Gallstones

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Medical Author:

Jay W. Marks, MD

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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Medical Editor:

Dennis Lee, MD

Dennis Lee, MD

Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.

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• Gallstones are "stones" that form in the gallbladder or bile ducts.

• The common types of gallstones are cholesterol, black pigment, and brown pigment.

• Cholesterol gallstones occur more frequently in several ethnic groups and are associated with female gender, obesity, pregnancy, oral hormonal therapy, rapid loss of weight, elevated blood triglyceride levels, and Crohn's disease.

• Black pigment gallstones occur when there is increased destruction of red blood cells, and brown pigment gallstones occur when there is slow flow and infection of bile.

• The majority of gallstones do not cause symptoms.

• The most common symptoms of gallstones are biliary colic and cholecystitis. Gallstones do not cause intolerance to fatty foods, belching, abdominal distention, or gas.

• Complications of gallstones include cholangitis, gangrene, jaundice, pancreatitis, sepsis, fistula, and ileus.

• Gallbladder sludge is associated with symptoms and complications of gallstones; however, like gallstones, sludge usually does not cause problems.

• The best single test for diagnosing gallstones is transabdominal ultrasonography. Other tests include endoscopic ultrasonography, magnetic resonance cholangio-pancreatography (MRCP), cholescintigraphy (HIDA scan), endoscopic retrograde cholangio-pancreatography (ERCP), liver and pancreatic blood tests, duodenal drainage, oral cholecystogram (OCG), and intravenous cholangiogram (IVC).

• Gallstones are managed primarily with observation (no treatment) or removal of the gallbladder (cholecystectomy). Less commonly used treatments include sphincterotomy and extraction of gallstones, dissolution with oral medications, and extra-corporeal shock-wave lithotripsy (ESWL). Prevention of cholesterol gallstones also is possible with oral medications.

• Symptoms of gallstones should stop following cholecystectomy. If they do not, it is likely that gallstones were left in the ducts, there is a second problem within the bile ducts, or there is sphincter of Oddi dysfunction.

• Continuing research is directed at uncovering the genes that are responsible for the formation of gallstones.