Gallstones: symptoms, a gallbladder attack, and when it's an emergency

Gallstones (cholelithiasis) are among the most common abdominal conditions. Many people have them without ever knowing. The question that really matters is not simply "do I have stones?" but "are they causing symptoms, and when should I worry?" Let's look at it clearly.

What gallstones are

The gallbladder is a small organ beneath the liver that stores bile, the fluid that helps digest fats. Sometimes components of the bile crystallise and form stones. As long as these sit quietly inside the gallbladder, they usually cause nothing. The problem begins when a stone becomes wedged and blocks the flow of bile.

Biliary colic — "the attack"

Biliary colic is the characteristic symptom. It typically appears as:

• A strong pain in the upper right abdomen or the epigastrium (below the ribs), often radiating to the back or the right shoulder blade.
• Frequently after a fatty meal or at night.
• Lasting from half an hour to a few hours, in episodes that come and settle.
• Accompanied by nausea or vomiting.

When attacks recur, they are not just a nuisance — they are a sign that the gallbladder is "causing trouble" and that it is time to plan treatment.

When it's an emergency: the warning signs

Sometimes a wedged stone causes not a simple colic but a complication that needs immediate care. Recognise the following:

• Acute cholecystitis: the pain persists for many hours, with fever and chills — the gallbladder is inflamed or infected.
• Blocked bile duct / cholangitis: a stone blocks the main bile duct and causes jaundice (yellowing of the skin and eyes), dark urine and pale stools, often with fever. This is an emergency.
• Gallstone pancreatitis: the stone irritates the pancreas — very severe pain boring through to the back, with vomiting. It needs immediate admission.

How the diagnosis is made

The key test is an abdominal ultrasound, which accurately detects the stones and any inflammation of the gallbladder. In addition, your doctor may request blood tests (liver panel, pancreatic markers) and, in selected cases where a duct stone is suspected, a dedicated MR cholangiopancreatography (MRCP).

The treatment: laparoscopic cholecystectomy

When gallstones cause symptoms, the established and definitive treatment is laparoscopic cholecystectomy — removal of the whole gallbladder through small incisions. It is one of the most common and best-studied operations, usually with a quick recovery and a return to daily life within a few days (see also the principle of enhanced recovery). We remove the gallbladder, not just the stones, precisely so the problem cannot come back.

For the practical steps before surgery, see the article "Preparing for a laparoscopic cholecystectomy".

Can they be managed with diet or medication?

It is a common and reasonable question. The truth:

• Diet (less fat) may reduce how often attacks happen, but it does not dissolve the stones.
• Dissolution medicines have very limited, slow and unreliable effects and are not a practical solution for most patients.
• Once stones become symptomatic, the risk of complications rises over time — which is why the definitive solution is removal of the gallbladder.

What to do

Two simple rules:

• If you have recurrent colic, it is not an emergency, but arrange an assessment with a surgeon to discuss removing the gallbladder before a complication develops. If the stones were found incidentally and cause no trouble, see the article on asymptomatic stones.
• If you develop warning signs (persistent pain, fever, jaundice), go to the emergency department right away.