Gallstones and Gallbladder Disease

The gallbladder stores bile made by the liver and releases it when a meal containing fat arrives. When bile holds more cholesterol or pigment than it can keep dissolved, crystals form and grow into stones.

Pain begins when the gallbladder contracts against a stone blocking the outlet. Pressure builds, the pain climbs over minutes, holds, and then eases when the stone falls back. That pattern is characteristic.

Risk rises with age, female sex, pregnancy, family history, certain medications, and metabolic disease.

A rapid drop in BMI from any cause can increase new gallstone formation, particularly in the first year. Routine removal of a healthy gallbladder at the time of a bariatric operation is not recommended. Removal at the same time is appropriate only when the gallbladder is already causing symptoms. Ursodeoxycholic acid is sometimes used during that period to reduce stone formation.

Certain blood disorders produce pigment stones rather than cholesterol stones. The mechanism differs but the consequences are similar.

Ultrasound is the first test and usually the only imaging needed. It shows stones, gallbladder wall thickening, and fluid suggesting inflammation, without radiation.

Bloodwork checks liver enzymes, bilirubin, and signs of infection. Elevated liver numbers raise the concern that a stone has moved into the bile duct, which changes management. Additional imaging such as MRCP or a HIDA scan is used in selected cases, the latter when the gallbladder is suspected of functioning poorly without stones.

Stones found incidentally, causing no symptoms, are usually left alone and watched. Symptomatic gallstone disease is treated by removing the gallbladder, because episodes recur and complications become more likely over time.

Gallbladder removal is performed laparoscopically, through several small incisions, in the large majority of cases. After gallbladder removal, bile flows continuously from the liver into the intestine. Adjustment varies by patient. Some people develop lasting looser or more frequent stools, often from bile acid malabsorption, and that is treatable.

Pain lasting more than several hours, fever with abdominal pain, yellowing of the eyes or skin, or dark urine with pale stools all warrant urgent evaluation. These can indicate infection, an obstructed bile duct, or pancreatitis, none of which should wait for a routine appointment.

For episodes that are recurrent but not emergent, an outpatient surgical evaluation is the appropriate next step.

This page is educational information, not medical advice. What is right for you is decided in consultation, after a review of your history, your symptoms, and your testing.