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Symptomatic Cholelithiasis (Gallstones)

  1. What is symptomatic cholelithiasis?
  2. Symptoms
  3. Causes
  4. Diagnosis
  5. Treatment
  6. Complications
  7. Prevention
  8. In children
  9. FAQs
  10. Other names associated with symptomatic cholelithiasis

What is symptomatic cholelithiasis?

Cholelithiasis is the medical term for gallstones: hard, crystal-like lumps that form out of a fluid called bile. After a meal, bile, which is produced by the liver and stored in the gallbladder, is released into the intestine to help with the digestion of fats. Gallstones mainly develop within the gallbladder, from excess cholesterol or pigments in the bile. Sometimes called gallbladder stones, they can vary in size and number. Having gallstones in one’s gallbladder is fairly common, and in many cases they do not cause any symptoms or complications. In these situations, they are known as “silent gallstones”, and treatment is generally unnecessary.[1][2][3][4][5]

When gallstones cause symptoms, the medical term symptomatic cholelithiasis is used to describe the condition. One of the main symptoms of gallstones is pain in the upper-right or middle part of the belly, which typically subsides after half an hour to a few hours. Other symptoms may include nausea and vomiting. Known as “gallbladder attacks” or biliary colic, the symptoms may be triggered by rich, fatty meals. Pain and other symptoms generally result if the stones block the normal flow of bile.[2][3][4]

Treatment for symptomatic cholelithiasis depends on the severity and frequency of gallbladder attacks. If gallstones are causing significant or recurrent pain or discomfort or there is a risk of complications occurring, doctors will typically recommend surgery to remove the gallbladder. This is called a cholecystectomy and is considered a common, routine procedure with a relatively short recovery time. In some cases, if symptoms are very occasional and mild, monitoring may be the recommended approach initially.[2][3][4][6]

Other treatment methods, such as using medication to try and dissolve smaller stones, are not considered to be very effective. Because the gallbladder is not essential, it is possible to live normally and healthily without one, and the outlook after surgery is generally good. Bile simply passes directly from the liver into the intestine, following gallbladder removal.[2][3][4][6]

If cholelithiasis is left untreated, a number of complications can occur. These include cholecystitis, where the gallbladder becomes inflamed, and pancreatitis, where the pancreas becomes inflamed, among other possible conditions.[1][4][5][7] If you experience high fever, extreme pain in the abdomen or any other severe symptoms, seek medical assistance without delay.

Symptoms of gallstones

In the majority of cases, gallstones do not cause any symptoms or problems. Symptoms typically occur when gallstones cause blockages in the gallbladder or bile ducts.[1][4]

Gallbladder attacks (biliary colic)

The main symptom of gallstones is pain located in the upper-right or middle area of the abdomen, just below the rib cage. This pain may come on suddenly and may be felt radiating into the arm, right shoulder, back or chest. Some people experience it as a sharp sensation, while for others it may be a deep ache. It is often triggered by a heavy meal and may wake a person up at night.[1][3][4][8][9][10]

The pain is sometimes mistaken for angina or a heart attack. Gallstone pain usually lasts for between half an hour and a few hours, easing as the stone moves and the blockage clears. In some cases, the pain may subside as quickly as within a few minutes.[1][3][4][8][9][10]

Other symptoms, in females and males, may include:[1][2][11][12][10]

  • Nausea
  • Vomiting
  • Indigestion
  • Bloating
  • Profuse sweating

These symptoms are collectively known as a gallbladder or gallstone attack, or biliary colic. A person may experience an episode of biliary colic only once, occasionally, or they may occur more frequently.[1][10] If you think that you might have gallstones, you can try using the Ada app to find out more about your symptoms.

When to see a doctor

If you suspect that you may be having or have had a gallbladder attack, it is important to see a doctor. If left untreated, gallstones can cause serious complications, some of which are medical emergencies.

Additionally, if you experience any of the following symptoms, it is important to seek urgent medical assistance:[4][8][10]

  • Fever
  • Chills
  • Excruciating abdominal pain that does not go away
  • Severe nausea and vomiting
  • Yellowing of the skin or eyes, i.e. signs of jaundice
  • Fast heart beat
  • Itchiness
  • Diarrhea
  • Light-colored stools
  • Dark urine
  • Confusion

What causes gallstones?

Most gallstones form in the gallbladder, hardening out of excess cholesterol or pigments in a person’s bile. The majority of gallstones are made mostly of cholesterol and are called cholesterol stones. Pigment stones are less common and are comprised mainly of bilirubin, a byproduct of the breakdown of red blood cells.[3][4][8]

Though the exact reasons for the development of gallstones are not yet fully understood, it is known that if the gallbladder is sluggish and does not contract or empty properly, the risk of cholesterol stones forming is increased. Pigment stones tend to be more common in people with certain conditions, including liver disease and some types of hemolytic anemia.[3][8][12][5]

Cholelithiasis risk factors

Other risk factors for gallstones may include the following:[2][3][4][8][12][9][5][13]

  • Being female
  • Being over 40; the risk of cholelithiasis increases with age
  • A family history of gallstones
  • Having European, Native American or Hispanic heritage
  • Being overweight or obese
  • Pregnancy
  • Hormonal contraceptives or treatments that contain estrogen
  • A high-fat, low-fiber diet
  • Certain medical conditions, including diabetes, sickle cell disease, cirrhosis of the liver, Crohn’s disease and cystic fibrosis
  • Rapid weight loss, e.g. as experienced after weight-loss surgery or intense dieting
  • Certain medications

Good to know: Some doctors may refer to what is colloquially known as “the rule of the 6Fs” to describe risk factors for cholelithiasis. The 6Fs are: “fat, female, fertile, forty, fair-skinned, family history”.[12] However, this is not an actual medical rule, and it certainly does not apply to everyone who develops gallstones. Not everyone who has the risk factors listed above will develop gallstones; furthermore, a person without them may develop cholelithiasis.

Diagnosis of cholelithiasis

After taking the person’s medical history, assessing their symptoms and performing a physical examination, a doctor will typically order tests to confirm a diagnosis of gallstones. It is important to rule out other conditions that may sometimes cause similar symptoms, including appendicitis, gastritis and kidney stones.[12]

During the physical examination, the doctor might press on the upper-right area of the belly and ask the person to take a breath, checking for what is known as Murphy’s sign. Pain while doing this may indicate that there is inflammation of the gallbladder.[12][14]

Diagnostic tests for suspected gallstones may include the following:[2][3][4][12][14][15][16]

  • Blood tests: To see if there are any signs of infection and to check the functioning of the liver.

  • Abdominal ultrasound: A quick, non-invasive scan that uses sound waves to confirm the presence of gallstones in the gallbladder. This is the most common test for gallstones and can also detect inflammation of the gallbladder. However, it may not be able to detect gallstones in the bile ducts.

Endoscopic ultrasound (EUS): This scan uses an endoscope, a flexible tube with a light and camera with an ultrasound probe attached, to provide more detailed images of the inside of the body. The endoscope is inserted into the mouth and passed down into the abdomen.[16][17]

  • CT scan: A scan that uses multiple X-rays in multiple layers to confirm the presence of gallstones in the biliary system, as well as check for possible complications, e.g. blocked bile ducts and pancreatitis.

  • MRI: A scan that uses powerful magnets and radio waves to check for gallstones in the bile ducts. MRI scans may offer more detail than other types of imaging tests.

  • Cholangiography: A test that uses dye and X-rays to check for gallstones and other blockages in the biliary system. This test may form part of a procedure called an endoscopic retrograde cholangiopancreatography (ERCP), where a thin, flexible tube called an endoscope is used to diagnose and remove gallstones that have become stuck in bile ducts.

  • Cholescintigraphy: A test that uses a safe, weakly radioactive substance and a special camera to check for blockages in the bile ducts and to assess whether the gallbladder is contracting as it should. This test is also known as a hydroxy iminodiacetic acid (HIDA) scan or hepatobiliary scan.

Good to know: Gallstones may be discovered incidentally while undergoing tests for a different health condition or as part of a general health check.[14][18] As long as the gallbladder stones are not causing symptoms, treatment will not usually be recommended. However, a doctor may advise on symptoms to watch out for.

Cholelithiasis treatment

Treatment for gallstones involves management of the symptoms and, usually, surgical removal.

Gallstones that do not cause symptoms, or “silent gallstones”, and are not considered to pose a significant risk of complications do not typically require treatment. Approximately 1 in 4 people with symptomless gallstones will go on to experience symptoms within 10 years.[2][4][6][12][19]

Surgery to remove gallstones

Surgery to remove the gallbladder, called cholecystectomy, is the preferred treatment for symptomatic cholelithiasis. A common procedure, it is considered the most effective way of preventing symptoms from recurring and preventing gallstone-related complications from developing.[11][20][21]

There are two types of gallbladder surgery:[2][6][9][21]

Laparoscopic cholecystectomy: A type of keyhole surgery where the gallbladder is removed through a small incision in the abdomen. In some cases, a person may be able to go home on the same day, though they might be kept in hospital for a few days after the surgery for monitoring.

Open cholecystectomy: An older type of surgery that requires a bigger incision in the abdomen to remove the gallbladder. This may be necessary if a laparoscopy is not advisable, or complications arise. The recovery time is longer for this type of surgery.

After gallbladder surgery

A person can live a normal, healthy life without their gallbladder. When it is removed, bile simply flows directly from the liver into the intestine via the common bile duct, aiding digestion as usual. In some cases, there may be mild cases of loose stools or indigestion for a while as the body adjusts, but this is usually temporary. The risk of complications from a cholecystectomy is considered low.[3][4][11][9][5][21]

Endoscopic retrograde cholangiopancreatography (ERCP)

This procedure is the preferred treatment option in cases where the common bile duct has become blocked. It relies on an endoscope which is inserted via the mouth.[6][21][22]

Non-surgical treatment options

Non-surgical treatments are typically recommended only where surgery is not an option, for example, where another health condition makes it inadvisable to operate. Treatment options may include:[3][6][9][20][21][19]

Bile acid pills: Medication taken orally to try and dissolve small gallstones. An example is ursodiol. The medication may need to be taken for months or years.

Percutaneous cholecystostomy and stone extraction: In emergencies where the gallbladder is severely inflamed and surgery is not possible, doctors might insert a catheter into the gallbladder to drain it and clear the blockage. In the following weeks, the gallstones might be removed via the incision created for the catheter.

Extracorporeal shock-wave lithotripsy: Shock waves, emitted outside the body, are used to break gallstones up into smaller pieces that can be dissolved with the help of bile acid pills, or safely excreted. This is rarely used for gallstone treatment today, though it may be recommended for the treatment of kidney stones.

Non-surgical approaches are not very effective, and gallstones will often recur. They may not work for pigment stones.[6][9][20][21][19]

Home remedies and natural treatments

Some sources may suggest a range of purported natural treatments and home remedies for gallbladder stones, including fasts, gallstone flushes or cleanses, turmeric, apple juice, coffee and other foods to eat or avoid. However, these approaches lack medical support and can in some cases be dangerous for a person to try. If you think that you may have symptoms of gallstones, it is very important to see a licensed medical doctor as soon as possible for safe, effective treatment and to avoid complications.

Complications of cholelithiasis

If left untreated, gallstones can cause a number of serious complications. These include:[1][3][4][12][9][7]

  • Cholecystitis, inflammation of the gallbladder
  • Pancreatitis, inflammation of the pancreas
  • Injury and/or infection of the biliary tract, i.e. the liver, gallbladder and bile ducts; inflammation of the bile ducts is known as cholangitis
  • Bowel obstruction

These conditions often require emergency treatment. If you experience any of the following symptoms, seek medical help urgently:[3][4]

  • Severe, persistent pain in the abdomen
  • High fever
  • Chills
  • Yellowing of the skin or the whites of the eyes (jaundice)

Gallbladder cancer

It is thought that the risk of developing gallbladder cancer is higher in people who have had gallstones. However, the risk is still considered very low – it is estimated to be less than 1 in 10, 000.[7]

Read more about Gallbladder Cancer »

Postcholecystectomy syndrome

After gallbladder surgery, approximately 1 in 10 people develop what is known as postcholecystectomy syndrome (PCS). They may experience a number of symptoms associated with gallbladder disease, as well as symptoms related to removal of the gallbladder. The syndrome is thought to be caused by changes in the flow of bile after gallbladder surgery.[11][23]

Symptoms of postcholecystectomy syndrome may include:[11][23]

In most cases, symptoms are mild and temporary, clearing up on their own. If you are concerned about any symptoms after surgery, it is advisable to see a doctor. They will be able to check to see if any complications have arisen, and recommend treatment where needed.[23]

Good to know: Postcholecystectomy syndrome is generally an initial diagnosis that can be revised when the disease or disorder that may be causing the symptoms is identified.[24]

Prevention

While it may not be possible to prevent gallstones, it is thought that the following might reduce the risk of them developing:[3][4][9][25][26][5]

  • Eating a healthy, balanced diet and avoiding an excess of fatty foods
  • Exercising regularly
  • Managing other health conditions, such as diabetes and Crohn’s disease, with the help of a licensed medical doctor
  • Maintaining a healthy weight
  • When trying to lose weight, doing so slowly rather than rapidly
  • When rapid weight loss is planned, e.g. with weight-loss surgery, taking bile acid pills as a preventive measure

Research into ways to prevent gallstones is ongoing.

Gallstones in children

Cholelithiasis can occur in children, though the condition is more common in adults. Pediatric gallstones are most often pigment stones, rather than the cholesterol stones that characterize the majority of cases of adult cholelithiasis. Children who have sickle cell disease or other types of hemolytic anemia are at an increased risk of developing these stones.

Symptoms and treatments for gallstones in children are largely the same as those for adults, and the outlook is generally good in uncomplicated cases.[27][28]

Cholelithiasis (gallstones) FAQs

Q: What are gallstones made of?
A: Gallstones develop from bile, a substance that aids in the digestion of fats. Bile, which is produced by the liver and stored in the gallbladder, contains cholesterol, bile salts and bile pigments, such as bilirubin, a byproduct of the breakdown of red blood cells. The majority of gallstones are made up mostly of hardened cholesterol and are called cholesterol stones. However, some gallstones are made up of mostly of bilirubin; these are called pigment stones.[1][29][2][3]

Q: Are gallstones treatable?
A: Yes. If gallstones cause symptoms or there is a risk of complications, surgery to remove the gallbladder will typically be recommended. This is known as a cholecystectomy and is a common procedure. In cases where the gallstones are very small, the use of medication to try and dissolve gallstones may sometimes be recommended (see the FAQ below). If gallstones only cause mild, occasional discomfort, observation and monitoring may be recommended initially.[2][3][6]

Q: Can gallstones dissolve?
A: It may be possible to dissolve some cholesterol-based stones using medication. However, this can take a long time and often does not work. Though a very uncommon treatment today,[9] shock waves, in the form of a lithotripsy procedure, may be used to break gallstones into smaller pieces to help with the dissolution and allow passage through the body. However, even if gallstones do go away using these methods, it is likely that they will come back.[3][6][20]

Q: What is the difference between gallstones and kidney stones?
A: Gallstones develop in the gallbladder, liver or bile duct, while kidney stones develop in the kidneys, from where they may move into the ureter, bladder and urethra (the urinary tract). Gallstones and kidney stones are made of different substances.

Read more about Kidney Stones »

Q: Cholelithiasis vs. cholecystitis – what is the difference?
A: Cholelithiasis is a condition where gallstones form in the gallbladder, liver or bile duct. Cholecystitis, on the other hand, is inflammation of the gallbladder, which is usually caused by gallstones. However, cholecystitis can also occur as the result of infection or certain other conditions.[30]

Read more about Cholecystitis »

Q: Can you have cholelithiasis without cholecystitis?
A: Yes. It is possible to have gallstones without them causing inflammation of the gallbladder. The majority of people with gallstones do not experience any symptoms or problems. However, the presence of gallstones may increase the risk of cholecystitis occurring.[3][4][11][31]

Q: Can you have gallstones without a gallbladder?
A: Yes. It is possible to develop gallstones, e.g. in the common bile duct, even though uncommon, after the surgical removal of one’s gallbladder.[32][9]

Q: Choledocholithiasis vs. cholelithiasis – what is the difference?
A: The medical term choledocholithiasis is used when gallstones are present in the common bile duct. This is a tube that connects the gallbladder to the small intestine. The term cholelithiasis refers to the presence of gallstones either generally or in the gallbladder specifically.[11][12][33][34]

Q: Can cholelithiasis cause diarrhea?
A: Diarrhea is not typically a symptom of gallstones, unless they are causing complications, as in the FAQ below. The most common symptom is pain in the upper-right or middle part of the belly, particularly after fatty meals. A person might also feel nauseous and vomit.[3][9] If you are concerned about any gastrointestinal symptoms, you can try using the Ada app for a free assessment.

Q: Can cholelithiasis cause jaundice?
A: If gallstones block the common bile duct at any point up to its exit into the intestines, they can cause inflammation and serious complications. In such cases, a person may become jaundiced, which means that their skin and the whites of their eyes become yellow or yellowish in color. Other symptoms, such as diarrhea, chills and high fever, may also be present.[3][10] If jaundice or any of these symptoms are present, seek medical help immediately.

Q: Can cholelithiasis cause pancreatitis?
A: If gallstones block the drainage duct shared by the gallbladder and pancreas, inflammation of the pancreas, known as pancreatitis, can result.[4][11] Pancreatitis is a very serious condition that requires urgent medical treatment.

Read more about Pancreatitis »

Q: Are gallstones dangerous?
A: Gallstones can be serious and may require emergency medical treatment if they are left untreated and lead to blockages in bile ducts or other parts of the digestive system. However, in many cases, gallstones do not cause any problems or even any symptoms.[1][3] If you are concerned about gallstones, it is recommended that you speak to a doctor. If you experience severe symptoms, seek medical help without delay.

Q: Does cholelithiasis require surgery?
A: If gallstones cause symptoms, or there is a risk of complications, surgery to remove the gallbladder will typically be recommended. This is called a cholecystectomy and is a common procedure. In rare cases, where gallstones are small, medication and/or the use of shock waves (lithotripsy) to dissolve and break up the stones may be recommended. However, this is not very effective and the stones, if they do disappear, will likely return.[2][3][6][20]

Q: What happens if you have gallstones (cholelithiasis) in pregnancy?
A: During pregnancy, the risk of developing gallstones is increased due to changes in the digestive system. If a person develops signs of gallstones while they are pregnant, medical advice should be sought without delay. If the stones are not causing severe symptoms, specific treatment may not be needed. However, if symptoms are severe or recurrent, or complications such as pancreatitis arise, surgery may be required.[35]

Q: What is the best diet for cholelithiasis?
A: While there is no specific recommended diet for gallstones, avoiding the excessive intake of high-fat foods may possibly help to reduce the risk of stones forming, as well as manage symptoms of attacks while waiting to receive treatment. It is recommended that one eat a healthy, balanced diet with lots of fresh vegetables and fruit, as well as whole grains, beans, pulses and nuts.[36][25][26]

Q: What is gallbladder sludge?
A: Also known as biliary sludge, this is a build-up, within the gallbladder, of small particles of cholesterol, pigments and other substances found in bile. It is a kind of sediment that can form when bile is kept in the gallbladder for longer than usual, e.g. during pregnancy or when the common bile duct is blocked. While in many cases the sludge goes away, gallstones may sometimes develop from it.[37][38]

Other names associated with symptomatic cholelithiasis

  • Gallstones
  • Symptomatic gallstones
  • Gallbladder stones
  • Gallstone disease
  • Bile duct stones

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