Q. What are gallstones and how are they treated?
A. Gallstones are clumps of cholesterol and other chemicals that form in the gallbladder — a small sac under the liver that holds a fat-digesting substance called bile — or in the bile duct, a tube that carries bile from the liver to the small intestine.
Many people who develop gallstones have no symptoms, and the stones can pass out of the body on their own. More severe cases can be painful. “The classic pain is either in the upper abdomen or right abdomen,” says William Brugge, director of gastrointestinal endoscopy at Massachusetts General Hospital. The pain is usually severe and sudden; it often occurs while eating but may last several hours and can be accompanied by nausea, vomiting, fever, and chills. If the stones block the gallbladder or bile duct, they can lead to infections, including cholangitis, a serious bacterial infection of the bile duct.
Brugge says that treatment depends on the stone’s location, which is determined with imaging tests. Although pain medications can help people get through an acute attack, Brugge says that most people with severe pain or multiple attacks will be treated with surgery, since the body can function without a gallbladder. “Almost all gallbladders are removed now through laparoscopy,” he says, and it usually requires only an overnight hospital stay. Stones in the bile duct require a more involved surgery, in which stones are removed with aid of a long flexible tube with a camera called an endoscope.