Gallstones are concretions that form in the cavity of the gallbladder, less often in the bile ducts. In most people they cause no symptoms and are discovered incidentally. When a stone blocks the duct, biliary colic occurs — pain with distinct characteristics.
What It Is and How Stones Form
The gallbladder is a small organ in the upper abdomen that helps digest food. Stones occur in the gallbladder itself or in the bile ducts — thin tubes that connect the gallbladder with the liver, pancreas, and other organs. The liver secretes from half a liter to a liter of bile per day — a colloidal solution containing up to 97% water.
Formation begins with biliary sludge — a suspension that precedes a stone. In 80–85% of cases sludge disappears but often returns; its appearance is promoted by pregnancy, use of hormonal medications, and rapid weight loss. Next, a stone forms from components of bile, whose stability is maintained by bile acid salts.
By composition, cholesterol, pigment, calcareous, and mixed stones are distinguished; most are mixed with a predominance of cholesterol. Sizes range from sand with particles smaller than a millimeter to a single stone that fills the entire gallbladder cavity and weighs 60–80 g. The shape of stones varies — spherical, ovoid, multifaceted, barrel-shaped, spicular; one person often has concretions of different composition and structure.
Asymptomatic Stones
Asymptomatic stones are discovered incidentally — during a scan or X-ray performed for another reason. They usually require no treatment; the doctor may schedule follow-up examinations to check whether complications are developing.
The likelihood of formation is higher after age 40, in women, with obesity, with a diet high in fats and low in fiber, after rapid weight loss, with diabetes or Crohn's disease. According to statistics, women develop cholelithiasis 3–5 times more often than men, and according to some authors — 8–15 times; stones form especially often in women who have given birth many times. In children the disease occurs rarely; with age the prevalence increases and after age 70 reaches 30% and more. Excess body weight is present in approximately two thirds of patients. These are risk factors, not the cause in every case: the etiology of the disease is not considered sufficiently studied.
Biliary Colic
Colic occurs when a stone blocks the bile duct. The pain has a recognizable set of characteristics:
- severe;
- constant;
- lasts longer than 30 minutes and up to several hours;
- in the middle of the abdomen or just under the ribs on the right;
- accompanied by nausea or vomiting.
If the pain lasts longer than 30 minutes, an urgent appointment with a family doctor is needed.
Cholecystitis, Jaundice, and Complications
Complications occur rarely, but blockage of the duct can lead to inflammation of the gallbladder (cholecystitis) or pancreas (pancreatitis). Migration of a stone into the common bile duct is a separate complication, choledocholithiasis; it causes acute cholestatic syndrome and cholestatic jaundice.
Jaundice manifests as a yellow tint of the skin or whites of the eyes, itching, darker urine, and lighter stool. On brown or black skin, yellowing is less noticeable. Yellowing is a reason to evaluate not only the ducts but also the liver and its test results.
Diagnosis and What to Ask the Doctor
With symptoms, an ultrasound examination and a blood test are usually performed.
At the appointment, it is advisable to clarify whether there are stones in the ducts, not only in the gallbladder; whether a repeat ultrasound is needed; which signs should be considered a reason to seek help immediately.
When to See a Doctor Immediately
Call 103 or 112 if: sudden severe abdominal pain; pain spreading from the abdomen to the back, with vomiting; very high temperature or a feeling of heat, cold, shivering; yellowing of the skin or whites of the eyes.
This text is for reference and does not replace consultation with a doctor who sees the situation as a whole.
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This content is for reference and does not replace a doctor's consultation. Medical disclaimer