My Stomach Hurts—Could It Be Gallstones?

My friend’s aunt has been suffering abdominal pain for the past several months. Her doctor was concerned that the pain was caused by gallstones, and she came to my office for a full workup. She had heard of people having gallstones and undergoing surgery, and others who never had a problem with them. She wanted to know how we could tell if she had gallstones and whether they were the cause of her pain.

Q: What is the gallbladder? What are gallstones?

A: The gallbladder is an organ that sits under the liver. The liver creates bile in order to help digest fat. When the liver creates bile, it is sent through a series of ducts (called the biliary ducts) where it is ultimately stored in the gallbladder. When we eat meals rich in fats, bile is released in our bowels directly from the liver and from the gallbladder. Bile contains many components including minerals, proteins, bile salts, water, and cholesterol. If one or more of the components that make up bile are out of balance, stones can form in the gallbladder. This can take the form of a single large stone or hundreds of tiny stones.

Q: How common are gallstones? What symptoms can gallstones cause?

A: It is estimated that up to 20% of the US population has gallstones. Of this number, only 1-2% have symptoms. Women have three times the chance of developing gallstones compared to men. Women who have had multiple pregnancies, a family history of gallstones, obesity, used oral contraception, or have a history of rapid weight loss are at increased risk for developing stones. Symptoms include abdominal pain and vomiting, usually after eating a meal rich in fats. These symptoms can last several hours. If these symptoms last longer than this, this could be caused by a stone blocking the biliary duct. This is called acute cholecystitis. This can be a medical emergency and usually requires surgery to remove the gallbladder. Fortunately, people can live without a gallbladder. If acute cholecystitis is left untreated, this could lead to infection or perforation of the gallbladder, which is life threatening.

Q: How do we detect gallstones?

A: Ultrasound is the best way to detect gallstones. Ultrasound uses sound waves to produce images, much like sonar. Ultrasound has an accuracy rate of up to 95% in detecting gallstones. It does not use radiation and is very safe. This is especially important in pregnant women. Many times, ultrasound can detect acute cholecystitis by detecting whether or not the gallbladder is inflamed. In these cases, the gallbladder will be dilated, the gallbladder wall will be thickened, and pain can be elicited if the ultrasound device is pressed directly on the gallbladder. Ultrasound is less accurate in detecting the gallstone if it has left the gallbladder and is located in the biliary ducts. This can cause obstruction and pain. A test called MRCP can be performed. This is a special kind of MRI that looks specifically at the biliary ducts. MRI does not use radiation and instead uses magnetic waves to generate images. Another way to determine whether gallstones are the cause of abdominal pain is performing a HIDA scan. A HIDA scan is a nuclear medicine test to detect whether gallstones are causing obstruction. A tiny amount of radioactive tracer is injected into the patient. That tracer is taken up by the liver and is incorporated into the bile. We can then follow the bile through the biliary ducts to determine whether the bile fills the gallbladder and empties into the bowel. If the gallbladder does not fill with bile, it is either caused by an obstructing stone, or the gallbladder is extremely inflamed and collapsed.

Q: What is the best treatment?

A: If the gallstones are causing pain, you should be evaluated by a surgeon. If the gallstones are not causing symptoms and are found accidentally, one could do nothing or be treated medically, including adopting a healthy low-fat diet. Alternatively, elective removal of the gallbladder may be considered. These decisions are best to be discussed with your doctors to weigh all your options.