Gallstones
The gallbladder is a small pouch tucked under the liver where bile is stored between meals.
On this page
The gallbladder is a small pouch tucked under the liver where bile is stored between meals. As soon as food reaches the duodenum, the gallbladder squeezes and releases a portion of bile to break down fat. If that bile sits for long spells and its composition shifts, sediment settles out of it, and stones grow from the sediment — anything from a grain of sand to the size of a plum. From then on everything turns on one question: do they lie quietly at the bottom, or do they set off towards the exit and block it? In most people they lie quietly and give no sign of themselves for years. That is why the commonest question in the consulting room is not "how do I dissolve them" but "is this pain even coming from them?".
What an attack feels like
A stone gives itself away when the gallbladder contracts after a fatty meal and pushes it towards a narrow outlet. The duct is blocked, pressure inside rises, and biliary colic begins. The name is misleading: the pain does not come in waves, it climbs and then holds at a steady plateau.
- it hurts under the right ribs or in the middle of the upper abdomen, and may travel to the right shoulder blade and shoulder;
- the pain is severe, dull and bursting, with no position that eases it;
- it lasts from half an hour to several hours and fades the way it arrived, once the stone rolls back;
- it often turns up in the evening or at night, an hour or two after a heavy meal;
- it comes with nausea and sometimes vomiting that brings no relief;
- between attacks the person feels perfectly well.
Attacks may return once a year, once a month or twice in the same week — there is no predicting it. Only one sign is plainly bad: pain that will not settle within a few hours is no longer colic, it is a complication.
Why the stone on the scan is not always to blame
Gallstones are found in a great many people, and abdominal pain is commoner still, so the two coincide by chance over and again. The scan shows a stone, every ache gets pinned on it, the patient is operated on, and the pain stays. Before blaming the stones, it is worth going through what mimics them:
- gastritis or an ulcer of the stomach or duodenum — the pain goes with hunger and settles with food rather than starting after it;
- reflux and functional dyspepsia — burning, early fullness, heaviness with no clear attack;
- irritable bowel syndrome — the pain is tied to bowel habit and bloating;
- right-sided renal colic — the pain runs down towards the groin and there is blood in the urine;
- pneumonia in the right lower lobe, along with a cough and breathlessness;
- a heart attack affecting the lower wall of the heart — it can masquerade as pain "in the pit of the stomach" with nausea and cold sweat, and it is the most dangerous mistake on this list.
Genuine biliary colic is given away by two features: it comes in attacks and it follows meals, with complete wellbeing in between. A constant dull heaviness in the right side is not usually explained by stones.
Who tends to get them
Most stones are built from cholesterol that has stopped staying dissolved in bile. That shapes the picture of who gets them more often:
- women — female hormones change the make-up of bile and slow the emptying of the gallbladder;
- pregnancy and childbirth, particularly several times over;
- preparations containing oestrogen;
- age: the chance climbs with the years, and past forty it climbs noticeably;
- excess weight and a diet heavy in fat and sugar with little fibre;
- rapid weight loss, crash diets, prolonged fasting and the period after weight-loss surgery — the gallbladder empties rarely and bile stagnates;
- diabetes and raised triglycerides;
- Crohn's disease and surgery on the ileum, which disturb the recycling of bile acids;
- gallstones in close relatives;
- cirrhosis of the liver and conditions that break down red blood cells, where the stones are of a different, pigment type.
Only part of that list can be influenced, so effort is best spent on the main thing: eating regularly, without long gaps and without swings in weight. Losing weight slowly is safer than fast.
What can go wrong
Quiet stones rarely turn into disaster, but everyone should know what they can lead to.
- Acute cholecystitis. The stone has stuck fast and the gallbladder wall becomes inflamed. The pain does not let go for more than a few hours, a temperature rises, and the right side hurts to touch.
- A stone in the common bile duct. Bile stops reaching the bowel: skin and the whites of the eyes turn yellow, urine darkens, stools go pale and the skin itches.
- Cholangitis. Infection is added to the blockage and passes into the blood. Pain, jaundice and fever with shivering together is a situation counted in hours.
- Gallstone pancreatitis. The stone blocks the pancreatic duct as well. The pain wraps round the waist, goes through to the back, and vomiting brings no relief.
- Gallstone ileus. Rare: a large stone works its way into the bowel and lodges there. Vomiting, a swollen abdomen, no stool and no wind.
- Gallbladder cancer. Uncommon, but almost always on the ground of long-standing stones and chronic inflammation, which is why a gallbladder with a calcified wall or very large stones is discussed separately with a surgeon.
How it is confirmed
The main test is an ultrasound scan of the upper abdomen, done fasting. It sees stones in the gallbladder reliably and shows the thickness of the wall and the width of the ducts as well. Blood tests are added to it: liver figures and bilirubin say whether a stone has moved into the duct, amylase and lipase whether the pancreas is involved, and the full blood count shows inflammation.
Ultrasound's blind spot is the lower part of the common bile duct, hidden behind bowel gas. If the blood tests hint at a duct stone and the scan stays silent, an MR cholangiogram is arranged, which maps the bile ducts without entering the body; the smallest stones are hunted with endoscopic ultrasound. ERCP stands apart: an endoscope is passed to where the duct opens into the bowel, the opening is widened and the stone retrieved. That is no longer a test, it is treatment.
What is done about the stones
If stones were found by chance and have never hurt, they are left alone: no diet, no tablets, no preventive operation — only the knowledge that they are there and an idea of which signs mean seeking advice. Rare situations are discussed separately — very large stones, a calcified gallbladder, malformations of the bile ducts — and there a surgeon decides.
If attacks have already happened, the main answer is removal of the gallbladder, usually through a few small cuts. The whole gallbladder is taken out rather than just the stones: an emptied gallbladder holding the same bile fills up again. The operation is short, people go home quickly, and normal life resumes within a couple of weeks.
While an attack is running or while surgery is awaited, painkillers from the non-steroidal anti-inflammatory group help, along with medicines that relieve spasm; for severe pain the doctor will prescribe something stronger. Fatty and fried food and large portions are best set aside — not because diet cures stones, but because it triggers fewer attacks. Bile acid preparations that dissolve cholesterol stones do exist, but they suit only a few people, take months, and the stones often return once they are stopped: they are kept for cases where surgery is not possible.
Life without a gallbladder
The gallbladder is a store, not a factory: bile is made by the liver and carries on being made after the operation, simply reaching the bowel steadily instead of in bursts. Digestion stays normal. In the first weeks some people notice looser and more frequent stools, especially after fatty meals; this usually settles by itself, and if it persists there are medicines that bind bile acids. No lifelong strict diet is needed: usual foods come back gradually while you watch how you react. If the old attacks return after surgery, or jaundice appears, or the pain wraps round the waist, that calls for further tests rather than putting up with it: it means the gallbladder was not the whole story, or a stone has been left in the duct.
When it cannot wait
Call an ambulance — in Spain, Italy, Portugal, Poland and Ukraine the single European number 112 is in service — if there is:
- severe abdominal pain that will not settle for more than a few hours;
- pain together with a high temperature and shivering;
- yellowing of the skin or the whites of the eyes, especially alongside pain and fever;
- pain wrapping round the waist and going through to the back, with vomiting that will not stop;
- confusion, sudden weakness, cold clammy skin, a fast weak pulse — signs of blood poisoning;
- an abdomen that has gone board-hard and hurts at the lightest touch.
Do not drive in that state: the pain may worsen on the way. Take the list of medicines you are on with you. The same day, though without an ambulance, it is worth seeing a doctor if a short attack passed and then came back; if urine has darkened and stools have gone pale without any pain; if fatty meals reliably bring nausea and a dragging feeling under the right ribs.
Online consultation
Gallstones are exactly the subject where talking to a doctor at a distance settles a great deal. The doctor will work out whether your pain looks like biliary colic, go over the scan and blood tests you already have and say what is missing from them, explain whether surgery is due now or watching is reasonable, and advise on eating in a way that brings fewer attacks. An appointment is also worth having after the gallbladder is out, if digestion has not settled. And remember the other side of it: pain that will not ease, yellow eyes or fever with shivering are not a matter for messages but a reason to call an ambulance, and you will be told exactly that in the consultation.
This material is for information only and does not replace medical advice.
Consult with a doctor about Gallstones
Discuss your symptoms and possible next steps with a doctor online.
Online doctors for Gallstones
Discuss your symptoms and possible next steps for Gallstones with a doctor online.
