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Health Information | 06/08/2017

Would You Know if You Had Gallstones?

By  Andrea Forde, NP
Primary Care
Have you ever had a gallstone? Many people haven’t even heard of them, but they are actually quite common. Although they sometimes occur and pass without a person experiencing any symptoms, they can cause pain, discomfort, and even complications, so it’s good to know what they are and the symptoms you may experience. First of all, it’s good to have some basic definitions. Gallstones are hardened deposits or “stones” of digestive fluid – also known as bile – that can form in your gallbladder. The gallbladder is a small organ located on the right side of your body that stores bile, which is produced by the liver. After you eat, the gallbladder goes to work, releasing bile into the small intestine to help with digestion. The more fat in your meal, the harder the gallbladder works to aid in digestion. When one of the substances that make up the bile (cholesterol or bilirubin, a waste product created when your body breaks down red blood cells) becomes too concentrated, it can form a gallstone. These hard stones – and you can develop just one or several at the same time – can be as small as a grain of sand or as large as a golf ball.

Symptoms of Gallstones

Gallstones may cause no symptoms at all or may cause symptoms intermittently depending on the foods you eat. Large fatty meals (such as a holiday dinner) are notorious for causing gallstone symptoms. If a gallstone gets stuck and causes blockage of the flow of bile, the gallbladder becomes inflamed, and you may experience the following symptoms:
  • Pain in the upper right area of your abdomen or in the center of your abdomen just below your breastbone – the pain can come on suddenly and intensify quickly
  • Back pain between your shoulder blades or in your right shoulder
  • Nausea or vomiting
The pain may last several minutes to a few hours, subside, and possibly reoccur. If the blockage from gallstones does not resolve, this can progress to an acute gallbladder attack known as cholecystitis. Cholecystitis causes the progression of the above symptoms and generally requires urgent surgical intervention.

Causes and Types

We are not completely certain what causes gallstones to form, but they are often a result of excess cholesterol or bilirubin in your bile or if your gallbladder doesn’t empty completely or often enough and bile becomes very concentrated. Gallstones are categorized into two main types. Cholesterol gallstones, the most common type, appear yellow in color and are composed mainly of undissolved cholesterol, although they may contain other components. Pigment gallstones caused by bilirubin are typically black or brown in color.

Risk Factors

Given we don’t fully know what causes gallstones to develop, it’s hard to pinpoint specific factors. Gallstones do seem to have a genetic link, occurring more frequently in those with a family history. They are also more common in women than men, people over the age of 40, and those of either Native-American or Mexican heritage. Beyond that, factors that may increase your risk of gallstones include:
  • Being overweight or obese
  • Being sedentary
  • Being pregnant
  • Eating a high-fat diet
  • Eating a high-cholesterol diet
  • Eating a low-fiber diet
  • Having diabetes
  • Losing weight very quickly
  • Taking medications that contain estrogen, such as oral contraceptives or hormone therapy drugs
  • Having liver disease

When to see your healthcare provider

If you have any of the symptoms listed earlier in this article, it’s a good idea to check in with your healthcare provider. You should immediately contact your primary care clinician if you have any of the symptoms listed below. These may be signs of a serious gallstone complication, such as cholecystitis (inflammation of the gallbladder), a blockage of either the common bile duct or the pancreatic duct, pancreatitis, or even cancer.
  • You experience intense abdominal pain where you can’t find a comfortable position.
  • You notice a yellowing of your skin and the whites of your eyes.
  • You have a high fever with chills.
Your clinician may perform special imaging tests to diagnose the presence of gallstones and determine what treatment options make sense for you based on those results and your symptoms. People with gallstones that have not caused symptoms probably will never need treatment. If you experience frequent episodes of gallstones, your clinician may recommend surgery to remove your gallbladder. Once the gallbladder is removed, bile flows directly from your liver into your small intestine rather than being stored in your gallbladder. This removal doesn’t usually affect your ability to digest food. Some patients experience diarrhea from fatty meals after gallbladder removal until their body adjusts. There are medications that can help this “post-cholecystectomy diarrhea.”  There are also medications to dissolve gallstones, but they are not commonly used and are reserved for people who can’t undergo surgery as these medications can take months or years of treatment to be effective, and the gallstones can form again if treatment is stopped.

About The Author

Andrea Forde, NP

Andrea Forde, NP, is a board-certified adult nurse practitioner and a primary care provider at Harvard Vanguard Watertown. Andrea received a bachelor’s degree from the University of Massachusetts in Amherst and earned her master’s degree in nursing from the University of Massachusetts in Boston. She has been in clinical practice since 2005.

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