The gallbladder is a sac that stores a substance called bile, which is produced by the liver. After meals, the gallbladder contracts and releases bile into the small intestine to aid in digestion. Gallstones occur when one or more of the substances that make up the bile (usually cholesterol or a waste product called bilirubin) become too concentrated and form a hard stone. Often gallstones just sit in the gallbladder and don’t cause problems. But sometimes they block the exit from the gallbladder, called the cystic duct. When this occurs, the gallbladder goes into spasms and becomes inflamed, a condition called cholecystitis. Cholecystitis generally does not self-resolve and should be treated with antibiotics, fluids, and usually surgery. (1,2)
Excess bilirubin, a chemical produced when your body breaks down red blood cells, in the bileExcess cholesterol in the bileImproper emptying of the gallbladder, causing bile to become concentrated (2)
A family history of gallstonesA sedentary lifestyleBeing femaleBeing age 40 or olderBeing of Native American or Mexican-American descentHaving diabetesHaving liver diseaseBeing pregnantBeing overweight or obeseRapid weight lossTaking birth control pills or estrogen-based hormone replacement therapyA diet rich in fat and cholesterol, or without enough fiber (2)
But in many people, gallstones can cause symptoms of cholecystitis (inflamed gallbladder). These symptoms may include:
Abdominal pain in the upper right part or center of your abdomen (often comes on suddenly and gets worse quickly)Back pain, especially between your shoulder bladesPain beneath your right shoulder bladeFever with chillsVomiting and nauseaJaundice (yellowing of your skin and whites of your eyes)Clay-colored stools, dark urine, or both (signs of a bile duct blockage)Pain that strikes after eating a heavy or fatty mealIndigestion, bloating, and gas (2,3)
If you have any of these symptoms, it’s possible that gallstones may be to blame. It’s important to see your doctor promptly for an exam and to get started on treatment. In rare cases, gallstones may also be an indication of gallbladder cancer, so it’s best to get the problem diagnosed right away. (1)
Ultrasound, which uses sound waves to visualize the areaComputed tomography (CT), which used radiation to create a detailed imageMagnetic resonance imaging (MRI), which uses magnetic fields and radio waves to create an image (2)
Another less commonly used procedure, called a hepatobiliary iminodiacetic acid (HIDA) scan, involves injecting a small amount of a harmless radioactive substance into your arm. A device called a gamma camera is then used to create images as this substance travels from your bloodstream to your liver, gallbladder, bile ducts, and small intestine. (4) Gallstones can also be diagnosed using endoscopic retrograde cholangiopancreatography (ERCP), in which a flexible tube is inserted down your throat and into your digestive tract. This procedure is typically used to fix other problems with your bile or pancreatic ducts, but gallstones may be discovered in the process. (5) Medication A few types of medication, including oral bile salt therapy, work to slowly break down small gallstones to reduce pain and other symptoms. These medicines may take months or even years to break down your gallstones, and sometimes they’re simply not effective. Gallstones may also return once you stop taking them. For these reasons, medication to remove gallstones is usually reserved for cases in which surgery isn’t an option. (2) Painkillers, including nonsteroidal anti-inflammatory drugs (NSAIDs), may be used to help control pain during an acute attack of cholecystitis. (6) Surgery If you experience severe symptoms, your doctor may recommend removing your gallbladder. Once your gallbladder is removed, bile will flow directly from your liver into your small intestine. This may cause digestive symptoms, including diarrhea, which are usually temporary. Significant advances have been made in gallbladder removal surgery (cholecystectomy). It’s now a minimally invasive procedure that uses laparoscopic technology. Tiny incisions are made, recovery is quick, and you may not even need to spend the night in the hospital following your surgery. (2) Conditions that can cause similar symptoms include: Acalculous Biliary Pain This refers to pain in the bile ducts that isn’t followed by any gallstones appearing in imaging tests. It may be due to improper emptying of the gallbladder, overly sensitive bile ducts or small intestine, or gallstones that are too small to be seen on imaging scans or passed through already. Surgery to remove the gallbladder is often successful at remedying pain without gallstones. (7) AIDS-Related Cholangiopathy In people with AIDS, a weakened immune system can lead to frequent and widespread infections, some of which can result in the bile ducts narrowing. (7) Primary Sclerosing Cholangitis This refers to inflammation that causes scarring and narrowing of the bile ducts, and isn’t caused by any other known condition. While the causes of primary sclerosing cholangitis aren’t completely understood, doctors believe that it’s most likely an autoimmune disorder, in which the immune system attacks the body’s own tissues. (7) Additional reporting by Quinn Phillips
