Gallstone

Gallstone disease refers to the condition where gallstones are either in the gallbladder or common bile duct. The presence of stones in the gallbladder is referred to as cholelithiasis, from the Greek {{wikt-lang|en|chole-}} ({{lang|grc|χολή}}, 'bile') + {{wikt-lang|en|lith-}} ({{lang|grc|λίθος}}, 'stone') + {{wikt-lang|en|-iasis}} ({{lang|grc|ἴασις}}, 'process').{{cite book | vauthors = Quick CR, Reed JB, Harper SJ, Saeb-Parsy K, Deakin PJ |title=Essential Surgery E-Book: Problems, Diagnosis and Management: With student consult online access |date=2013 |publisher=Elsevier Health Sciences |isbn=978-0-7020-5483-9 |page=281 |url=https://books.google.com/books?id=RYhRAAAAQBAJ&pg=PA281 |language=en}} The presence of gallstones in the common bile duct is called choledocholithiasis, from the Greek {{wikt-lang|en|choledocho-}} ({{lang|grc|χοληδόχος}}, 'bile-containing', from {{lang|grc-Latn|chol-}} + {{lang|grc-Latn|docho-}}, 'duct') + {{lang|grc-Latn|lith-}} + {{lang|en|-iasis|italic=yes}}. Choledocholithiasis is frequently associated with obstruction of the bile ducts, which can lead to cholangitis, from the Greek: {{lang|grc-Latn|chol-}} + {{wikt-lang|en|angio-|ang-}} ({{lang|grc|ἄγγος}}, 'vessel') + {{wikt-lang|en|-itis}} ({{wikt-lang|grc|-ῖτις}}, 'inflammation'), a serious infection of the bile ducts. Gallstones within the ampulla of Vater can obstruct the exocrine system of the pancreas and can result in pancreatitis.{{cn|date=March 2022}}

File:Prevalence2.png

Gallstones, regardless of size or number, are asymptomatic in 60–80% of patients.{{Cite journal |last=Acalovschi |first=Monica |last2=Blendea |first2=Dan |last3=Feier |first3=Cristina |last4=Letia |first4=Alfred I. |last5=Ratiu |first5=Nadia |last6=Dumitrascu |first6=Dan L. |last7=Veres |first7=Adina |date=August 2003 |title=Risk factors for symptomatic gallstones in patients with liver cirrhosis: a case-control study |url= |journal=The American Journal of Gastroenterology |language=en |volume=98 |issue=8 |pages=1856–1860 |doi=10.1111/j.1572-0241.2003.07618.x |issn=0002-9270}}{{Cite journal |last=Lammert |first=Frank |last2=Wittenburg |first2=Henning |date=August 2024 |title=Gallstones: Prevention, Diagnosis, and Treatment |url=http://www.thieme-connect.de/DOI/DOI?10.1055/a-2378-9025 |journal=Seminars in Liver Disease |language=en |volume=44 |issue=03 |pages=394–404 |doi=10.1055/a-2378-9025 |issn=0272-8087|url-access=subscription }} These "silent stones" do not require treatment and can remain asymptomatic even years after they form.

Biliary colic, also known as symptomatic cholelithiasis, is what patients consider to be a "gallstone attack".{{Cite journal |last=Haisley |first=KR |last2=Hunter |first2=JG |date=2019 |title=Gallbladder and the Extrahepatic Biliary System |journal=Schwartz's Principles of Surgery, 11e |via=McGraw-Hill Education}} These attacks occur when a gallstone blocks the opening to the cystic duct or the cystic duct itself, increasing the pressure inside the gallbladder as it contracts, which leads to pain. Patients typically experience sudden, severe pain in the right upper side of their abdomen or in the epigastric area (the upper, center part of the abdomen). This pain typically peaks approximately 1 hour after the onset and usually subsides completely within 5 hours.{{Cite journal |last=Patel |first=H |last2=Jepsen |first2=J |date=2024 |title=Gallstone Disease: Common Questions and Answers |journal=Am Fam Physciian |volume=109 |issue=6 |pages=518-524}} Sometimes, the pain may be referred to the right shoulder; this is called "Collin's sign".{{Cite journal |last=Gilani |first=S. N. S. |last2=Bass |first2=G. |last3=Leader |first3=F. |last4=Walsh |first4=T. N. |date=December 2009 |title=Collins’ sign: validation of a clinical sign in cholelithiasis |url=http://link.springer.com/10.1007/s11845-009-0404-7 |journal=Irish Journal of Medical Science |language=en |volume=178 |issue=4 |pages=397–400 |doi=10.1007/s11845-009-0404-7 |issn=0021-1265|url-access=subscription }} Patients may also experience nausea and vomiting. These attacks often occur after eating a fatty meal or at night.{{Cite journal |last=Doherty |first=GM |date=2010 |title=Cholelithiasis |journal=Quick Answers Surgery |via=The McGraw-Hill Companies}} Of note, laboratory studies of AST, ALT, alkaline phosphatase, direct bilirubin, amylase, lipase, and white blood cell count are normal.

Acute cholecystitis, or inflammation of the gallbladder, is caused by gallstones in 90–95% of cases. It presents very similarly to biliary colic: a sudden onset of severe pain in the right upper side of the abdomen or epigastric area. However, this pain differs from a gallstone attack because it lasts more than 6 hours and does not subside like a normal attack would. In addition, patients also experience fever, decreased appetite, nausea, and vomiting.{{Citation |last=Jones |first=Mark W. |title=Gallstones (Cholelithiasis) |date=2025 |work=StatPearls |url=https://www.ncbi.nlm.nih.gov/books/NBK459370/ |access-date=2025-04-24 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=29083691 |last2=Weir |first2=Connor B. |last3=Ghassemzadeh |first3=Sassan}} On physical exam, the patient can have an increased temperature, tachycardia (fast heart rate greater than 100 beats per minute), tenderness in the right upper quadrant (RUQ) of the abdomen, and a positive Murphy's sign. Murphy's sign, which is specific for acute cholecystitis, is the sudden stoppage of inspiration when deep pressure is applied to the RUQ.{{Cite journal |last=Ahern |first=G |last2=Brygel |first2=M |date=2014 |title=Abdomen |url=https://accesssurgery-mhmedical-com/content.aspx?bookid=2740§ionid=232638265 |journal=Exploring Essential Surgery |via=McGraw-Hill Education}} Laboratory studies typically show a moderately increased white blood cell count and normal to slightly elevated AST, ALT, alkaline phosphatase, and direct bilirubin.

Choledocholithiasis refers to a gallstone obstructing the common bile duct.{{Cite journal |last=Fujita |first=Naotaka |last2=Yasuda |first2=Ichiro |last3=Endo |first3=Itaru |last4=Isayama |first4=Hiroyuki |last5=Iwashita |first5=Takuji |last6=Ueki |first6=Toshiharu |last7=Uemura |first7=Kenichiro |last8=Umezawa |first8=Akiko |last9=Katanuma |first9=Akio |last10=Katayose |first10=Yu |last11=Suzuki |first11=Yutaka |last12=Shoda |first12=Junichi |last13=Tsuyuguchi |first13=Toshio |last14=Wakai |first14=Toshifumi |last15=Inui |first15=Kazuo |date=September 2023 |title=Evidence-based clinical practice guidelines for cholelithiasis 2021 |url=https://link.springer.com/10.1007/s00535-023-02014-6 |journal=Journal of Gastroenterology |language=en |volume=58 |issue=9 |pages=801–833 |doi=10.1007/s00535-023-02014-6 |issn=0944-1174 |pmc=10423145 |pmid=37452855}} Patients typically experience right upper quadrant pain, back pain, jaundice (or yellowing of the skin), decreased appetite, nausea, vomiting, and fever. However, choledocholithiasis, just like gallstones, can also be asymptomatic.{{Cite journal |last=Doherty |first=GM |date=2010 |title=Choledocholithiasis & Gallstone Pancreatitis |journal=Quick Answers Surgery |via=The McGraw-Hill Companies}} If the patient has symptoms, the physical exam is similar to that of acute cholecystitis. Laboratory studies show an increase in direct (conjugated) bilirubin, gamma-glutamyl transpeptidase (GGT), and alkaline phosphatase. AST and ALT can be elevated or normal.

Ascending cholangitis is a complication of choledocholithiasis. When a gallstone obstructs the common bile duct, inflammation and infection of the biliary tree can occur. Approximately 2/3 of patients present with the classic Charcot's triad: jaundice, fever or chills, and right upper quadrant pain. This can progress to septic shock, which presents as Reynold's pentad (Charcot's triad plus hypotension and altered mental status). Laboratory studies show an increase in white blood cell count, direct bilirubin, alkaline phosphatase, AST, and ALT.

Pancreatitis is the inflammation of the pancreas. Gallstone pancreatitis occurs when a gallstone slips down the biliary tree and gets stuck in either the pancreatic duct or at the ampulla of Vater. Gallstone pancreatitis presents the same as acute pancreatitis: a sudden onset of epigastric pain that moves towards the back, decrease in appetite, nausea, and vomiting. Laboratory studies will show an elevated lipase, amylase, and white blood cell count.

Large gallstones can potentially erode through the gallbladder wall and into the neighboring small intestine. This large stone then travels through the small intestine until it is too narrow for the stone to continue, causing a small bowel obstruction. This obstruction often occurs at previous surgical sites or at the ileocecal valve (the portion of the bowel where the small intestine meets the large intestine). The patient presents with the inability to defecate or pass gas, nausea, vomiting, and severe abdominal pain.

Rarely, gallbladder cancer may occur as a complication in the setting of chronic gallstones.

Gallstone risk increases for females (especially before menopause) and for people near or above 40 years; the condition is more prevalent among people of European or American Indigenous descent than among other ethnicities.{{Cite web |last1=Afdhal |first1=Nezam |last2=Zakko |first2=Salam |date=Sep 2022 |title=Gallstones: Epidemiology, risk factors and prevention |url=https://www.uptodate.com/contents/gallstones-epidemiology-risk-factors-and-prevention |access-date=2023-05-26 |website=UpToDate}} A lack of melatonin could significantly contribute to gallbladder stones, as melatonin inhibits cholesterol secretion from the gallbladder, enhances the conversion of cholesterol to bile, and is an antioxidant, which is able to reduce oxidative stress to the gallbladder. Gilbert syndrome has been linked to an increased risk of gallstones.{{cite journal |last1=del Giudice |first1=Emanuele Miraglia |last2=Perrotta |first2=Silverio |last3=Nobili |first3=Bruno |last4=Specchia |first4=Claudia |last5=d'Urzo |first5=Giovanna |last6=Iolascon |first6=Achille |title=Coinheritance of Gilbert Syndrome Increases the Risk for Developing Gallstones in Patients With Hereditary Spherocytosis |journal=Blood |date=October 1999 |volume=94 |issue=7 |pages=2259–2262 |doi=10.1182/blood.V94.7.2259.419k42_2259_2262 |pmid=10498597 |s2cid=40558696 |url=http://ashpublications.org/blood/article-pdf/94/7/2259/1658539/2259.pdf }} Researchers believe that gallstones may be caused by a combination of factors, including inherited body chemistry, body weight, gallbladder motility (movement), and low-calorie diet. The absence of such risk factors does not, however, preclude the formation of gallstones.

Nutritional factors that may increase risk of gallstones include constipation; eating fewer meals per day; low intake of the nutrients folate, magnesium, calcium, and vitamin C; low fluid consumption;{{Cite book|url=https://www.nap.edu/read/10925/chapter/6#124|title=4 Water {{!}} Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate | publisher = The National Academies Press|year=2005|isbn=978-0-309-09169-5 |pages=124|doi=10.17226/10925 | author1 = Institute of Medicine | author2 = Food Nutrition Board |author3 = Standing Committee on the Scientific Evaluation of Dietary Reference Intakes | author4 = Panel on Dietary Reference Intakes for Electrolytes and Water}} and, at least for men, a high intake of carbohydrate, a high glycemic load, and high glycemic index diet.{{cite journal | vauthors = Tsai CJ, Leitzmann MF, Willett WC, Giovannucci EL | title = Dietary carbohydrates and glycaemic load and the incidence of symptomatic gall stone disease in men | journal = Gut | volume = 54 | issue = 6 | pages = 823–8 | date = June 2005 | pmid = 15888792 | pmc = 1774557 | doi = 10.1136/gut.2003.031435 }} Wine and whole-grained bread may decrease the risk of gallstones.

Rapid weight loss increases risk of gallstones.{{Cite web|url=http://www.nhs.uk/Livewell/loseweight/Pages/should-you-lose-weight-fast.aspx|title=Should you lose weight fast? – Live Well—NHS Choices | author = NHS Choices |website=www.nhs.uk|access-date=2016-02-16|url-status=live|archive-url=https://web.archive.org/web/20160216025459/http://www.nhs.uk/livewell/loseweight/Pages/should-you-lose-weight-fast.aspx|archive-date=2016-02-16}} The weight loss drug orlistat is known to increase the risk of gallstones.{{Cite web|url=https://www.fda.gov/Safety/MedWatch/SafetyInformation/ucm215504.htm|title=Safety Information—Xenical (orlistat) capsules | author = Office of the Commissioner |website=www.fda.gov|language=en|access-date=2016-06-18|url-status=dead|archive-url=https://web.archive.org/web/20160611084534/https://www.fda.gov/Safety/MedWatch/SafetyInformation/ucm215504.htm|archive-date=2016-06-11}}

Cholecystokinin deficiency caused by celiac disease increases risk of gallstone formation, especially when diagnosis of celiac disease is delayed.{{cite journal | vauthors = Wang HH, Liu M, Li X, Portincasa P, Wang DQ | title = Impaired intestinal cholecystokinin secretion, a fascinating but overlooked link between coeliac disease and cholesterol gallstone disease | journal = European Journal of Clinical Investigation | volume = 47 | issue = 4 | pages = 328–333 | date = April 2017 | pmid = 28186337 | pmc = 8135131 | doi = 10.1111/eci.12734 | type = Review | doi-access = free }}

Pigment gallstones are most commonly seen in the developing world. Risk factors for pigment stones include hemolytic anemias (such as from sickle-cell disease and hereditary spherocytosis), cirrhosis, and biliary tract infections. People with erythropoietic protoporphyria (EPP) are at increased risk to develop gallstones. Additionally, prolonged use of proton pump inhibitors has been shown to decrease gallbladder function, potentially leading to gallstone formation.{{cite journal | vauthors = Cahan MA, Balduf L, Colton K, Palacioz B, McCartney W, Farrell TM | title = Proton pump inhibitors reduce gallbladder function | journal = Surgical Endoscopy | volume = 20 | issue = 9 | pages = 1364–7 | date = September 2006 | pmid = 16858534 | doi = 10.1007/s00464-005-0247-x | s2cid = 20833380 }}

Cholesterol modifying medications can affect gallstone formation. Statins inhibit cholesterol synthesis and there is evidence that their use may decrease the risk of getting gallstones.{{cite journal | vauthors = Kan HP, Guo WB, Tan YF, Zhou J, Liu CD, Huang YQ | title = Statin use and risk of gallstone disease: A meta-analysis | journal = Hepatology Research | volume = 45 | issue = 9 | pages = 942–948 | date = September 2015 | pmid = 25297889 | doi = 10.1111/hepr.12433 | s2cid = 25636425 }}{{cite journal | vauthors = Preiss D, Tikkanen MJ, Welsh P, Ford I, Lovato LC, Elam MB, LaRosa JC, DeMicco DA, Colhoun HM, Goldenberg I, Murphy MJ, MacDonald TM, Pedersen TR, Keech AC, Ridker PM, Kjekshus J, Sattar N, McMurray JJ | title = Lipid-modifying therapies and risk of pancreatitis: a meta-analysis | journal = JAMA | volume = 308 | issue = 8 | pages = 804–11 | date = August 2012 | pmid = 22910758 | doi = 10.1001/jama.2012.8439 | doi-access = free | url = http://eprints.gla.ac.uk/69063/3/69063.pdf }} Fibrates increase cholesterol concentration in bile and their use has been associated with an increased risk of gallstones. Bile acid malabsorption may also be a risk.

Cholesterol gallstones develop when bile contains too much cholesterol and not enough bile salts. Besides a high concentration of cholesterol, two other factors are important in causing gallstones. The first is how often and how well the gallbladder contracts; incomplete and infrequent emptying of the gallbladder may cause the bile to become overconcentrated and contribute to gallstone formation. This can be caused by high resistance to the flow of bile out of the gallbladder due to the complicated internal geometry of the cystic duct.Experimental investigation of the flow of bile in patient specific cystic duct models M Al-Atabi, SB Chin..., Journal of biomechanical engineering, 2010 The second factor is the presence of proteins in the liver and bile that either promote or inhibit cholesterol crystallization into gallstones. In addition, increased levels of the hormone estrogen, as a result of pregnancy or hormone therapy, or the use of combined (estrogen-containing) forms of hormonal contraception, may increase cholesterol levels in bile and also decrease gallbladder motility, resulting in gallstone formation.{{cn|date=March 2022}}

File:Types of Gallstones.jpg

The composition of gallstones is affected by age, diet and ethnicity. On the basis of their composition, gallstones can be divided into the following types: cholesterol stones, pigment stones, and mixed stones. An ideal classification system is yet to be defined.

Cholesterol stones vary from light yellow to dark green or brown or chalk white and are oval, usually solitary, between 2 and 3 cm long, each often having a tiny, dark, central spot. To be classified as such, they must be at least 80% cholesterol by weight (or 70%, according to the Japanese classification system). Between 35% and 90% of stones are cholesterol stones.

Bilirubin ("pigment", "black pigment") stones are small, dark (often appearing black), and usually numerous. They are composed primarily of bilirubin (insoluble bilirubin pigment polymer) and calcium (calcium phosphate) salts that are found in bile. They contain less than 20% of cholesterol (or 30%, according to the Japanese classification system). Between 2% and 30% of stones are bilirubin stones.

Mixed (brown pigment stones) typically contain 20–80% cholesterol (or 30–70%, according to the Japanese classification system). Other common constituents are calcium carbonate, palmitate phosphate, bilirubin and other bile pigments (calcium bilirubinate, calcium palmitate and calcium stearate). Because of their calcium content, they are often radiographically visible. They typically arise secondary to infection of the biliary tract which results in the release of β-glucuronidase (by injured hepatocytes and bacteria) which hydrolyzes bilirubin glucuronides and increases the amount of unconjugated bilirubin in bile. Between 4% and 20% of stones are mixed.

Gallstones can vary in size and shape from as small as a grain of sand to as large as a golf ball.[https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001318 Gallstones—Cholelithiasis; Gallbladder attack; Biliary colic; Gallstone attack; Bile calculus; Biliary calculus] {{webarchive|url=https://web.archive.org/web/20110207050708/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001318 |date=2011-02-07 }} Last reviewed: July 6, 2009. Reviewed by: George F. Longstreth. Also reviewed by David Zieve The gallbladder may contain a single large stone or many smaller ones. Pseudoliths, sometimes referred to as sludge, are thick secretions that may be present within the gallbladder, either alone or in conjunction with fully formed gallstones.

File:Gallstones.JPG|Gallbladder opened to show small cholesterol gallstones

File:Gallstone µCT.jpg|X-ray microtomograph of a gallstone

File:Gallstones.jpg|The large, yellow stone is largely cholesterol, while the green-to-brown stones are mostly composed of bile pigments

File:Gallenstein FRONT.OGG|CT images of gallstones

File:Big Gallstone.JPG|Large gallstone

File:Human gallstones 2015 G1.jpg|Numerous small gallstones made up largely of cholesterol

Diagnosis is typically confirmed by abdominal ultrasound. Other imaging techniques used are ERCP and MRCP. Gallstone complications may be detected on blood tests.

On abdominal ultrasound, sinking gallstones usually have posterior acoustic shadowing. In floating gallstones, reverberation echoes (or comet-tail artifact) is seen instead in a clinical condition called adenomyomatosis. Another sign is wall-echo-shadow (WES) triad (or double-arc shadow) which is also characteristic of gallstones.{{cite journal | vauthors = Fitzgerald EJ, Toi A | title = Pitfalls in the ultrasonographic diagnosis of gallbladder diseases | journal = Postgraduate Medical Journal | volume = 63 | issue = 741 | pages = 525–32 | date = July 1987 | pmid = 3309915 | pmc = 2428351 | doi = 10.1136/pgmj.63.741.525 }}

A positive Murphy's sign is a common finding on physical examination during a gallbladder attack.

File:Gallstones.PNG|A 1.9 cm gallstone impacted in the neck of the gallbladder and leading to cholecystitis as seen on ultrasound. There is 4 mm gall bladder wall thickening.

File:Ultrasonography of sludge and gallstones, annotated.jpg|Biliary sludge and gallstones. There is borderline thickening of the gallbladder wall.

File:StonesXray.PNG|Gallstones as seen on plain X-ray

File:LargeGstoneMark.png|Large gallstone as seen on CT

File:UOTW 8 - Ultrasound of the Week 1.webm|A normal gallbladder on ultrasound with bowel peristalsis creating the false appearance of stones

Maintaining a healthy weight by getting sufficient exercise and eating a healthy diet that is high in fiber may help prevent gallstone formation.

Ursodeoxycholic acid (UDCA) appears to prevent formation of gallstones during weight loss. A high fat diet during weight loss also appears to prevent gallstones.{{cite journal | vauthors = Stokes CS, Gluud LL, Casper M, Lammert F | title = Ursodeoxycholic acid and diets higher in fat prevent gallbladder stones during weight loss: a meta-analysis of randomized controlled trials | journal = Clinical Gastroenterology and Hepatology | volume = 12 | issue = 7 | pages = 1090–1100.e2; quiz e61 | date = July 2014 | pmid = 24321208 | doi = 10.1016/j.cgh.2013.11.031 | doi-access = free }}

Extracorporeal shock wave lithotripsy is a non-invasive method to manage gallstones that uses high-energy sound waves to disintegrate them first applied in January 1985.{{cite web | title=Gallstone Disease Treatment | website=Johns Hopkins Medicine | url=https://www.hopkinsmedicine.org/health/conditions-and-diseases/gallstone-disease-treatment | access-date=2021-09-25}}{{cite journal |last1=Paumgartner |first1=Gustav |last2=Sauter |first2=Gerd H. |title=Extracorporeal shock wave lithotripsy of gallstones: 20th anniversary of the first treatment |journal=European Journal of Gastroenterology & Hepatology |date=May 2005 |volume=17 |issue=5 |pages=525–527 |doi=10.1097/00042737-200505000-00009 |pmid=15827443 }}

Side effects of extracorporeal shock wave lithotripsy include biliary pancreatitis and liver haematoma.{{cite journal |last1=Paumgartner |first1=Gustav |last2=Sauter |first2=Gerd H. |title=Extracorporeal shock wave lithotripsy of gallstones: 20th anniversary of the first treatment |journal=European Journal of Gastroenterology & Hepatology |date=May 2005 |volume=17 |issue=5 |pages=525–527 |doi=10.1097/00042737-200505000-00009 |pmid=15827443 }}

The term is derived from the Greek words meaning 'breaking (or pulverizing) stones': {{wikt-lang|en|litho-}} + {{wikt-lang|grc|τρίβω|τρίψω}}, {{lang|grc-Latn|tripso}}).

Cholecystectomy (gallbladder removal) has a 99% chance of eliminating the recurrence of cholelithiasis. The lack of a gallbladder has no negative consequences in most people, however 10 to 15% of people develop postcholecystectomy syndrome, which may cause nausea, indigestion, diarrhea, and episodes of abdominal pain.{{cite journal | title = Postcholecystectomy Syndrome | journal = StatPearls | date = January 2019 | pmid = 30969724 | last1 = Zackria | first1 = R. | last2 = Lopez | first2 = R. A. }}

File:Benefits.png

There are two surgical options for cholecystectomy:

• Open cholecystectomy is performed via an abdominal incision (laparotomy) below the lower right ribs. Recovery typically requires 3–5 days of hospitalization, with a return to normal diet a week after release and to normal activity several weeks after release.
• Laparoscopic cholecystectomy, introduced in the 1980s, is performed via three to four small puncture holes for a camera and instruments. Post-operative care typically includes a same-day release or a one-night hospital stay, followed by a few days of home rest and pain medication. Perforation of the gall bladder is not uncommon—it has been reported in the range of 10% to 40%. Unretrieved gallstone spillage has been reported as 6% to 30%, but gallstones that are not retrieved rarely cause complications (0.08%–0.3%).{{cite journal |last1=Sathesh-Kumar |first1=T |last2=Saklani |first2=A P |last3=Vinayagam |first3=R |last4=Blackett |first4=R L |title=Spilled gall stones during laparoscopic cholecystectomy: a review of the literature |journal=Postgraduate Medical Journal |date=17 February 2004 |volume=80 |issue=940 |pages=77–79 |doi=10.1136/pmj.2003.006023 |pmid=14970293 |pmc=1742934 }}

File:Risks.png

Obstruction of the common bile duct with gallstones can sometimes be relieved by endoscopic retrograde sphincterotomy (ERS) following endoscopic retrograde cholangiopancreatography (ERCP).

File:ERCP Risks.pngSurgery carries risks and some people continue to experience symptoms (including pain) afterwards, for reasons that remain unclear. An alternative option is to adopt a ‘watch and wait’ strategy before operating to see if symptoms resolve. A study compared the 2 approaches for uncomplicated gallstones and after 18 months, both approaches were associated with similar levels of pain. The watch and wait approach was also less costly (more than £1000 less per patient).{{Cite journal |last1=Ahmed |first1=Irfan |last2=Hudson |first2=Jemma |last3=Innes |first3=Karen |last4=Hernández |first4=Rodolfo |last5=Gillies |first5=Katie |last6=Bruce |first6=Rebecca |last7=Bell |first7=Victoria |last8=Avenell |first8=Alison |last9=Blazeby |first9=Jane |last10=Brazzelli |first10=Miriam |last11=Cotton |first11=Seonaidh |last12=Croal |first12=Bernard |last13=Forrest |first13=Mark |last14=MacLennan |first14=Graeme |last15=Murchie |first15=Peter |date=2023-12-06 |title=Effectiveness of conservative management versus laparoscopic cholecystectomy in the prevention of recurrent symptoms and complications in adults with uncomplicated symptomatic gallstone disease (C-GALL trial): pragmatic, multicentre randomised controlled trial |url=https://www.bmj.com/content/383/bmj-2023-075383 |journal=BMJ |language=en |volume=383 |pages=e075383 |doi=10.1136/bmj-2023-075383 |issn=1756-1833 |pmc=10698555 |pmid=38084426}}{{Cite journal |date=31 October 2024 |title=Gallstones: surgery might not always be needed |url=https://evidence.nihr.ac.uk/alert/gallstones-surgery-might-not-always-be-needed/ |journal=NIHR Evidence}}

The medications ursodeoxycholic acid (UDCA) and chenodeoxycholic acid (CDCA) have been used in treatment to dissolve gallstones.{{cite journal | vauthors = Thistle JL, Hofmann AF | title = Efficacy and specificity of chenodeoxycholic acid therapy for dissolving gallstones | journal = The New England Journal of Medicine | volume = 289 | issue = 13 | pages = 655–9 | date = September 1973 | pmid = 4580472 | doi = 10.1056/NEJM197309272891303 }}{{cite journal | vauthors = Hofmann AF | title = Medical dissolution of gallstones by oral bile acid therapy | journal = American Journal of Surgery | volume = 158 | issue = 3 | pages = 198–204 | date = September 1989 | pmid = 2672842 | doi = 10.1016/0002-9610(89)90252-3 }} A 2013 meta-analysis concluded that UDCA or higher dietary fat content appeared to prevent formation of gallstones during weight loss. Medical therapy with oral bile acids has been used to treat small cholesterol stones, and for larger cholesterol gallstones when surgery is either not possible or unwanted. CDCA treatment can cause diarrhea, mild reversible hepatic injury, and a small increase in the plasma cholesterol level. UDCA may need to be taken for years.

Gallstones can be a valued by-product of animals butchered for meat because of their use as an antipyretic and antidote in the traditional medicine of some cultures, particularly traditional Chinese medicine. The most highly prized gallstones tend to be sourced from old dairy cows, termed calculus bovis or niu-huang (yellow thing of cattle) in Chinese. Some slaughterhouses carefully scrutinize workers for gallstone theft.

• Mirizzi's syndrome
• Porcelain gallbladder

{{reflist|30em|refs=

{{cite journal | vauthors = Channa NA, Khand FD, Khand TU, Leghari MH, Memon AN |title=Analysis of human gallstones by Fourier Transform Infrared (FTIR) |journal=Pakistan Journal of Medical Sciences |volume=23 |issue=4 |pages=546–50 |year=2007 |url=http://pjms.com.pk/issues/julsep07/article/article15.html |access-date=2010-11-06 |url-status=live |archive-url=https://web.archive.org/web/20110824133936/http://pjms.com.pk/issues/julsep07/article/article15.html |archive-date=2011-08-24 }}

{{cite journal | vauthors = Kim IS, Myung SJ, Lee SS, Lee SK, Kim MH | title = Classification and nomenclature of gallstones revisited | journal = Yonsei Medical Journal | volume = 44 | issue = 4 | pages = 561–70 | date = August 2003 | pmid = 12950109 | doi = 10.3349/ymj.2003.44.4.561 | doi-access = free }}

{{cite journal | vauthors = Koppisetti S, Jenigiri B, Terron MP, Tengattini S, Tamura H, Flores LJ, Tan DX, Reiter RJ | title = Reactive oxygen species and the hypomotility of the gall bladder as targets for the treatment of gallstones with melatonin: a review | journal = Digestive Diseases and Sciences | volume = 53 | issue = 10 | pages = 2592–603 | date = October 2008 | pmid = 18338264 | doi = 10.1007/s10620-007-0195-5 | s2cid = 22785223 }}

Endocrine and Metabolic Disorders: Cutaneous Porphyrias, pp. 63–220 in Beers, Porter and Jones (2006)

{{cite journal | vauthors = Misciagna G, Leoci C, Guerra V, Chiloiro M, Elba S, Petruzzi J, Mossa A, Noviello MR, Coviello A, Minutolo MC, Mangini V, Messa C, Cavallini A, De Michele G, Giorgio I | title = Epidemiology of cholelithiasis in southern Italy. Part II: Risk factors | journal = European Journal of Gastroenterology & Hepatology | volume = 8 | issue = 6 | pages = 585–93 | date = June 1996 | pmid = 8823575 | doi = 10.1097/00042737-199606000-00017 | s2cid = 11355563 }}

{{cite web|author=National Institute of Diabetes and Digestive and Kidney Diseases|author-link=National Institute of Diabetes and Digestive and Kidney Diseases|title=Gallstones|year=2007|publisher=National Digestive Diseases Information Clearinghouse, National Institutes of Health, United States Department of Health and Human Services|location=Bethesda, Maryland|url=http://digestive.niddk.nih.gov/ddiseases/pubs/gallstones/Gallstones.pdf|access-date=2010-11-06|url-status=dead|archive-url=https://web.archive.org/web/20101205101957/http://digestive.niddk.nih.gov/ddiseases/pubs/gallstones/Gallstones.pdf|archive-date=2010-12-05}}

{{cite web|author=National Health Service|author-link=National Health Service (England)|title=Gallstones — Treatment|year=2010|publisher=National Health Service|location=London|work=NHS Choices: Health A-Z—Conditions and treatments|url=http://www.nhs.uk/conditions/gallstones/pages/treatment.aspx|access-date=2010-11-06|url-status=live|archive-url=https://web.archive.org/web/20101114084152/http://www.nhs.uk/Conditions/Gallstones/Pages/Treatment.aspx|archive-date=2010-11-14}}

{{cite journal | vauthors = Ortega RM, Fernández-Azuela M, Encinas-Sotillos A, Andrés P, López-Sobaler AM | title = Differences in diet and food habits between patients with gallstones and controls | journal = Journal of the American College of Nutrition | volume = 16 | issue = 1 | pages = 88–95 | date = February 1997 | pmid = 9013440 | doi = 10.1080/07315724.1997.10718655 | url = http://www.jacn.org/cgi/content/abstract/16/1/88 | access-date = 2010-11-06 | url-status = dead | archive-url = https://web.archive.org/web/20080720125626/http://www.jacn.org/cgi/content/abstract/16/1/88 | archive-date = 2008-07-20 | url-access = subscription }}

{{cite journal | vauthors = Trotman BW, Bernstein SE, Bove KE, Wirt GD | title = Studies on the pathogenesis of pigment gallstones in hemolytic anemia: description and characteristics of a mouse model | journal = The Journal of Clinical Investigation | volume = 65 | issue = 6 | pages = 1301–8 | date = June 1980 | pmid = 7410545 | pmc = 371467 | doi = 10.1172/JCI109793 }}

{{cite book | vauthors = Roizen MF, Oz MC | title = Gut Feelings: Your Digestive System | pages = 175–206 | date = 2005 |publisher=HarperCollins e-books |location=Pymble, NSW |isbn=978-0-06-198079-4}}

{{cite web|vauthors=Thunell S|title=Endocrine and Metabolic Disorders: Cutaneous Porphyrias|year=2008|publisher=Merck Sharp & Dohme Corporation|location=Whitehouse Station, New Jersey|url=http://www.merck.com/mmpe/sec12/ch155/ch155c.html?qt=Erythropoietic%20Protoporphyria&alt=sh#sec12-ch155-ch155c-635|access-date=2010-11-07|archive-date=2020-03-12|archive-url=https://web.archive.org/web/20200312142747/http://www.merck.com/mmpe/sec12/ch155/ch155c.html?qt=Erythropoietic%20Protoporphyria&alt=sh#sec12-ch155-ch155c-635|url-status=dead}}

{{cite web|author=Jensen|title=Postcholecystectomy syndrome|year=2010|publisher=Medscape (WebMD)|location=Omaha, Nebraska|url=http://emedicine.medscape.com/article/192761-overview|access-date=2011-01-20|url-status=live|archive-url=https://web.archive.org/web/20101223003851/http://emedicine.medscape.com/article/192761-overview|archive-date=2010-12-23}}

{{cite web |title=Interview with Darren Wise. Transcrip |publisher=Medscape (WebMD) |location=Omaha, Nebraska |url=http://sgp1.paddington.ninemsn.com.au/sunday/cover_stories/transcript_785.asp |access-date=2010-11-06 |url-status=dead |archive-url=https://web.archive.org/web/20101121121630/http://sgp1.paddington.ninemsn.com.au/sunday/cover_stories/transcript_785.asp |archive-date=2010-11-21 }}

}}

{{Commons category|Gallstones}}

• {{cite web | url = https://medlineplus.gov/gallstones.html | publisher = U.S. National Library of Medicine | department = MedlinePlus | title = Gallstones }}

{{Medical resources

| ICD10 = {{ICD10|K|80||k|80}}

| ICD9 = {{ICD9|574}}

| ICDO =

| OMIM = 600803

| MedlinePlus = 000273

| eMedicineSubj = emerg

| eMedicineTopic = 97

| DiseasesDB = 2533

| MeshID = D042882

| SNOMED CT = 235919008

}}

{{Gastroenterology}}

{{Authority control}}

Category:Abdominal pain

Category:Articles containing video clips

Category:Gallbladder disorders

Category:Hepatology

Category:Steatorrhea-related diseases

Category:Wikipedia emergency medicine articles ready to translate

Category:Wikipedia medicine articles ready to translate