What are Gallstones?
Written by: Chanté Grant
Updated: January 30th, 2023
Many of us have heard of the term gallstones, but how much do we actually know about this disease? Whether you may be experiencing symptoms yourself, asking for a friend or concerned for a family member, we’re here to answer all of your questions!
What is the Gallbladder?
The gallbladder forms part of the biliary system, along with your liver and small intestine. Excess bile (a fluid made up of cholesterol, bile salts, phospholipids, bilirubin, electrolytes and water that helps with digestion) is created in the liver and gets transferred to the gallbladder where it is stored (1). The hormone cholecystokinin (CCK) triggers the gallbladder to secrete bile through the cystic duct, where it transfers it to the common bile duct. Finally, the bile travels to the small intestine (duodenum) where it breaks down large fat food particles (2).
Bile Function:
Foods that are high in fat are typically harder for the small intestine to absorb when being digested. This is when the hormone CCK triggers the gallbladder to contract and release bile. The bile works to combine the fats and breaks food particles into smaller, easy to digest pieces. Bile also helps the body eliminate excess cholesterol out of the body when you poop! (3).
Gallstone Disease:
Gallstones, also called cholelithiasis, are little stone-like clumps that develop in the gallbladder. Gallstones can block the cystic duct that leads to the common bile duct. This occurrence is referred to as biliary colic and can lead to severe pain, liver complications, bacterial infection, gallbladder inflammation and acute pancreatitis. Some gallstones can be very small and/or go undetected. These small gallstones don’t block any major ducts and cause virtually no symptoms.
There are two main types of gallstones: cholesterol stones and bilirubin (pigment) stones.
What’s the Difference Between Cholesterol and Pigment Stones?
Cholesterol Stones:
Cholesterol stones are the main type of gallstones found within gallstone disease patients. If there is a high amount of cholesterol found in the bloodstream, this may lead to a more cholesterol dense bile. When the bile is oversaturated with cholesterol, other bile chemicals struggle to balance out the bile contents. As a result, cholesterol stone-like formations may occur in the gallbladder. Those who suffer from obesity and diabetes often experience increased levels of cholesterol, leading to an increased likelihood of developing cholesterol stones.
Bilirubin (Pigment) Stones:
Bilirubin stones, also called pigment stones, are made up of bilirubin (a substance made from red blood cells) which is found in bile. Bilirubin stones occur when there is a higher-than-normal amount of bilirubin found in the gallbladder. Red blood cell disorders, infection, chronic illness and liver disease can all lead to bilirubin formation occurring in the gallbladder (4).
Symptoms of Gallstones:
It is important to consider that certain gallstone cases do not have any present or overt pain related symptoms. However, symptoms may include (5):
- Pain in the upper right abdomen
- Pain just under your chest area
- Back pain in the shoulder area
- Nausea
- Vomiting
- Indigestion
How Gallstones are Diagnosed:
If a doctor suspects you have gallstones, they may recommend you take the following test(s) to diagnose the presence of gallstones (6):
- Abdominal ultrasonography
- Abdominal CT
- HIDA (hepatobiliary iminodiacetic acid) scan
- ERCP (endoscopic retrograde cholangiopancreatogram)
- MRCP (magnetic resonance cholangiopancreatography)
Complications of Gallstones
Some people with gallstone may develop other complications, such as:
Acute Pancreatitis: Acute Pancreatitis occurs when gallstones get lodged in the pancreatic duct. Gallstones, along with high alcohol consumption, are the two main causes of this disease (7).
Bacterial Cholangitis: A lodged gallstone can lead to a bacterial infection called bacterial cholangitis. This is a potentially deadly illness with symptoms such as a fever, pain, septic shock, confusion and jaundice (8).
Cholecystitis: Cholecystitis occurs when a gallstone gets stuck in a cystic duct for a long period of time. The lodged gallstone can cause an inflamed gallbladder, leading to other possible health complications. Cholecystitis is considered a gastrointestinal emergency (9).
Jaundice: Jaundice is a disorder that occurs when a high amount of bilirubin is present in the blood. If gallstone build up is blocking the common bile duct, regular bile release from the liver to the gallbladder will stop. This can lead to jaundice and/or liver damage. Yellow skin and the yellowing of the whites of the eyes are tell-tale signs of jaundice (10).
Gallstone Treatment Options:
Gallstone treatment options include both noninvasive treatments and in severe instances, surgery treatments. Noninvasive treatments include:
- Shock-Wave Lithotripsy: High-amplitude sound waves that break down gallstones.
- Ursodeoxycholic Acid: An oral bile pill that helps soften gallstones.
More severe cases may require surgical intervention.
As always, speak to a doctor if you suspect you are experiencing signs and symptoms of gallstones.
References:
- Hundt M., Basit H., John S. Physiology, Bile Secretion. [Updated 2022 Sep 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470209/
- Rolfes, S., Pinna, K., Whitney, E. (2020). Understanding Normal & Clinical Nutrition: 12th Edition. Cengage.
- Patton, K. T., Thibodeau, G.A. (2019). Structure & Function of the Body: 16th Edition. Elsevier.
- Cleveland Clinic. (2022, June). Gallstones. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/7313-gallstones
- Hopkins Medicine (2023). https://www.hopkinsmedicine.org/health/conditions-and-diseases/gallstones
- Portincasa, P., Moschetta, A., Palasciano, G. (2006). Cholesterol gallstone disease. The Lancet. 368(9531) 230-239. https://doi.org/10.1016/S0140-6736(06)69044-2
- Bartel, M. (2022, September). Acute Pancreatitis. Merck Manual. https://www.merckmanuals.com/en-ca/professional/gastrointestinal-disorders/pancreatitis/acute-pancreatitis
- Zimmer, V., & Lammert, F. (2015). Acute Bacterial Cholangitis. Viszeralmedizin, 31(3), 166–172. https://doi.org/10.1159/000430965
- Jones, M.W., Genova, R., O’Rourke, M.C. Acute Cholecystitis. [Updated 2022 Oct 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459171/
- NHS. (2023, January). Gallstones. NHS Inform. https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/gallstones#:~:text=If%20a%20gallstone%20passes%20out,dark%20brown%20urine
