The gallbladder is an organ located in the upper right abdomen, under the liver. primary purpose of the gallbladder is to store and concentrate bile, a greenish-brown fluid that is produced by the liver. Bile carries waste products out of the liver and is needed to digest and absorb fatty foods and vitamins.

Gallstones are solid, pebble-like concretions that form inside the gallbladder. Most of the time, gallstones are asymptomatic and do not require any treatment. However, in some cases, they may cause symptoms and thus require treatment. Some factors increase the risk of developing gallstones including female sex, older age, family history of gallstones, pregnancy, estrogen containing medications, obesity, rapid weight loss, diabetes and others.

In the cases where the gallstones are symptomatic, patients will experience gallstone or biliary pain. The pain is located in the right upper abdomen and sometimes in the upper center of the abdomen and may be accompanied by pain in the right shoulder, nausea and vomiting. The pain results from the blockage of the gallbladder outlet by stones that are compressed when the gallbladder contracts after a meal. The pain resolves when the gallbladder relaxes hours after the meal.

If the patient’s symptoms are typical of biliary colic and the presence of gallstones is confirmed by an ultrasound, then the treatment would be the removal of the gallbladder surgically.

Complications of gallstones include acute cholecystitis and choledocholithiasis.

Acute cholecystitis refers to inflammation of the gallbladder when there is a complete blockage of the gallbladder, caused by a gallstone. Unlike biliary colic, which resolves within a few hours, pain is constant with acute cholecystitis and fever is common. This condition requires hospital admission and treatment with antibiotics and surgery to remove the gallbladder with the stones.

Choledocholithiasis can develop if one or more gallstones leave the gallbladder to the main bile ducts and block the area where bile exits into the intestine. It may lead to a yellow discoloration of the skin and eyes, to acute cholangitis, which is an infection of the bile ducts that causes pain, chills, and fever and requires prompt treatment involving removal of the blocking gallstone with ERCP and finally to acute pancreatitis which is inflammation of the pancreas, leading to severe abdominal pain.