• Digestive Disorders

Recognizing the Symptoms of Gallstones

Medically reviewed and edited by Samantha Wannos, FNP-C

Gallstones are a relatively common condition that affects around 10% of adults in the U.S, but many of these individuals may never receive a diagnosis or require treatment.

Although this condition is generally not cause for concern, it’s important to know when to seek medical care.

This can help you avoid prolonged discomfort and severe health conditions that could significantly affect your quality of life. 

In this article, we’ll cover everything you need to know about gallstones, including symptoms, treatment, and prevention strategies to help you stay healthy. 

What are Gallstones?

Gallstones are deposits of digestive fluid that harden and form pebble-like particles in the gallbladder. 

These stones vary in size, ranging from as small as a grain of sand to as large as a golf ball. 

They usually develop when there is an imbalance in the composition of stomach bile – the digestive fluid produced by the liver. 

There are two main types of gallstones:

• Cholesterol stones: These are the most common type of gallstones, primarily composed of hardened cholesterol that was not digested.

• Pigment stones: These stones are smaller and darker and contain bilirubin – a substance produced when red blood cells break down. Pigment stones are more prevalent in individuals with medical conditions – such as cirrhosis or blood disorders – that cause elevated bilirubin levels.

Common gallstone symptoms 

Many individuals with gallstones are asymptomatic and may not even know they have them. 

However, if a gallstone blocks a common bile duct in the liver, it can cause mild to severe symptoms — known as a gallstone attack. These symptoms may include:

• Pain in the upper right-hand side of the abdomen 

• Abdominal pain that radiates to the back or right shoulder blade

• Nausea and vomiting

• Bloating, especially after eating a fatty meal 

• Indigestion, including heartburn and excessive gas

How Do Gallstones Develop?

There are two common causes of gallstones: an imbalance in bile composition and a gallbladder that doesn’t function properly. Let’s take a closer look at these causes.

Imbalanced bile composition 

The primary reason for gallstones is a chemical imbalance in the composition of stomach bile. This substance is composed of compounds like cholesterol, bilirubin, and bile salts.

An imbalance in these compounds can occur because of:

• Excess cholesterol that can’t be dissolved by bile salts, which causes a buildup 

• Excess bilirubin in the bile, which is typically a result of medical conditions

These factors can cause bile to crystallize and form gallstones. 

Improper gallbladder function

The gallbladder is responsible for concentrating and storing bile. However, if the gallbladder does not empty completely or frequently enough, the bile may become too concentrated.

This can cause cholesterol and bilirubin to crystalize, causing gallstones.

Who is most likely to develop gallstones?

Several risk factors can increase the likelihood of developing gallstones, including:

• Having a high body mass index (BMI) or obesity

• Following a diet rich in cholesterol and refined carbohydrates and low in fiber

• Age and gender

• Genetic factors 

• Health conditions like diabetes, metabolic syndrome, and certain liver diseases 

• Rapid weight loss

If you’ve experienced any of these factors, consult your doctor about your risk of developing gallstones. 

How are Gallstones Diagnosed?

Only a healthcare professional can accurately diagnose gallstones through detailed evaluations and imaging tests. 

The diagnostic process may involve:

• Clinical evaluations: During this step, your doctor will ask about your symptoms, medical history, and lifestyle habits to assess potential risk factors. They may also perform a physical examination to check for signs of jaundice or unusual tenderness around the abdomen.

• Blood tests: The next step is to have a blood test done to measure bilirubin, liver enzymes, and other substances that may indicate gallstones. 

• Imaging tests: If gallstones are suspected, your doctor may recommend imaging tests — like an ultrasound, CT scan, or MRI — to create a visual picture of the gallbladder. This allows them to pinpoint the gallstones and identify any additional abnormalities. 

Depending on the results of these tests, your doctor will recommend appropriate treatment options to help you manage your gallstones.

What are the Treatment Options for Gallstones?

Treatment for gallstones largely depends on their size and the severity of the symptoms they cause.

Nonsurgical treatments

Nonsurgical treatments are generally considered for individuals who can’t undergo surgery due to certain health issues. They may also be recommended for people with smaller stones.

These treatments may include:

• Medications: Oral bile acid pills — such as ursodeoxycholic acid or chenodeoxycholic acid — can dissolve cholesterol gallstones. These medications reduce cholesterol released by the liver and in the stones. 

• Shock wave lithotripsy (SWL): This method uses high-energy sound waves to break gallstones into smaller pieces that can be easily passed through the bile ducts. It’s typically used for patients who have small gallstones.

• Endoscopic retrograde cholangiopancreatography (ERCP): While primarily a diagnostic tool, ERCP can also be used to remove gallstones located in the bile ducts. During this procedure, a flexible tube with a camera is inserted through the mouth, down the stomach, and into the small intestine to access and clear the bile ducts.

Surgical treatments 

Surgery is the most common and effective treatment for gallstones that cause symptoms. The standard procedure is called a cholecystectomy, which involves the removal of the gallbladder.

There are three types of cholecystectomies:

• Laparoscopic cholecystectomy: This is the most common gallstone surgery and it involves making several small incisions in the abdomen to insert a laparoscope — a small, lighted camera — and other surgical tools. The gallbladder is then removed through one of the incisions. This method is less invasive and has a shorter recovery time compared to other surgical options.

• Open cholecystectomy: In cases where laparoscopic surgery isn’t possible or safe, an open cholecystectomy may be performed. This procedure involves making a larger incision in the abdomen to remove the gallbladder. Recovery from open cholecystectomy usually takes longer, and the surgery carries a higher risk of complications.

• Robotic cholecystectomy: This is a modern approach that uses robotic systems to assist the surgeon with the procedure. It provides more precision and flexibility than traditional laparoscopic surgery and is useful in more complex cases.

Can Gallstones Be Prevented?

While not all gallstones can be prevented, many risk factors can be reduced by making dietary and lifestyle changes. 

This can significantly decrease your likelihood of developing gallstones.

Dietary changes

An unhealthy diet can cause elevated cholesterol levels, which is a common risk factor for gallstones. To avoid this, make the following adjustments:

• Increase dietary fiber: A diet rich in fiber can help reduce the risk of gallstones by aiding the digestive process and reducing cholesterol levels. To increase your fiber intake, eat plenty of fruits, vegetables, whole grains, and legumes.

• Limit fats: Reduce the intake of saturated fats found in red and processed meat and dairy products. Opt for healthier fats — like those in olive oil, avocados, and nuts — which can help maintain healthy bile chemistry and support your overall well-being.

• Moderate sugar intake: High sugar consumption can contribute to obesity, which is a gallstone risk factor. Limit foods and beverages high in refined sugars, such as sodas, candies, and takeout.

• Eat lean proteins: Incorporate lean protein sources — like fish, poultry, and plant-based proteins — which are easier on your gallbladder than high-fat meats.

• Stay hydrated: Drinking plenty of water throughout the day helps keep the bile in your gallbladder fluid and less prone to forming gallstones.

Lifestyle adjustments 

Some lifestyle habits can also increase your risk of gallstones. Preventing this may involve making changes such as:

• Reducing your weight: Obesity significantly increases the risk of developing gallstones. Aim to maintain a healthy body weight by following a balanced diet and exercising regularly.

• Avoid fasting or skipping meals: Skipping meals or fasting can increase the risk of gallstones because it can cause bile to remain in the gallbladder for longer. This may increase your risk of developing gallstones and additional health complications.

When Should You See a Doctor About Gallstones?

While gallstones don’t always cause symptoms, it’s important to know which signs to look out for that may require medical intervention.

Consult your doctor immediately if you develop any of the following symptoms:

• Signs of a gallbladder attack, including severe and sudden abdominal pain, back pain between your shoulder blades, and nausea or vomiting

• Signs of jaundice, such as yellowing skin and eyes

• High fever with chills 

• Persistent pain that lasts for more than a few hours

These symptoms may indicate a severe case of gallstones that requires prompt medical treatment. 

Where Can You Learn More About Managing Gallstones?

If you’re concerned about your symptoms or want to know more about managing gallstones, LifeMD can help.

A team of medical professionals can assist you with medications, prescriptions, and advice on coping with the painful or uncomfortable gallstones symptoms.

We can also refer you to a trusted specialist if gallstone or gallbladder removal becomes necessary. 

Make your online appointment today.

Samantha Wannos, FNP-C

Samantha has 10 years of critical care experience and approximately six years of internal medicine experience. She is skilled in helping patients manage a multitude of chronic health conditions. In her free time, Samantha enjoys spending time with her husband and children, going boating, and attending concerts.

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