Gallstones (Cholelithiasis): Overview and More

Gallstones (also called cholelithiasis) form when there is an imbalance in the composition of bile in the gallbladder. This causes hard stones made of crystallized cholesterol, pigment, or a mixture of the two.

Gallbladder stones can range in size from as small as a grain of sand to as large as a golf ball. You can have one large gallstone, dozens to hundreds of smaller gallstones, or a combination of both large and small stones.

There are two types of gallstones:

• Cholesterol stones: Cholesterol stones result from bile made of too much cholesterol or bilirubin and not enough bile salts. Cholesterol stones may also form when the gallbladder fails to empty during the digestive process. These usually yellow-green gallstones are the most common type.
• Pigment stones: People who develop pigment stones are typically people who have cirrhosis of the liver, biliary tract infections, and hereditary blood disorders, including sickle cell anemia. These are all conditions that cause too much bilirubin, which is what the stones are made of. Pigment stones tend to be dark brown or black.

Gallstone Symptoms

Symptoms are not always present, so anyone can have gallstones and not be aware of it. In fact, most people with gallstones don't have symptoms.

However, when gallstones travel into and block the ducts of your biliary tract, a sudden sharp pain is felt in the upper right or center of your abdomen. The pain that can occur with this blockage is what is often referred to as biliary colic, or a gallbladder attack. That pain, which is usually severe, can last a few minutes to several hours.

Pain from a gallbladder attack is commonly in the upper abdomen, on the right side just under your ribs. Sometimes the pain is referred to other areas, specifically your right shoulder or upper back. Gallstones may also present as other digestive problems, such as indigestions, heartburn, and gas.

Causes of Gallstones

The biliary tract is the pathway between your liver and pancreas to the first part of the small intestine. The gallbladder, part of that tract, is a small, pear-shaped organ that sits under your liver on the upper right side of your body between your chest and your hips. It acts as a storehouse for bile, which is a fluid produced by your liver to help your body digest fat.

Bile helps your body digest fats and fat-soluble vitamins. After eating fats, your gallbladder contracts, pushing the stored bile into the common bile duct, which brings the liquid to your small intestine to aid digestion.

The bile stored in the gallbladder contains water, bile salts, cholesterol, fats, proteins, and bilirubin. Bile salts break up the fat that is consumed in the food we eat. The bilirubin gives the bile a yellowish-green color and our stools their brown color.

Gallstones can form in the gallbladder when bile hardens into a stone-like material, which can happen if there are too much bile salts, cholesterol, or bilirubin in it.

There are a variety of possible reasons why this can happen. Obesity and diets high in refined carbohydrates—such as white bread and pasta—and fat, as well as low-calorie diets and rapid weight loss, have been associated with gallstones. 

Diagnosis

There are a number of tests that your healthcare provider may perform to diagnose gallstones. Blood may be done to check for infection or inflammation, though not gallstones themselves. Imaging tests are used for that purpose, with ultrasound considered the test of choice; magnetic resonance imaging (MRI) or computerized tomography (CT) scans may also be performed.

Gallstone Treatment

Treatment of gallstones is only suggested if you have symptoms. If they are present—especially if there's severe pain—surgical removal of the gallbladder (laparoscopic cholecystectomy) is the most common option. 

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In some cases, nonsurgical approaches may be used, but they are only considered when surgery is ill-advised. Procedures like oral dissolution therapy and extracorporeal shockwave lithotripsy (EWSL), among others, may be considered, but they are only appropriate for treating cholesterol stones.

Prevention

While you may not be able to prevent gallstones entirely, you can lower your risk of developing gallbladder stones by following a health diet and getting regular physical exercises. 

Your diet should include foods that are high in fiber, such as fruits, vegetables, beans, peas, and whole grains, such as brown rice, oats, and whole wheat bread. 

Limit the amount of refined carbohydrates, sugar, and unhealthy fats, such as fried food. Instead, include healthy monounsaturated fats, like fish oil and olive oil. This will help your gallbladder contract and empty on a regular basis and prevent the risk of gallstones. 

A Word From Verywell

If you suspect that you have gallstones or you have been diagnosed with the condition, keep in mind that gallbladder surgery is one of the most common surgeries for adults. Be sure to talk to your healthcare provider about any concerns or questions you have.