The gallbladder is a small, pear-shaped sac located below the liver in the right upper abdomen that stores bile. Bile is a greenish-yellow, thick, sticky fluid that aids in digesting fats and eliminating certain waste products. Bile aids digestion by making cholesterol, fats, and fat soluble vitamins easier to absorb from the intestine. Bile is produced in the liver and flows into the gall bladder through the common bile duct. When food enters the small intestine, hormones are released that trigger the release of bile into the intestine where it mixes with the food to aid in digestion.

Gallstones are collections of solid material, usually mostly cholesterol crystals, that precipitate out of bile in the gall bladder. Gallstones are usually formed when the liver produces too much cholesterol and bile becomes saturated and forms crystals which begin to clump together. Other types of gallstones are precipitates of calcium compounds and bilirubin, the main pigment in bile. Sometimes gallstones can move into and block a bile duct. Gallstones can cause upper abdominal pain that can last for hours. If pain is recurrent or problems arise, the gallbladder is removed.

Gallstones can be present for years without causing symptoms, particularly if they do not move out of the gallbladder. The most common symptom of gallstones is pain. Pain occurs when stones pass from the gallbladder into a duct and block it. This causes the gallbladder to swell and cause pain in the upper right abdomen usually under the ribs. The pain typically increases in intensity over 15 minutes to an hour and remains steady for up to 12 hours. The pain is usually severe enough to send people to the emergency department for relief. The pain can cause nausea and vomiting. Although eating a heavy meal may trigger an attack of pain, gallstones do not cause indigestion, belching or bloating. Most episodes of pain resolve spontaneously but pain returns in 20-40% of cases and complications may develop. If the blockage persists, the gallbladder may become inflamed and infection may occur. Ultrasound is 95% accurate in diagnosing gallstones.

Gallstones are more common in women, Hispanics and American Indians. About 20% of Americans over age 65 have gallstones. Other risk factors include obesity, a high-fat diet, and a family history of gallstones.

Gallstones that do not cause pain do not require treatment. Changing diet does not help reduce pain. Surgery is usually required when pain is recurrent and disruptive. About 90% of gallbladder removals can be done with a flexible scope called a laparoscope. Others require open abdominal surgery. Laparoscopic surgery requires much smaller incisions which lessens discomfort from the surgery, shortens the recovery period and reduces scarring. Patients who cannot undergo surgery may be able to have stones dissolved by taking medications. Dissolving stones is usually reserved for those who absolutely cannot undergo surgery because it may take up to 2 years of daily medication to dissolve larger stones (some stones never dissolve) and most will return within 5 years after the medication is stopped.

Reference: http://www.merck.com/mmhe/sec10/ch140/ch140b.html.

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