an open operation. This is more likely if your gallbladder is very inflamed or you’re very overweight. It means you’ll have to stay in hospital longer.
  • 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. It may be the best option if you need urgent treatment and you may need to stay in hospital for 3–5 days.

For more information see our topic on gallbladder removal.

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 special dye and a narrow, flexible, tube-like telescopic camera called an endoscope is passed down your throat into your stomach. An ERCP can help to identify and remove any gallstones that may be found in your bile duct. Most people will still need to have an operation to remove their gallbladder because there may be more gallstones in it. Even if there aren’t, it’s likely that more would form if you don’t have your gallbladder removed. So you would still be at risk of having symptoms and possible complications.

It might be possible to break up gallstones using shock waves although this treatment isn’t used very often. The treatment is called extracorporeal shock wave lithotripsy (ESWL) and uses high-energy shock waves to break up the stones.

Causes of gallstones

You can develop gallstones at any age but your chance of getting them increases as you get older. Women are up to three times more likely to get gallstones than men. If you’re overweight, this can be a big risk factor. Trying to safely lose any excess weight may help prevent gallstones developing in the first place.

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

  • have high cholesterol and use medicines to control it
  • are pregnant
  • have someone in your family who has had them
  • have lost weight quickly – through long periods of fasting, weight loss surgery or a very low calorie or liquids-only diet, for example
  • keep losing weight then putting it back on (a ‘yo-yo diet’)
  • 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)
  • have certain genetic factors
  • take certain medicines, including growth hormones and some antibiotics
  • eat a lot of fat and refined carbohydrates but not much fibre

Complications of gallstones

Some gallstones stay in your gallbladder or pass out your system without any problems. But if you experience symptoms, it may be a sign that your gallstones have moved and are causing 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 outlined below.

  • Biliary colic. This is the most common complication. You might feel pain around the upper right side of your tummy. If gallstones move, your gallbladder or duct (connecting tube) could tighten around them causing pain.
  • Cholecystitis. This is an inflamed gallbladder and is the second most common problem. It can lead to a severe infection, damage to your gallbladder and abscesses.

Other complications, including those listed here, are much less common but can be more harmful and need urgent hospital treatment.

  • 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.
  • Cholangitis. If a gallstone obstructs your bile duct and becomes infected, you may get a high temperature, shivering and sweating. It 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 and possibly liver cancer.

Frequently asked questions

  • You can reduce the risk of developing symptoms by eating regularly, including having breakfast first thing. This helps to keep the level of bile in your system steady.

    You shouldn’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.

    Being overweight can increase the risk of developing more gallstones but if you need to lose weight, do it gradually. You’re also 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

    Fibre is particularly important if one of your symptoms is diarrhoea because it makes your poo firmer.

    Doing more physical activity can help you to stay a healthy weight and may help to prevent symptoms like tummy pain returning.

    You should talk to your doctor about how safe it is for you to drink alcohol, especially if your gallstones are linked to liver problems.

  • Typical stomach pain from gallstones – called biliary colic – can last from minutes to hours, often at night. Painkillers or medicines to stop muscle spasms should relieve painful symptoms within an hour of taking them.

    You should see your doctor if your normal painkillers aren’t helping. They may be able to prescribe something stronger.

    Get advice from your GP if you’re in severe, constant pain which doesn’t resolve itself and isn’t helped by painkillers. If it’s really bad, seek urgent hospital treatment, especially if you’ve also got other symptoms, like fever, jaundice or vomiting.

    At hospital you may be given a painkilling injection and antibiotics if the pain is caused by infection.

  • 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. You may need another sort of scan that will show if stones under 5mm are inside your bile duct.

    Even if you don’t have gallstones, there may be problems with your gall bladder.


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Related information

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  • Reviewed by Michelle Harrison, Specialist Health Editor, Bupa Health Content Team, October 2017.
    Expert reviewer, Dr Yiannis Kallis, Consultant Hepatologist and Gastroenterologist
    Next review due October 2020



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