Gallstones

Gallstones are solid particles that form from bile in the gallbladder.

• The gallbladder is a small saclike organ in the upper right part of the abdomen. It is located under the liver, just below the front rib cage on the right side.
  
• The gallbladder is part of the biliary system, which includes the liver and the pancreas.
  
• The biliary system, among other functions, produces bile and digestive enzymes.

Bile is a fluid made by the liver to help in the digestion of fats.

• It contains several different substances, including cholesterol and bilirubin, a waste product of normal breakdown of blood cells in the liver.
  
• Bile is stored in the gallbladder until needed.
  
• When we eat a high-fat, high-cholesterol meal, the gallbladder contracts and injects bile into the small intestine via a small tube called the common bile duct.

There are two types of gallstones: cholesterol stones and pigment stones.

• Cholesterol stones are more common in the United States, making up about 80% of all gallstones. They form when there is too much cholesterol in the bile.
  
• Pigment stones form when there is excess bilirubin in the bile.

Gallstones can be any size, from tiny as a grain of sand to large as a golf ball.

• Although it is common to have many smaller stones, a single larger stone or any combination of sizes is possible.
  
• If stones are very small, they may form sludge.
  
• Whether gallstones cause symptoms depends partly on their size and their number, although no combination of number and size can predict whether symptoms will occur or the severity of the symptoms.
  
• Gallstones within the gallbladder often cause no problems. If there are many or they are large, they may cause pain when the gallbladder responds to a fatty meal. They also may cause problems if they move out of the gallbladder.
  
• If their movement leads to blockage of any of the ducts connecting the gallbladder, liver, or pancreas with the intestine, serious complications may result.
  
• Blockage of a duct can cause bile or digestive enzymes to be trapped in the duct.
  
• This can cause inflammation and ultimately severe pain, infection, and organ damage.
  
• If these conditions go untreated, they can even cause death.

Up to 20% of adults in the United States may have gallstones, yet only 1%-3% develop symptoms.

• Hispanics, Native Americans, and whites of northern European descent are most likely to be at risk for gallstones. African Americans are at lower risk.
  
• Gallstones are most common among overweight, middle-aged women, but the elderly and men are more likely to experience more serious complications from gallstones.
• Women who have been pregnant are more likely to develop gallstones. The same is true for women taking birth control pills or on hormonal therapy as this can mimic pregnancy in terms of hormone levels.