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National Digestive Diseases Information Clearinghouse
Gallstones form when liquid stored in thegallbladder hardens into pieces of stone- like material. The liquid, called bile, is National
used to help the body digest fats. Bile is Institute of
made in the liver, then stored in the gall- Diabetes and

bladder until the body needs to digest fat.
and Kidney
At that time, the gallbladder contracts and Diseases
pushes the bile into a tube—called a duct— NATIONAL
that carries it to the small intestine, where INSTITUTES

Bile contains water, cholesterol, fats, bilesalts, and bilirubin. Bile salts break up fat, and bilirubin gives bile and stool a brown- ish color. If the liquid bile contains toomuch cholesterol, bile salts, or bilirubin, itcan harden into stones.
the cystic and hepatic ducts to the small The two types of gallstones are cholesterol intestine. Bile trapped in these ducts can cause inflammation in the gallbladder, the ducts, or, rarely, the liver. Other ducts open made primarily of hardened cholesterol.
gallstones. Pigment stones are small, dark enzymes out of the pancreas. If a gallstone stones made of bilirubin. Gallstones can be blocks the opening to that duct, digestive as small as a grain of sand or as large as a golf ball. The gallbladder can develop just creas and cause an extremely painful inflam- one large stone, hundreds of tiny stones, Gallstones can block the normal flow of bileif they lodge in any of the ducts that carry bile from the liver to the small intestine.
That includes the hepatic ducts, which carry bile out of the liver; the cystic duct, which takes bile to and from the gallbladder; and the common bile duct, which takes bile from If any of these ducts remain blocked for a or birth control pills appears to increase significant period of time, severe—possibly signs of a serious problem are fever, jaun- • Ethnicity. Native Americans have a
genetic predisposition to secrete highlevels of cholesterol in bile. In fact, they What Causes Gallstones?
have the highest rates of gallstones inthe United States. A majority of Native Cholesterol Stones
Scientists believe cholesterol stones form too much bilirubin, or not enough bile salts, or when the gallbladder does not empty as Pigment Stones
Gender. Women between 20 and
The cause of pigment stones is uncertain.
They tend to develop in people who havecirrhosis, biliary tract infections, and heredi- • Age. People over age 60 are more likely
tary blood disorders such as sickle cell anemia.
to develop gallstones than youngerpeople.
Other Factors
Cholesterol-lowering drugs. Drugs that
lower cholesterol levels in blood actually contribute to gallstones have been identi- fied, especially for cholesterol stones.
Diabetes. People with diabetes gener-
ally have high levels of fatty acids called • Obesity. Obesity is a major risk factor
triglycerides. These fatty acids increase large clinical study showed that beingeven moderately overweight increases • Rapid weight loss. As the body metabo-
one’s risk for developing gallstones. The lizes fat during rapid weight loss, it causes the liver to secrete extra cholesterol into to reduce the amount of bile salts in bile, • Fasting. Fasting decreases gallbladder
also decreases gallbladder emptying.
Estrogen. Excess estrogen from preg-
What Are the Symptoms?
Symptoms of gallstones are often called a
Who Is at Risk for
gallstone “attack” because they occur sud- Gallstones?
• Steady, severe pain in the upper abdo- men that increases rapidly and lastsfrom 30 minutes to several hours.
• Pain in the back between the shoulder Gallstone attacks often follow fatty meals, and they may occur during the night. Other • Recurring intolerance of fatty foods.
How Are Gallstones
Many gallstones, especially silent stones, are discovered by accident during tests for otherproblems. But when gallstones are sus- doctor is likely to do an ultrasound exam.
Ultrasound uses sound waves to createimages of organs. Sound waves are sent toward the gallbladder through a handheld abdomen. The sound waves bounce off thegallbladder, liver, and other organs, and • Yellowish color of the skin or whites their echoes make electrical impulses that monitor. If stones are present, the soundwaves will bounce off them, too, showing Many people with gallstones have no symp- toms. These patients are said to be asymp-tomatic, and these stones are called “silentstones.” They do not interfere in gallblad-der, liver, or pancreas function and do notneed treatment.
The standard surgery is called laparoscopiccholecystectomy. For this operation, the sur- • Cholecystogram or cholescintigraphy.
geon makes several tiny incisions in the abdo- men and inserts surgical instruments and a miniature video camera into the abdomen. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a closeup view of the organs and tissues. While watching the monitor, the surgeon uses the instruments to carefully separate the gallbladder • Endoscopic retrograde
from the liver, ducts, and other structures. Then cholangiopancreatography (ERCP).
the cystic duct is cut and the gallbladder re- moved through one of the small incisions.
scope—a long, flexible, lighted tubeconnected to a computer and TV Because the abdominal muscles are not cut during laparoscopic surgery, patients have less pain and fewer complications than they would have had after surgery using a large incision volves only one night in the hospital, followed by several days of restricted activity at home.
If the surgeon discovers any obstacles to the • Blood tests. Blood tests may be used
laparoscopic procedure, such as infection or scarring from other operations, the operating team may have to switch to open surgery. In some cases the obstacles are known before surgery, and an open surgery is planned. It is called “open” surgery because the surgeon has to make a 5- to 8-inch incision in the abdomen to remove the gallbladder. This is a majorsurgery and may require about a 2- to 7-daystay in the hospital and several more weeks at What Is the Treatment?
home to recover. Open surgery is required inabout 5 percent of gallbladder operations.
Surgery to remove the gallbladder is the
The most common complication in gallbladder surgery is injury to the bile ducts. An injured common bile duct can leak bile and cause a painful and potentially dangerous infection.
gallbladder surgery. The surgery is called nonsurgically. Major injury, however, is more serious and requires additional surgery.
Nonsurgical Treatment
Nonsurgical approaches are used only in
Don’t People Need Their
special situations—such as when a patient’s Gallbladders?
condition prevents using an anesthetic—and only for cholesterol stones. Stones recur after nonsurgical treatment about half the won’t even require a change in diet.
Once the gallbladder is removed, bileflows out of the liver through the hepatic • Oral dissolution therapy. Drugs made
stored in the gallbladder, it flows into the • Contact dissolution therapy. This
experimental procedure involvesinjecting a drug directly into the gall- If gallstones are in the bile ducts, the sur- before or during the gallbladder surgery.
stones in 1 to 3 days, but it must be used Once the endoscope is in the small intestine, the surgeon locates the affected bile duct.
An instrument on the endoscope is used to cut the duct, and the stone is captured in a tiny basket and removed with the endoscope.
This two-step procedure is called ERCP with • Extracorporeal shockwave lithotripsy
(ESWL). This treatment uses shock
waves to break up stones into tiny
Occasionally, a person who has had a chole- cystectomy is diagnosed with a gallstone in the bile ducts weeks, months, or even years tacks of biliary colic (intense pain) are procedure is usually successful in removing ing stones can sometimes be dissolvedwith medication.
National Digestive Diseases
Points To Remember
Information Clearinghouse
The National Digestive Diseases Information Clearinghouse (NDDIC) is a service of the National Institute of Diabetes and Digestive part of the National Institutes of Health Human Services. Established in 1980, theclearinghouse provides information about digestive diseases to people with digestive disorders and to their families, health care swers inquiries; develops, reviews, and distrib- utes publications; and works closely with professional and patient organizations andGovernment agencies to coordinate resourcesabout digestive diseases.
Publications produced by the clearinghouseare carefully reviewed for scientific accuracy,content, and readability.
This publication is not copyrighted.
The clearinghouse encourages users ofthis fact sheet to duplicate anddistribute as many copies as desired.
This publication is also available at<>.
U.S. DEPARTMENT OF HEALTHAND HUMAN SERVICESNational Institutes of Health NIH Publication No. 99–2897January 1999


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