Gallstones

Medical Author: Jay W. Marks, M.D.
Medical Editor: Dennis Lee, M.D.

• What are gallstones?
• What causes gallstones?
• Who is at risk for gallstones?
• What are the symptoms of gallstones?
• What are the complications of gallstones?
• What is the relationship of sludge to gallstones?
• How are gallstones diagnosed?
• What are the potential pitfalls of diagnosing gallstones?
• How are gallstones treated?
• Can gallstones be prevented?
• Can symptoms continue after gallstones are removed?
• What is new with gallstones?
• Gallstones At A Glance
• Patient Discussions: Gallstones - Symptoms Experienced

Gallstones' Bark Is Bigger Than Its Bite Medical Author: Jay W. Marks, MD Medical Editor: Dennis Lee, MD A patient came to see me for a second opinion about having his gallbladder removed surgically. Although the patient was anxious for the surgery, the referring physician had some doubts. I took a careful history from the patient, examined him, and reviewed the ultrasound study that had found his gallstones. There was no doubt that the patient had gallstones; the ultrasound was clear. What was not so clear was whether his gallstones were responsible for his most troublesome symptom. Gallstones usually, though not always, cause a characteristic type of abdominal pain referred to as biliary colic. Although the patient had had several episodes of pain that were fairly typical of gallstones, his most frequent and bothersome discomfort was not typical of biliary colic. It was more dyspeptic than biliary. That is, the discomfort was related to meals. (Although it is generally believed that pain from gallstones occurs mostly after meals, studies have shown that this is not so. The pain occurs most commonly in the evening after falling asleep.) I discussed my thoughts with the patient and concluded by telling him that although I thought his gallstones were causing pain, his most bothersome symptom was not likely to be caused by his gallstones. I had an uneasy feeling that he did not understand what I was telling him. "Doc, I’m so uncomfortable I've got to have this surgery." Read More » Top Searched Gallstones Terms: gallstone symptoms, gallbladder, gallbladder diet, gallstone treatment, gallbladder removal, gallstone causes, gallstone surgery, upset stomach

What are gallstones?

Gallstones are stones that form in the gall (bile).

• Bile is a watery liquid made by the cells of the liver that is important for digesting food in the intestine, particularly fat.
  
  
• Liver cells secrete the bile they make into small canals within the liver.
  
  
• The bile flows through the canals and into larger collecting ducts within the liver (the intrahepatic bile ducts).
  
  
• The bile then flows within the intrahepatic bile ducts out of the liver and into the extrahepatic bile ducts-first into the hepatic bile ducts, then into the common hepatic duct, and finally into the common bile duct.

From the common bile duct, there are two different directions that bile can flow.

• The first direction is on down the common bile duct and into the intestine where the bile mixes with food and promotes digestion of food.
  
  
• The second direction is into the cystic duct, and from there into the gallbladder (often misspelled as gall bladder).

Once in the gallbladder, bile is concentrated by the removal (absorption) of water. During a meal, the muscle that makes up the wall of the gallbladder contracts and squeezes the concentrated bile in the gallbladder back through the cystic duct into the common duct and then into the intestine. (Concentrated bile is much more effective for digestion than the un-concentrated bile that goes from the liver straight into the intestine.) The timing of gallbladder contraction-during a meal-allows the concentrated bile from the gallbladder to mix with food.

Gallstones usually form in the gallbladder; however, they also may form anywhere there is bile; in the intrahepatic, hepatic, common bile, and cystic ducts.

Gallstones also may move about within bile, for example, from the gallbladder into the cystic or common duct.

Gallstones - Symptoms Experienced

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