Gallstones

Overview

Gallstones (A.K.A. cholelithiasis) are pebble-like deposits that can naturally form inside the gallbladder, which is the small organ in the abdomen where the body stores bile. Bile is a digestive fluid produced by the liver that helps the intestine digest fats. 

Gallstones can range in size from as small as a grain of sand to golf-ball sized. They are usually made of cholesterol — a waxy, fat-like substance made in the liver — or bilirubin. Bilirubin is a waste product your body forms when it breaks down hemoglobin, an oxygen-transporting protein in red blood cells. 

There are two main types of gallstones: 

• Cholesterol stones, which are made mostly of hardened cholesterol and are yellow-green in color
• Pigment stones, which are made of bilirubin and are dark colored. 

People can have a mix of both cholesterol stones and pigment stones. Some people can have hundreds of small gallstones, just a few or only one. Some have a mix of small and large gallstones.  

Most gallstones, called “silent” gallstones, never cause trouble inside the body, and don’t require medical treatment. Sometimes, however, gallstones can block bile ducts in your biliary tract, the network of small tubes that transport bile from the liver to the gallbladder and intestine. 

When these blockages occur, this can result in what’s called a “biliary attack” or “biliary colic,” which usually includes sudden pain in the upper right abdomen that can be severe. 

If the blockage persists without relief or treatment, it can result in serious and potentially life-threatening complications, including: 

• inflammation of the gallbladder
• Severe damage to the gallbladder, bile ducts, or liver
• Cholangitis, which is a serious infection of the bile ducts that’s most commonly caused by a gallstone blocking a duct. Read more about cholangitis. 
• Gallstone pancreatitis, which is inflammation of the pancreas that’s usually due to a gallstone blocking a bile ducts. Read more about pancreatitis

Why Hoag for Gallstone Treatment in Orange County?

Gallstones can be painful and are potentially dangerous if allowed to progress too far. When you need answers now for serious biliary conditions like gallstones, cholangitis or gallstone pancreatitis, trust the Hoag Digestive Health Institute to help you heal. 

Hoag’s comprehensive Midgut Program offers the most advanced diagnosis and treatment in Orange County for conditions involving the gallbladder, pancreas and biliary system. We’re leading the way in complex hepatobiliary care, with the accurate diagnosis you need for peace of mind and the next generation treatment options that can get you on the road to recovery fast. 

Symptoms and Causes of Gallstones

Most people who have gallstones may never know they have them, as they have so called “silent” gallstones that never cause pain, blockages or other issues inside the body. 

For those who do experience issues, the symptoms of gallstones can be different for every patient and may mimic those of other conditions. 

Early Symptoms

Early or initial symptoms of gallstones that cause blockage of the bile ducts may include:

• Long-lasting pain in your upper right abdomen that may be severe
• Fever and chills
• Jaundice, which is a yellowish tint to the skin and the whites of the eyes. 
• Nausea and vomiting
• Light-brown urine and pale bowel movements

Advanced Symptoms

Some gallstone blockages resolve themselves after a time. Some do not, and require medical intervention. Serious and sometimes life-threatening complications can occur if your bile duct stays blocked. These can include:

• Confusion
• Weakness and fatigue
• infection
• Sepsis
• Death

According to data from the National Institutes of Health, almost 3,000 deaths per year in the U.S. occur due to complications of gallstones and gallbladder disease. Having gallstones is also thought to increase the risk of developing gallbladder cancer, as nearly 85% of patients with cancer of the gallbladder have gallstones. Read more about gallbladder cancer. 

Risk Factors

About 10 to 20% of the U.S. population have gallstones, with about 1 million new cases diagnosed each year. Women are much more likely to have gallstones than men, with about 6 million men and 14 million women in the U.S. currently diagnosed. About a quarter of those diagnosed will need medical treatment.

There are a number of factors that can potentially increase your risk of developing gallstones. These include:

• Being female
• Obesity
• Hyperinsulinemia, which means the amount of insulin in your blood is higher than normal
• Dyslipidemia, which is the presence of high levels of fats in the blood, including cholesterol and triglycerides. 
• Having type 2 diabetes
• Having metabolic syndrome, which is a cluster of conditions usually associated with being overweight or obese, including high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels
• Eating a diet that’s high in calories and cholesterol, with little fiber
• Experiencing rapid weight loss
• Being on estrogen-replacement therapy 
• Being on oral contraceptives
• Certain inherited genetic conditions 

Diagnosis and Tests for Gallstones

Some people with so-called “silent” gallstones that produce no pain or other symptoms are diagnosed after their gallstones are noticed on imaging tests of the abdomen for unrelated issues. 

Most people, however, are diagnosed with gallstones after going to their doctor with upper-right abdominal pain and other symptoms related to a bile duct that has become blocked by a gallstone, a condition called cholangitis. 

Cholangitis is most often initially diagnosed due to a physician recognizing a cluster of symptoms that are known as “Charcot’s Triad,” which includes fever, upper abdominal pain and jaundice. Jaundice is a yellowish discoloration of the skin and the whites of the eyes. 

Advanced cholangitis can quickly progress to what’s called “Reynold’s Pentad,” a group of symptoms that include fever, upper abdominal pain, jaundice, confusion and low blood pressure.  

If you visit a doctor with these symptoms you may be referred for further diagnostic testing. This usually includes blood tests, including:

• A Complete Blood Count (CBC) which measures your white blood cell count. An elevated white blood cell count can indicate an infection. 
• Liver function tests, which are specialized blood tests to check if your liver is functioning properly
• Blood cultures, which can reveal a blood infection

Advanced Diagnosis of Gallstones at Hoag

In addition to blood testing, you may also be asked to undergo diagnostic imaging tests, which allow doctors to directly view issues and structures inside the body, including any gallstones that may be blocking the bile ducts.  

At the Hoag Digestive Health Institute, these imaging tests may include: 

• Abdominal Ultrasound, which uses sound waves to create images of structures and tissues inside the body, including gallstones or obstructions of the bile ducts that might be causing blockages, inflammation or cholangitis. 
• Endoscopic Retrograde Cholangiopancreatography (ERCP), in which doctors use X-rays, a radioactive tracer substance and a small, flexible camera called an endoscope to view the bile ducts and examine them for tumors, gallstones or narrowing. During the ERCP procedure, physicians pass an endoscope down your throat, through the stomach, into the small intestine and into the bile ducts. 
• Hepatobiliary iminodiacetic acid (HIDA) Scan (A.K.A. Cholescintigraphy) which utilizes a harmless radioactive tracer that’s injected into your bloodstream to “light up” the bile ducts on imaging scans. This allows the bile ducts and any obstructions in them to be more easily seen by physicians
• Magnetic Resonance Cholangiopancreatography (MRCP), which utilizes powerful magnetic fields, radio waves and advanced computing to evaluate the gallbladder and bile ducts without the use of ionizing radiation

Management and Treatment for Gallstones

If you are diagnosed with gallstones that aren’t causing symptoms — also known as “silent” gallstones —  it’s likely your doctor will recommend no medical treatment. However, if your gallstones are causing painful gallstone attacks or if you experience a prolonged bile duct blockage by a gallstone — a serious condition called cholangitis — you may have to be hospitalized and have the issue addressed. 

Surgery at Hoag

The most common treatment for gallstones is surgery to remove the gallbladder, the organ in the abdomen where bile is stored and where gallstones can form. This operation is known as a cholecystectomy. 

The operation is common, and most patients suffer no ill effects afterward because the gallbladder isn’t essential to the healthy function of the liver, biliary system or intestine. Some patients whose gallbladder has been removed may experience more frequent or softer bowel movements for a while after the surgery, but this is usually only temporary.  

At Hoag, gallbladder removal surgery is usually performed laparoscopically, with the surgeon inserting instruments and a thin, flexible camera through small incisions in the abdomen. A less-invasive form of traditional “open” gallbladder surgery, laparoscopic cholecystectomy generally has a faster recovery time, and is usually performed on an outpatient basis, meaning patients can often go home to recover without a hospital stay.  Read more about laparoscopic cholecystectomy at Hoag. 

Non-Surgical Treatments at Hoag

Physicians generally use non-surgical treatments for gallstones only in certain cases, including if you have issues caused by the type of gallstones known as cholesterol stones or conditions that don’t make you a good candidate for surgery. 

In these cases, doctors may use special techniques to drain excess bile and break up or remove gallstones from the gallbladder that may be blocking bile ducts.  These techniques may include: 

• Endoscopic Retrograde Cholangiopancreatography (ERCP), in which doctors use X-rays, a radioactive tracer substance and a small, flexible camera called an endoscope to view the bile ducts and examine them for gallstones or strictures. ERCP can also be used to break up and remove gallstones that might be blocking the bile ducts
• Oral dissolution therapy, which utilizes certain medications that contain bile acids that can dissolve small cholesterol stones.

Prevention of Gallstones

Researchers can’t yet explain why some people develop gallstones while others of similar weight, diet, age and other factors do not. However, there are ways to potentially reduce your risk of developing gallstones. These may include: 

• Maintaining a healthy weight, as obesity — especially in women — is known risk factor for gallstones
• Monitoring and managing your diabetes, as diabetics often have high levels of triglycerides, a fatty acid which can increase the risk of gallstones
• Avoiding rapid weight loss, as fat metabolized during dieting or fasting can cause the liver to secrete more cholesterol into bile, which can increase the chance of developing gallstones