Gallstone

Gallstone
Other names	Gallstone disease, cholelith, cholecystolithiasis (gallstone in the gallbladder), choledocholithiasis (gallstone in a bile duct)[1]
Gallstones typically form in the gallbladder and may result in symptoms if they block the biliary system.
Pronunciation	Cholelith /ˈkoʊləlɪθ/, cholelithiasis /ˌkoʊləlɪˈθaɪəsɪs/
Specialty	Gastroenterology General surgery
Symptoms	None, crampy pain in the right upper abdomen[2][3][4]
Complications	Inflammation of the gallbladder, inflammation of the pancreas, liver inflammation[2][4]
Usual onset	After 40 years old[2]
Risk factors	Birth control pills, pregnancy, family history, obesity, diabetes, liver disease, rapid weight loss[2]
Diagnostic method	Based on symptoms, confirmed by ultrasound[2][4]
Prevention	Healthy weight, diet high in fiber, diet low in simple carbohydrates[2]
Treatment	Asymptomatic: none,[2] ursodeoxycholic acid (UDCA) and Chenodeoxycholic acid Pain: surgery ERCP, Cholecystectomy[2]
Prognosis	Good after surgery[2]
Frequency	10–15% of adults (developed world)[4]

A gallstone is a stone formed within the gallbladder from precipitated bile components.^[2] The term cholelithiasis may refer to the presence of gallstones or to any disease caused by gallstones,^[5] and choledocholithiasis refers to the presence of migrated gallstones within bile ducts.

Most people with gallstones (about 80%) are asymptomatic.^[2][3] However, when a gallstone obstructs the bile duct and causes acute cholestasis, a reflexive smooth muscle spasm often occurs, resulting in an intense cramp-like visceral pain in the right upper part of the abdomen known as a biliary colic (or "gallbladder attack").^[4] This happens in 1–4% of those with gallstones each year.^[4] Complications from gallstones may include inflammation of the gallbladder (cholecystitis), inflammation of the pancreas (pancreatitis), obstructive jaundice, and infection in bile ducts (cholangitis).^[4][6] Symptoms of these complications may include pain that lasts longer than five hours, fever, yellowish skin, vomiting, dark urine, and pale stools.^[2]

Risk factors for gallstones include birth control pills, pregnancy, a family history of gallstones, obesity, diabetes, liver disease, or rapid weight loss.^[2] The bile components that form gallstones include cholesterol, bile salts, and bilirubin.^[2] Gallstones formed mainly from cholesterol are termed cholesterol stones, and those formed mainly from bilirubin are termed pigment stones.^[2][3] Gallstones may be suspected based on symptoms.^[4] Diagnosis is then typically confirmed by ultrasound.^[2] Complications may be detected using blood tests.^[2]

The risk of gallstones may be decreased by maintaining a healthy weight with exercise and a healthy diet.^[2] If there are no symptoms, treatment is usually not needed.^[2] In those who are having gallbladder attacks, surgery to remove the gallbladder is typically recommended.^[2] This can be carried out either through several small incisions or through a single larger incision, usually under general anesthesia.^[2] In rare cases when surgery is not possible, medication can be used to dissolve the stones or lithotripsy can be used to break them down.^[7]

In developed countries, 10–15% of adults experience gallstones.^[4] Gallbladder and biliary-related diseases occurred in about 104 million people (1.6% of people) in 2013 and resulted in 106,000 deaths.^[8][9] Gallstones are more common among women than men and occur more commonly after the age of 40.^[2] Gallstones occur more frequently among certain ethnic groups than others.^[2] For example, 48% of Native Americans experience gallstones, whereas gallstone rates in many parts of Africa are as low as 3%.^[10][2] Once the gallbladder is removed, outcomes are generally positive.^[2]