Gallstones form when bile stored in the gallbladder hardens into stone-like material. Too much cholesterol, bile salts, or bilirubin (bile pigment) can cause gallstones.

Gallstones don’t usually cause any symptoms. But if a gallstone blocks one of the bile ducts, it can cause sudden, severe abdominal pain, known as biliary colic.

Abdominal pain (biliary colic)

Gallstones can cause sudden, severe abdominal pain that usually lasts 1 to 5 hours, although it can sometimes last just a few minutes.

The pain can be felt:

  • In the center of your abdomen (tummy)
  • Just under the ribs on your right-hand side – it may spread from here to your side or shoulder blade

The pain is constant and isn’t relieved by going to the toilet, passing wind or being sick. 

It’s sometimes triggered by eating fatty foods, but may occur at any time of day and may wake you up during the night.

Other symptoms

Occasionally, gallstones can cause more serious problems if they obstruct the flow of bile for longer periods or move into other organs, such as the pancreas or small bowel.

If this happens, you may develop:

  • A high temperature of 38C or above
  • More persistent pain
  • A rapid heartbeat
  • Yellowing of the skin and whites of the eyes (jaundice)
  • Itchy skin
  • Diarrhoea
  • Chills or shivering attacks
  • Confusion
  • A loss of appetite

How are gallstones diagnosed?

In some cases, asymptomatic gallstones are discovered by accident–during testing for another diagnosis. However, when pain persists or happens again and again, your health care provider may want to conduct a complete medical history and physical examination, in addition to the following diagnostic procedures for gallstones:

  • Ultrasound. A diagnostic technique that uses high-frequency sound waves to create an image of the internal organs.
  • Cholecystography. X-ray that shows the flow of contrast fluid through the intestines into the gallbladder.
  • Blood tests. These look for signs of infection, obstruction, jaundice, and/or pancreatitis.
  • Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
  • Endoscopic retrograde cholangiopancreatography (ERCP). A procedure that involves inserting an endoscope (viewing tube) through the stomach and into the small intestine. A special dye injected during this procedure shows the ducts in the biliary system.
  • Sphincterotomy. Opening the muscle sphincter, a ring of muscle around a natural opening that acts like a valve, wide enough so stones can pass into the intestine.

When to get medical advice

Make an appointment to see your doctor if you think you may have biliary colic.

Contact your Doctor immediately for advice if you develop:

  • Jaundice
  • Abdominal pain lasting longer than 8 hours
  • A high temperature and chills
  • Abdominal pain so intense that you can’t find a position to relieve it

Treatment for gallstones

Specific treatment for gallstones will be determined by your health care provider based on:

  • Age, overall health, and medical history
  • Extent of the condition
  • Your tolerance of specific medicines, procedures, or therapies
  • Expectations for the course of the condition
  • Your opinion or preference

If the gallstones cause no symptoms, treatment is usually not necessary. However, if pain persists, treatment may include:

  • Gallbladder removal (cholecystectomy). Once removed, the bile flows directly from the liver to the small intestine. Side effects of this may include diarrhea because the bile is no longer stored in the gallbladder.
  • Oral dissolution therapy. Drugs made from bile acid are used to dissolve the stones.
  • Methyl-tert-butyl ether. A solution injected into the gallbladder to dissolve stones.
  • Extracorporeal shockwave lithotripsy (ESWL). A procedure that uses shock waves to break stones up into tiny pieces that can pass through the bile ducts without causing blockages.
  • Contact dissolution therapy. An experimental procedure that involves injecting a drug directly into the gallbladder to dissolve the stones.

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  • Johns Hopkins Medicine