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