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Posted by Shawn Bishop (@Shawngbishop) · Jul 15, 2011

Gallstones Without Symptoms Don't Require Treatment

Gallstones Without Symptoms Don't Require Treatment

July 15, 2011

Dear Mayo Clinic:

I have heard that sometimes people have gallstones and don't even know it, while others have severe pain because of them. Am I at greater risk if some of my family members have had them? How will I know if I have gallstones?

Answer:

It is true that even if you develop gallstones — a condition in which digestive fluid hardens into pebble-like deposits — you might not even notice. In fact, many are discovered by chance during an abdominal X-ray or ultrasound exam for some other reason. That's because in most patients, gallstones do not cause symptoms.

In other cases, though, you know all too well that something's wrong. Gallstones can cause attacks of pain, known as gallbladder attacks, in your upper abdomen or chest. You might even feel like you're having a heart attack.

Your gallbladder is a pear-shaped sac that sits beneath your liver. The gallbladder's main job is to store bile — a thick, greenish-brown liquid that's produced by the liver. After you eat, your gallbladder contracts, pushing bile through a small tube called the common bile duct into the upper portion of your small intestine.

There, the bile helps your body absorb fats, cholesterol and certain vitamins. Gallstones form when components of bile harden into crystals. Most gallstones are made of cholesterol. A less common type, pigment gallstones, forms out of bilirubin — a waste product. It is possible to have just one gallstone or hundreds, ranging in size from a grain of sand to a golf ball.

Gallstones may form because of changes in the composition of bile, such as an increased amount or proportion of cholesterol. In other cases, the gallbladder muscle loses some of its squeezing power, so it doesn't empty completely. Infection and inflammation also can damage the gallbladder and trigger the development of gallstones.

Gallstones are twice as common in women as in men and usually appear after age 40. American Indian and Mexican-American women have high rates of gallstones, while women of Asian or African ancestry are less likely to have them.

Other factors that may increase your risk of cholesterol gallstones include:

  • Obesity and excess weight
  • Pregnancy
  • High-fat, high-cholesterol or low-fiber diet
  • Family history of gallstones
  • Diabetes
  • Liver disease
  • Crohn's disease
  • Rapid weight loss
  • Certain cholesterol-lowering medications
  • Medications that contain estrogen, such as hormone therapy drugs and oral contraceptives

You can reduce your risk of developing gallstones by maintaining a healthy weight, losing excess weight slowly (1 or 2 pounds a week), and eating three balanced meals a day.

Gallstones usually settle at the bottom of your gallbladder, where they're unlikely to cause problems. Symptoms may arise if a stone migrates up the neck of the gallbladder and blocks the flow of bile out of the gallbladder or through the bile duct.

A blocked gallbladder or bile duct can cause intense pain in your abdomen that may extend to your shoulder blade, chest or arm. The pain usually lasts from 30 minutes to several hours and is sometimes accompanied by nausea and vomiting.

A gallbladder attack often subsides as the stones move. But if the blockage persists, your gallbladder can become inflamed or infected. If this happens, the pain in your right upper abdomen may become severe, and the area may feel extremely tender to the touch. You might have a fever, with sweating or chills. This condition is called acute cholecystitis and requires treatment in a hospital, where you'll likely receive fluids, pain relievers and antibiotics intravenously.

Treatment also includes surgery to remove the gallbladder (cholecystectomy), usually within 24 to 48 hours. Other serious complications can occur if a stone blocks the outflow of bile, causing jaundice. Sometimes a stone leaving the gallbladder enters the bile duct and triggers inflammation of the pancreas (acute pancreatitis).

If you think you've had a gallbladder attack, see your doctor. Seek medical attention immediately if the pain is persistent and severe, if you have a fever or chills, or if your skin or the whites of your eyes are yellowish.

Gallstones typically are diagnosed with lab tests, including a complete blood count and liver function studies, and with abdominal ultrasound. If gallstones have moved into the bile duct, a flexible viewing tube (endoscope) can be passed through your mouth and into your small intestine. This allows your doctor to locate the stones and then remove them using small surgical instruments passed through the tube.

If your gallstones aren't causing any symptoms, you do not need treatment. Your doctor may simply recommend staying alert for symptoms of complications. If you have one gallbladder attack, however, you're likely to have another one. If you have frequent attacks, your doctor will likely recommend that you have your gallbladder removed.

After your gallbladder is removed, bile flows directly from your liver into your small intestine. You'll still be able to digest food. Rarely, stools become more frequent and looser following the surgery and can be an ongoing issue.

Whether you find out accidentally that you have gallstones or experience a sudden gallbladder attack, treatment can resolve the problem. You'll be able to get back to your usual activities, with or without a gallbladder.

— John Poterucha, M.D., Gastroenterology, Mayo Clinic, Rochester, Minn.

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