Gallstones

Gallstones are solid particles that form in the gallbladder or biliary tract. Most stones are cholesterol stones; pigment stones form from elevated bilirubin. Stones vary in size and can be solitary or multiple. They are common worldwide, with higher prevalence in developed countries and among older adults.

Formation results from an imbalance between bile components and gallbladder motility. Risk factors include obesity, rapid weight loss, pregnancy, female sex, older age, and certain ethnic backgrounds. Hemolytic disorders and chronic liver disease can promote pigment stone formation. Gallstones may remain asymptomatic for years.

Many stones cause no symptoms. When symptoms occur, they typically cause biliary colic—upright right upper abdominal pain after meals, lasting minutes to hours, sometimes with nausea. Complications include cholecystitis, obstruction of the common bile duct, pancreatitis, and cholangitis. Diagnostic evaluation starts with abdominal ultrasound; blood tests assess liver and pancreatic function; MRCP or CT may be used.

Treatment depends on symptoms and complications. Asymptomatic stones usually require no treatment. Symptomatic stones or complications are commonly managed with cholecystectomy, usually by laparoscopy. Stones in the common bile duct are often removed with ERCP, sometimes followed by cholecystectomy. Nonoperative options include ursodeoxycholic acid dissolution therapy for select small cholesterol stones and, rarely, lithotripsy. In acute cholecystitis, antibiotics and timely surgery are standard.

Prevention focuses on risk factor modification, such as maintaining a healthy weight and balanced diet. Prognosis is favorable after treatment, with low recurrence after gallbladder removal.