home > diseases, conditions and tests a-z list > gallstones article

Gallstones

Digestive Disease Myths Slideshow Pictures Take the Quiz: Tummy Trouble Digestive Disorders Diverticulitis (Diverticulosis) Slideshow Pictures

Medical Author:

Jay W. Marks, MD

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

View Full Profile

Medical Editor:

Dennis Lee, MD

Dennis Lee, MD

Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.

View Full Profile

Gallstones facts

• Gallstones are "stones" that form in the gallbladder or bile ducts.

• The common types of gallstones are cholesterol, black pigment, and brown pigment.

• Cholesterol gallstones occur more frequently in several ethnic groups and are associated with female gender, obesity, pregnancy, oral hormonal therapy, rapid loss of weight, elevated blood triglyceride levels, and Crohn's disease.

• Black pigment gallstones occur when there is increased destruction of red blood cells, and brown pigment gallstones occur when there is slow flow and infection of bile.

• The majority of gallstones do not cause symptoms.

• The most common symptoms of gallstones are biliary colic and cholecystitis. Gallstones do not cause intolerance to fatty foods, belching, abdominal distention, or gas.

• Complications of gallstones include cholangitis, gangrene, jaundice, pancreatitis, sepsis, fistula, and ileus.

• Gallbladder sludge is associated with symptoms and complications of gallstones; however, like gallstones, sludge usually does not cause problems.

• The best single test for diagnosing gallstones is transabdominal ultrasonography. Other tests include endoscopic ultrasonography, magnetic resonance cholangio-pancreatography (MRCP), cholescintigraphy (HIDA scan), endoscopic retrograde cholangio-pancreatography (ERCP), liver and pancreatic blood tests, duodenal drainage, oral cholecystogram (OCG), and intravenous cholangiogram (IVC).

• Gallstones are managed primarily with observation (no treatment) or removal of the gallbladder (cholecystectomy). Less commonly used treatments include sphincterotomy and extraction of gallstones, dissolution with oral medications, and extra-corporeal shock-wave lithotripsy (ESWL). Prevention of cholesterol gallstones also is possible with oral medications.

• Symptoms of gallstones should stop following cholecystectomy. If they do not, it is likely that gallstones were left in the ducts, there is a second problem within the bile ducts, or there is sphincter of Oddi dysfunction.

• Continuing research is directed at uncovering the genes that are responsible for the formation of gallstones.

What are gallstones?

Gallstones (often misspelled as gall stones, or gall stone) are stones that form in the gall (bile) within the gallbladder. (The gallbladder is a pear-shaped organ just below the liver that stores the bile secreted by the liver.)

• Bile is a watery liquid made by the cells of the liver that is important for digesting food in the intestine, particularly fat.
  
  
• Liver cells secrete the bile into small canals within the liver.
  
  
• The bile flows through the canals and into larger collecting ducts within the liver (the intrahepatic bile ducts).
  
  
• The bile then flows through the intrahepatic bile ducts out of the liver and into the extrahepatic bile ducts-first into the hepatic bile ducts, then into the common hepatic duct, and finally into the common bile duct.

From the common bile duct, there are two different directions that bile can flow.

• The first direction is the common bile duct and into the intestine where the bile mixes with food and promotes digestion of food.
  
  
• The second direction is into the cystic duct, and from there into the gallbladder (often misspelled as gall bladder).

Once in the gallbladder, bile is concentrated by the removal (absorption) of water. During a meal, the muscle that makes up the wall of the gallbladder contracts and squeezes the concentrated bile in the gallbladder back through the cystic duct into the common duct and then into the intestine. (Concentrated bile is much more effective for digestion than the un-concentrated bile that goes from the liver straight into the intestine.) The timing of gallbladder contraction-during a meal-allows the concentrated bile from the gallbladder to mix with food.

Gallstones usually form in the gallbladder; however, they also may form anywhere there is bile; in the intrahepatic, hepatic, common bile, and cystic ducts.

Gallstones also may move about in the bile, for example, from the gallbladder into the cystic or common duct.