Gallstones and Biliary Stones


Dr. Mansfield
Gallstones are hardened collections of cholesterol, bilirubin, or a combination of the two, that can form in the gallbladder. When they lodge in a bile duct, they are called biliary stones. Dr. Patel, can you tell us more about gallstones and biliary stones?

Dr. Patel
Sure thing, Dr. Mansfield. Gallstones can range in size from a grain of sand to a golf ball. The gallbladder can develop a single large gallstone, hundreds of tiny stones, or both large and small stones.

The gallbladder stores bile produced by the liver. Bile is made up of cholesterol, bile salts, and bilirubin. Gallstones form when there is an imbalance in these substances, such as too much cholesterol, too much bilirubin, or not enough bile salts. Gallstones can also occur if the gallbladder doesn't empty completely or often enough.

The most common type of gallstones in the United States are made of cholesterol. Cholesterol stones are usually yellow-green in color. Stones made of bilirubin, called pigment stones, are less common in the United States, but more common in other parts of the world. They are generally dark in color.

In many cases, gallstones do not cause symptoms. These are called silent gallstones. When gallstones block any of the bile ducts, however, pressure increases in the gallbladder, causing a gallbladder attack. A gallbladder attack, also called a gallstone attack, may cause pain in the upper abdomen that sometimes radiates to the chest and right shoulder. Attacks often follow heavy meals, and the pain can last from one to several hours. When gallstones move and no longer block the bile duct, the attack stops.

A gallstone that becomes lodged in the common bile duct and blocks the pancreatic duct can cause inflammation of the pancreas, or gallstone pancreatitis. The pain from pancreatitis is usually quite severe, and may cause nausea and vomiting.

Treatment for gallstones found in the gallbladder itself usually involves surgery to remove the gallbladder. This is called cholecystectomy. When gallstones block a bile duct, a procedure called endoscopic retrograde cholangiopancreatography, or ERCP, may be done to remove the stones.