Gallstones Unveiled: All You Need to Know About this Silent Threat

Gallstones Unveiled: All You Need to Know About this Silent Threat
December 23 10:56 2025 Print This Article

Gallstones are solid deposits that form within the gallbladder—a small, sac-like organ located beneath the liver. The primary function of the gallbladder is to store bile, a digestive fluid produced by the liver. During meals, the gallbladder contracts to release bile into the digestive tract, aiding in the digestion of fats. Between meals or during fasting, the gallbladder fills and distends with bile.

How Do Gallstones Form? 

Gallstones develop when substances normally dissolved in bile—such as cholesterol and bile salts—precipitate and form solid particles. This precipitation occurs when these substances are present in abnormally high concentrations.

Types of Gallstones

Gallstones are generally classified based on their primary content:

  • Cholesterol Stones: Made mostly of hardened cholesterol, they are yellow-green and are most common in Western countries
  • Pigment Stones: Darker in colour, formed from bilirubin, and more frequently seen in populations outside the West

Additionally, biliary sludge is a thick, sand-like mix of tiny cholesterol crystals and calcium salts in the gallbladder. It can be an early stage of gallstone formation or cause similar symptoms.

Do Size and Number Matter? 

The size and number of gallstones are clinically significant. A single stone larger than 3 cm or multiple stones that completely fill the gallbladder are indications for surgery, even if the patient is asymptomatic, as these conditions increase the risk of gallbladder cancer. Otherwise, asymptomatic stones usually do not require surgery unless other risk factors are present.

Symptoms of Gallbladder Stones 

Gallstones can cause a variety of symptoms, including:

  • Biliary Colic: Characterised by episodic, crampy pain in the right upper abdomen, sometimes accompanied by nausea and vomiting. This pain is often due to temporary blockage of the duct connecting the gallbladder to the bile duct.
  • Acute Cholecystitis: Presents as continuous right upper abdominal pain and tenderness, often with fever and, in severe cases, systemic signs such as increased heart rate and low blood pressure.
  • Chronic Cholecystitis: Repeated episodes of pain lead to a scarred, less functional gallbladder, with ongoing tenderness but typically without fever or vomiting.
  • Jaundice and Cholangitis: When stones migrate into the bile duct, they can cause jaundice (yellowing of the eyes and skin, dark urine) and, if infection occurs, fever with chills.
  • Biliary Pancreatitis: Stones may travel further to block the pancreatic duct, causing severe, continuous upper abdominal pain radiating to the back.

Diagnosis and Investigations 

Doctors usually start by using an abdominal ultrasound, a painless scan that can easily spot gallstones and check if your gallbladder is inflamed. If they think a stone might be blocking your bile duct, they may recommend a more detailed scan called MRCP, which provides clearer images of your bile ducts. Blood tests are also done to look for signs of infection, inflammation, or issues with your liver or pancreas. These tests help your doctor decide on the best treatment for your condition.

Treatment Options

  • Surgical Treatment: The most common treatment for gallstone problems is a keyhole surgery called laparoscopic cholecystectomy, where the gallbladder is removed through small cuts in your abdomen. If you are unable to have this type of surgery, doctors may do a traditional open surgery instead. If a stone is blocking your bile or pancreatic duct, a special procedure called ERCP is used—this involves passing an endoscopy, a thin tube with a camera, through your mouth to remove the stone.
  • Treatment for Asymptomatic Gallstones: Surgery is usually not needed if you have no symptoms. However, it may be recommended if you have a single large stone (over 3 cm), a gallbladder full of stones, or if you are at higher risk (such as older adults with diabetes, those with sickle cell disease, or people who have had an organ transplant). Sometimes, the gallbladder is removed if you need other abdominal surgery anyway.
  • Medical Treatment: Oral bile Acids like ursodeoxycholic acid, used in medical treatments to dissolve gallstones, are usually ineffective. This remedy is more effective with cholesterol stones. In symptomatic gallstones, this is indicated only in patients unfit for surgery in a non-acute setting. In asymptomatic stones, these might be considered to delay progression to symptoms, though complete dissolution might not be achieved. 
  • Percutaneous Cholecystostomy: If you have a severe gallbladder infection and are too unwell for surgery, doctors may temporarily drain the gallbladder by inserting a tube through the skin using imaging guidance. Once you are feeling better, surgery to remove the gallbladder is usually done after 4–6 weeks.

Gallstones are a common condition that can range from being completely silent to causing significant discomfort and complications. The good news is that with modern diagnostic tools and various treatment options—from watchful waiting to minimally invasive surgery—most people can be managed effectively and recover well. If you experience symptoms such as ongoing abdominal pain or jaundice, it’s important to seek medical advice early to prevent complications. With proper care, gallstone disease can be treated successfully, helping you return to your normal activities and improve your quality of life.

Dr T S Chandrasekar
Senior Consultant, Surgical Gastroenterology
Kauvery Hospital Chennai – Radial Road

 

Frequently Asked Questions (FAQs)

What are gallstones?

Gallstones are solid deposits that form inside the gallbladder from substances such as cholesterol or bilirubin present in bile. They can vary in size and number and may or may not cause symptoms.

How do gallstones form?

Gallstones form when bile contains too much cholesterol or bilirubin, or when the gallbladder does not empty properly. This causes bile components to crystallise and harden into stones over time.

What are the different types of gallstones?

There are two main types:

  • Cholesterol stones, which are yellow-green and the most common
  • Pigment stones, which are dark and formed from excess bilirubin Biliary sludge may also occur and can be a precursor to gallstones.

Do gallstones always cause symptoms?

No. Many people have gallstones without symptoms, known as asymptomatic gallstones. These often do not require treatment unless certain risk factors are present.

What symptoms can gallstones cause?

Symptoms may include right upper abdominal pain, nausea, vomiting, fever, jaundice, dark urine, or pain radiating to the back. Severe cases can lead to complications like cholecystitis or pancreatitis.

 

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