Gallstones (cholelithiasis)

Gallstones occur in 13-22% of the population in the Western world. In 80% of these people, the gallstones do not cause complaints, but in some people they do. People can suffer from a wide variety of complaints, but pain in the abdomen (upper right side of the abdomen to be precise) is often central. In this article you can read about the causes, symptoms and treatment of gallstones.


  • What are gallstones?
  • What are the causes of gallstones?
  • What are the symptoms of gallstones?
  • How are gallstones diagnosed?
  • How are gallstones treated?
  • Do people need their gallbladder?


What are gallstones?

Gallstones are small, hard, pebble-shaped structures that can develop in the gallbladder. In medical terms, having gallstones is also called cholelithiasis . The gallbladder is an organ in the human body that is located under the liver, in the upper right side of the abdomen, just below the costal margin. The gallbladder looks like a pear-shaped sac that lies against the liver. The gallbladder stores bile, which is a fluid made in the liver that helps the body digest fats. When the gallbladder contracts, the bile from the gallbladder flows through the bile ducts (the cystic duct and later the common bile duct) into the small intestine, where the bile mixes with the food in the digestive tract. The bile salts in bile ensure that fats are emulsified, making these fats easier to absorb. Gallstones form when deposits form in the bile.
Bile contains various substances including water, cholesterol, fats, bile salts, proteins and bilirubin. Bile salts, as mentioned, break down fat. Bilirubin, a waste product excreted through the bile, gives bile and feces a yellow-brown color. If bile contains too much cholesterol, bile salts or bilirubin, this can lead to the formation of gallstones.
There are two types of gallstones: cholesterol stones and pigment stones. Cholesterol stones are usually yellow-green in color and, as the name suggests, consist mainly of cholesterol. About 80 percent of gallstones are cholesterol stones, so these are by far the most common. Pigment stones are rarer, these are small, dark stones that consist mainly of bilirubin. Gallstones can take different sizes, from a few millimeters in diameter to several centimeters.
Gallstones can prevent the normal flow of bile when they block the gallbladder or bile ducts. This can happen at different points along the route that bile travels from the liver to the small intestine. If bile stands still for too long, it can lead to inflammation of the gallbladder ( cholecystitis ), inflammation of the bile ducts ( cholangitis ), or in rare cases even inflammation of the liver ( hepatitis ). There is also a risk of inflammation of the pancreas ( pancreatitis ) because the pancreatic duct, the tube that carries digestive enzymes from the pancreas to the small intestine, is also connected to the bile ducts.

What are the causes of gallstones?

Gallstones are caused by a combination of factors, the most important factors that play a role in the development of gallstones are discussed below.
Composition of bile: Gallstones form when the bile composition is not good. This may mean that the bile contains too much cholesterol, too much bilirubin or too few bile salts. Gallstones can also form when the gallbladder is not completely emptied often enough. It is not always known exactly how these types of disruptions arise.
Gender: Women are twice as likely as men to develop gallstones. High estrogen levels during pregnancy, hormone replacement therapy, and birth control pills appear to increase bile cholesterol and affect gallbladder emptying.
Genetic aspect: Gallstones are more common in certain families than others, possibly indicating a genetic component.
Obesity: Being overweight (even moderately overweight) increases the risk of developing gallstones.
Rapid weight loss: Rapid weight loss or fasting, such as the so-called “crash diets”, causes the liver to secrete extra cholesterol into the bile, which can lead to gallstones.
Diet: Eating a lot of fat and cholesterol and little fiber increases the risk of gallstones. This is related to the increased cholesterol content in the bile.
Age: People over 60 are more likely to develop gallstones than younger people.
Cholesterol-lowering medications: This sounds counterintuitive, but the medications that lower blood cholesterol levels do so by increasing the amount of cholesterol excreted in the bile. This increases the risk of gallstone formation.

What are the symptoms of gallstones?

Gallstones often have an asymptomatic course, which means that people do not experience any complaints. However, if gallstones are located in the bile ducts and lead to a blockage of the bile flow, this leads to an increase in pressure in the gallbladder. The most common symptom is pain in the right upper abdomen that increases rapidly and lasts more than 30 minutes. This is a severe colicky pain in which patients often experience the urge to move. They try to adopt all kinds of positions to reduce the pain. Such a pain attack is also called a biliary colic (pain). These pain attacks often follow fatty meals but can also occur at night.
In addition, pain is also often reported in the back, between the shoulder blades and under the right shoulder. Nausea and vomiting can also typically be associated with a blockage of the bile ducts or gallbladder as a result of a stuck gallstone. In extreme cases, the stool and urine can discolour, the stool then becomes discolored (this is also called putty stool) and the urine becomes darker. This has to do with the disturbed excretion of bilirubin.

How are gallstones diagnosed?

Gallstones are often discovered by chance. A large part of the Western population has gallstones, but only a small part of that group of people develops complaints. If someone presents with complaints consistent with gallstones, the doctor will probably order an ultrasound examination. This is the test with the greatest sensitivity and specificity for detecting gallstones. An echo emits sound waves. The sound waves reflect off the gallbladder, liver and other organs, and by capturing the reflection an image of the gallbladder can be obtained.
Signs of infection, bile duct obstruction and pancreatitis may also be shown in the blood.

How are gallstones treated?

If you have no complaints from gallstones, you do not need treatment. If you regularly experience complaints, your doctor will probably recommend having your gallbladder removed. This is done with surgery; a cholecystectomy. This is one of the most common operations performed on adults in the Western world. Almost all cholecystectomies are performed laparoscopically, which means that they are performed with keyhole surgery. You will then receive a number of small incisions in the abdomen and the instruments will be inserted through these incisions after which the surgeon can operate. This usually happens in day care.

Do people need their gallbladder?

Fortunately, the gallbladder is an organ in the human body that we don’t necessarily need. People can live just fine without a gallbladder. The liver produces enough bile to digest a normal diet. Once the gallbladder is removed, bile from the liver flows directly into the small intestine, instead of being stored in the gallbladder first.

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