Gallstone | |
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Other names | Gallstone disease, cholelith, cholecystolithiasis (gallstone in the gallbladder), choledocholithiasis (gallstone in a bile duct)[1] |
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Gallstones typically form in the gallbladder and may result in symptoms if they block the biliary system. | |
Pronunciation |
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Specialty | Gastroenterology General surgery |
Symptoms | None, crampy pain in the right upper abdomen[2][3][4] |
Complications | Inflammation of the gallbladder, inflammation of the pancreas, liver inflammation[2][4] |
Usual onset | After 40 years old[2] |
Risk factors | Birth control pills, pregnancy, family history, obesity, diabetes, liver disease, rapid weight loss[2] |
Diagnostic method | Based on symptoms, confirmed by ultrasound[2][4] |
Prevention | Healthy weight, diet high in fiber, diet low in simple carbohydrates[2] |
Treatment | Asymptomatic: none,[2] ursodeoxycholic acid (UDCA) and Chenodeoxycholic acid Pain: surgery ERCP, Cholecystectomy[2] |
Prognosis | Good after surgery[2] |
Frequency | 10–15% of adults (developed world)[4] |
A gallstone is a stone formed within the gallbladder from precipitated bile components.[2] The term cholelithiasis may refer to the presence of gallstones or to any disease caused by gallstones,[5] and choledocholithiasis refers to the presence of migrated gallstones within bile ducts.
Most people with gallstones (about 80%) are asymptomatic.[2][3] However, when a gallstone obstructs the bile duct and causes acute cholestasis, a reflexive smooth muscle spasm often occurs, resulting in an intense cramp-like visceral pain in the right upper part of the abdomen known as a biliary colic (or "gallbladder attack").[4] This happens in 1–4% of those with gallstones each year.[4] Complications from gallstones may include inflammation of the gallbladder (cholecystitis), inflammation of the pancreas (pancreatitis), obstructive jaundice, and infection in bile ducts (cholangitis).[4][6] Symptoms of these complications may include pain that lasts longer than five hours, fever, yellowish skin, vomiting, dark urine, and pale stools.[2]
Risk factors for gallstones include birth control pills, pregnancy, a family history of gallstones, obesity, diabetes, liver disease, or rapid weight loss.[2] The bile components that form gallstones include cholesterol, bile salts, and bilirubin.[2] Gallstones formed mainly from cholesterol are termed cholesterol stones, and those formed mainly from bilirubin are termed pigment stones.[2][3] Gallstones may be suspected based on symptoms.[4] Diagnosis is then typically confirmed by ultrasound.[2] Complications may be detected using blood tests.[2]
The risk of gallstones may be decreased by maintaining a healthy weight with exercise and a healthy diet.[2] If there are no symptoms, treatment is usually not needed.[2] In those who are having gallbladder attacks, surgery to remove the gallbladder is typically recommended.[2] This can be carried out either through several small incisions or through a single larger incision, usually under general anesthesia.[2] In rare cases when surgery is not possible, medication can be used to dissolve the stones or lithotripsy can be used to break them down.[7]
In developed countries, 10–15% of adults experience gallstones.[4] Gallbladder and biliary-related diseases occurred in about 104 million people (1.6% of people) in 2013 and resulted in 106,000 deaths.[8][9] Gallstones are more common among women than men and occur more commonly after the age of 40.[2] Gallstones occur more frequently among certain ethnic groups than others.[2] For example, 48% of Native Americans experience gallstones, whereas gallstone rates in many parts of Africa are as low as 3%.[10][2] Once the gallbladder is removed, outcomes are generally positive.[2]
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