Gallstones are solid particles that form in the gallbladder- a small organ located beneath the liver. These stones can vary in size and composition, ranging from as small as a grain of sand to as large as a golf ball. 


Gallstones form when there is an imbalance in the substances that make up bile (a fluid produced by the liver to aid in the digestion of fats). 


There are two main types of gallstones: cholesterol stones and pigment stones. Most people have stones that are a combination- so called ‘mixed’ stones.

Causes and Risk Factors

Several factors can contribute to the formation of gallstones, including:

  • Excess cholesterol in the bile (cholesterol stones)
  • Excess bilirubin- a compound derived from the breakdown of red blood cells- resulting in pigment stones
  • Reduced gallbladder emptying from factors such as obesity, rapid weight loss, or certain medications
  • Certain medical conditions (e.g. cirrhosis and certain blood disorders)
  • Family history of gallstones
  • Female gender and older age



Gallstones may or may not cause symptoms, depending on their size and whether they obstruct the gallbladder/bile ducts. Common symptoms may include:

  • Sudden and intense pain in the upper right abdomen
  • Back pain between the shoulder blades
  • Nausea and vomiting
  • Indigestion and bloating
  • Jaundice, indicated by yellowing of the skin and eyes
  • Fever, chills and shakes


The spectrum of symptoms can include infrequent or frequent attacks of pain (biliary colic) or more severe pain accompanied by fever and infection (cholecystitis). If a stone passes down into the main bile pipe (common bile duct), it can cause jaundice (choledocholithiasis) and severe infection (cholangitis). Further passage of a stone may also cause inflammation of the pancreas (pancreatitis) or blockage of the bowel (gallstone ileus).



Gallstones are usually diagnosed by an ultrasound scan. Other types of investigations (e.g. CT/ MRI/ Endoscopy) may be required either for further detail or to exclude alternative diagnoses. Blood tests may also be performed to assess liver function and identify any signs of infection or inflammation.



Treatment options for gallstones depend on the presence of symptoms and the person’s overall health. Treatment modalities may include:

  • Pain relief and lifestyle changes (e.g. altering diet)
  • Surgical removal of the gallbladder- known as cholecystectomy. This is usually the mainstay of definitive treatment.
  • Regular follow-up visits with a healthcare provider are important for individuals with asymptomatic gallstones to monitor the condition and prevent potential complications, such as inflammation of the gallbladder or blockage of the bile ducts. 
  • Lifestyle modifications, such as maintaining a healthy weight and following a balanced diet, can help reduce the risk of developing gallstones. Patients who have symptomatic gallstones are usually recommended to consider cholecystectomy for lasting relief.
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