Gallstones

Digestive Cholelithiasis

Hardened lumps that form in the gallbladder and cause pain when they block the flow of bile, especially after fatty meals.

Educational summary only — not medical advice, and no substitute for assessment by a clinician. Diagrams are simplified illustrations.

Stones form in the gallbladder; pain begins when one jams the neck or duct and bile can't drain.

Overview

Gallstones are hardened deposits — most often made of cholesterol — that form inside the gallbladder, a small pear-shaped pouch tucked under the liver. Gallstones are very common and frequently cause no symptoms at all. Problems arise when a stone blocks the flow of bile, the fluid the body uses to digest fat.

How the system normally works

The liver continuously makes bile, which the gallbladder stores and concentrates. When you eat — especially fatty food — the gallbladder squeezes, pushing bile down the cystic duct and into the common bile duct, which empties into the small intestine to help break down fat.

What goes wrong

When bile contains too much cholesterol, stones can form. Pain (biliary colic) happens when the gallbladder contracts against a stone blocking its outlet — the pressure builds and produces a deep, gripping ache. If the stone stays stuck, the gallbladder wall becomes inflamed and infected (cholecystitis). A stone that escapes into the common bile duct can block bile drainage entirely, or plug the nearby pancreas outlet and trigger pancreatitis.

Diagram of acute cholecystitis: a stone stuck in the gallbladder neck with a thickened, inflamed gallbladder wall. — When a stone jams the gallbladder's neck and stays there, the trapped, irritated gallbladder wall becomes thickened and inflamed — acute cholecystitis.

Symptoms and why they happen

Upper-right belly pain, often after fatty meals — the gallbladder straining against a blockage.
Pain spreading to the right shoulder blade — referred along shared nerves.
Nausea and vomiting.
Fever — suggests inflammation/infection has set in.
Yellow eyes/skin (jaundice) and dark urine — bile backing up because the main duct is blocked.

Causes and risk factors

Often remembered as the “four F's”: Female, Fat (overweight), Forty (older), and Fertile (pregnancy). Other factors include rapid weight loss, a high-cholesterol diet, diabetes, and family history.

How it's diagnosed

Ultrasound is the first and best test — it readily shows stones and a thickened, inflamed gallbladder wall. Blood tests check for infection, liver irritation, and pancreas involvement. If a duct stone is suspected, specialized scans (MRCP) or an endoscopic procedure (ERCP) can find and remove it.

Diagram of a gallstone blocking the common bile duct, causing bile to back up toward the liver. — If a stone escapes into the common bile duct, bile backs up toward the liver — causing jaundice and, if it blocks the pancreas outlet, pancreatitis.

Treatment and management

Silent stones usually need no treatment. For repeated attacks or cholecystitis, the standard cure is keyhole removal of the gallbladder (laparoscopic cholecystectomy) — you can live normally without it. Stones lodged in the common bile duct are commonly removed with ERCP, a scope passed down to the duct.

Possible complications

Untreated, gallstones can lead to a severely infected gallbladder, a blocked bile duct with jaundice and infection (cholangitis), or gallstone pancreatitis — all of which can become serious.

Prevention and outlook

Maintaining a healthy weight, avoiding crash diets, and eating a balanced, lower-fat diet reduce risk. After gallbladder removal the outlook is excellent; most people digest normally, though some notice looser stools with very fatty meals.

When to seek emergency care

Belly pain with fever and chills — possible gallbladder or bile-duct infection.
Yellowing of the eyes or skin, dark urine, pale stools — a blocked main bile duct.
Severe, constant pain wrapping to the back with vomiting — possible pancreatitis.