Gallstones: Don't Ignore the Signs

How often do you think about your gallbladder? If you’re like most people, the answer is probably never. But, if you’re like 15% of the US population who have gallstone issues, you may have found yourself thinking about it a little more than you’d like.

A small, pear-shaped organ found on the right side of your abdomen; the gallbladder stores bile made by the liver. When that bile is released by the gallbladder, it helps breaks down fats and aids with digestion. Bile itself is made up of cholesterol, bile salts, and bilirubin. Often, bile can accumulate and harden into crystals in the gallbladder called gallstones. Millions of people live blissfully pain-free with one—or many—‘silent’ gallstones, completely unaware of their presence. However, if a gallstone ends up blocking one of the bile’s exits (called bile ducts) from the gallbladder, bile can build up and lead to a gallbladder attack.

In most cases, gallbladder attacks occur in the evening or sometime at night after a heavy meal. In addition to prolonged dull or severe pain on the upper right side, other symptoms of gallstones include:

• Pain between the shoulder blades or in the right shoulder
• Changes in appetite
• Nausea and vomiting
• low- or high-grade fever and/or chills
• yellowish color of your skin or whites of your eyes, called jaundice
• tea-colored urine and light-colored stool  

In addition to being incredibly painful, gallstones can be dangerous. Untreated, they can lead to life-threatening infections of the bile ducts, pancreas, liver, and in rare cases, the small intestines.

Gallstones are often diagnosed in the emergency department through a combination of blood tests and imaging. Pain related to gallstones can come and go, which is called biliary colic. If pain does not resolve after a few hours and is associated with fevers, chills, nausea and vomiting it is more likely to represent acute cholecystitis and requires urgent treatment.

Once you have issues related to gallstones, you’re likely to get them again (and again). For that reason, the mainstay of treatment is surgery to remove the gallbladder.

While there's no proven way to prevent gallstones, you can lower your risk by getting regular exercise, maintaining a healthy weight, and eating a diet high in fiber (fruits, vegetable, beans, whole grains) and healthy fats (fish, olive oil). When possible, avoid or limit carbohydrates, sugar, and unhealthy, fatty foods. Again, dietary changes are helpful but alone, they are not sufficient to stop the recurrent attacks.

 Julie DiSano, MD, is a surgeon at Southwestern Vermont Medical Center.