Gallstones: Symptoms, Causes & Which Doctor to See

What are gallstones and who gets them?

The gallbladder is a small pouch under the liver that stores bile, which helps digest fat. When bile contains too much cholesterol or pigment, or the gallbladder does not empty well, crystals form and grow into stones. They range from grains of sand to stones several centimetres across.

Gallstones are common and become more frequent with age. Many people discover them on an ultrasound done for another reason, such as a health check. Gallbladder cancer is more common in some parts of India, and long-standing gallstones are one recognised risk factor, which is one reason scan reports should be reviewed by a surgeon rather than ignored or over-treated.

• Women, especially after pregnancy
• Age over 40
• Overweight and obesity
• Rapid weight loss or crash diets
• Diabetes and high triglycerides
• Family history of gallstones
• Certain blood disorders and liver cirrhosis

What are the symptoms of gallstones?

Most gallstones never cause symptoms. When a stone temporarily blocks the gallbladder outlet, it causes biliary colic: a steady, often severe pain under the right ribs or in the upper middle abdomen, sometimes spreading to the right shoulder blade or back. It often starts in the evening or after a large or fatty meal and lasts from about half an hour to a few hours.

Vague bloating, burping, gas and acidity are common in everyone and are frequently blamed on gallstones, but they are not typical of them. Removing the gallbladder for these symptoms alone may not help, so the surgeon looks carefully at whether your symptoms match the stones.

Gallstone pain is often mistaken for acidity or a muscle strain. Pain severe enough to stop you sitting still, that comes on after a meal and lasts more than half an hour, should be checked, especially if it has happened before. Chest pain with breathlessness or sweating should always be treated as a possible heart problem first.

• Pain under the right ribs or upper middle abdomen
• Pain lasting 30 minutes to several hours
• Pain spreading to the right shoulder blade or back
• Nausea or vomiting during episodes
• Attacks after heavy or oily meals
• Often pain-free between attacks

When is gallstone pain an emergency?

Stones can cause inflammation of the gallbladder (cholecystitis), block the bile duct, cause infection of the bile duct (cholangitis) or trigger pancreatitis. These need urgent hospital care. If you have any of the following, go to the nearest emergency department or call 112 or 108.

Bring a list of your medicines and any previous scan reports with you.

• Abdominal pain lasting more than a few hours or getting worse
• Fever, chills or shivering with abdominal pain
• Yellow skin or eyes (jaundice)
• Dark urine with pale or clay-coloured stools
• Severe upper abdominal pain going through to the back with vomiting
• Feeling confused, faint or very unwell

Which doctor should I see for gallstones?

A general and laparoscopic surgeon assesses gallstones and performs gallbladder removal. At Lotus, the general and laparoscopic surgery team reviews symptoms, scan findings and blood tests and explains whether surgery, monitoring or no treatment is appropriate. A gastroenterologist becomes involved when stones are in the bile duct and need removal by endoscopy (ERCP).

Book a surgical review if you have had one or more attacks of typical pain, if an ultrasound shows stones and you want to know what it means, or if your report mentions a thickened gallbladder wall, polyps, a stone larger than about 3 cm or a calcified gallbladder.

• One or more episodes of typical gallstone pain
• Gallstones found on a routine ultrasound
• Report showing a polyp, thick wall or very large stone
• Previous jaundice or pancreatitis
• Diabetes with gallstones and symptoms

What happens at the surgical consultation?

The surgeon asks about the timing, site and duration of pain, its link to meals, any jaundice, fever or pancreatitis, and your general health. They examine your abdomen and review your ultrasound and blood tests.

If surgery is recommended, the surgeon explains laparoscopic cholecystectomy, the anaesthetic, possible risks including bile leak and bile duct injury, and recovery. If you choose to wait, they will explain which symptoms should bring you back sooner.

If you have diabetes, heart or lung disease, an anaesthetist assesses you before surgery and may suggest adjustments to your medicines.

• Describe exactly where the pain is and how long it lasts
• Bring ultrasound and liver function reports
• List blood thinners and diabetes medicines
• Ask whether your symptoms fit gallstones
• Ask about recovery and return to work

Which tests are done for gallstones?

An abdominal ultrasound is the main test; it shows stones, gallbladder wall thickness and whether the bile duct is widened. Fasting for six hours or so beforehand improves the pictures.

Blood tests check for inflammation, liver function and pancreatitis. If there is a suspicion of stones in the bile duct, an MRCP (a special MRI) or an endoscopic ultrasound is used. CT is helpful when complications are suspected.

• Ultrasound abdomen
• Liver function tests
• Complete blood count and CRP
• Amylase or lipase for pancreatitis
• MRCP for bile duct stones
• Endoscopic ultrasound in selected cases

How are gallstones treated?

Gallstones that have never caused symptoms usually need no treatment. When stones cause pain, removing the gallbladder by laparoscopic (keyhole) cholecystectomy is the standard treatment, because attacks tend to recur and complications can develop. After an attack of acute cholecystitis, early surgery during the same illness is often recommended.

Bile duct stones may be removed by ERCP before or after gallbladder surgery. Medicines to dissolve stones work only for a small group of people with small cholesterol stones, take months, and stones often return when they are stopped. While waiting for surgery, pain relief and smaller, lower-fat meals can reduce attacks.

Some people have stones along with a gallbladder polyp, a thickened wall or a very large stone on the scan. These findings can change the advice, sometimes favouring removal even when symptoms are mild, so ask your surgeon to explain what your report means. Gallbladder removal is a common operation, but like any surgery it carries risks, and the decision should weigh your symptoms against them.

• No treatment for stones without symptoms
• Laparoscopic cholecystectomy for symptomatic stones
• Early surgery after acute cholecystitis in suitable patients
• ERCP for stones in the bile duct
• Antibiotics and hospital care for infection
• Dietary adjustment while awaiting surgery

Can diet prevent gallstones or gallstone attacks?

Keeping a healthy weight and avoiding rapid weight loss are the most useful steps. If you are losing weight, aim for a gradual reduction rather than crash diets or long fasts. Regular meals, plenty of vegetables, whole grains, pulses and fruit, and regular physical activity lower risk.

If you already have symptomatic stones, heavy and oily meals often trigger attacks. Common Bengaluru triggers include fried snacks such as bajji, vada and samosa, ghee-rich dishes and late-night restaurant meals. Smaller portions and steamed, grilled or lightly tempered food are better tolerated.

• Avoid crash diets and very long fasts
• Keep a healthy weight
• Eat regular, moderate meals
• Limit deep-fried food and heavy ghee
• Stay physically active
• Control diabetes and triglycerides

Can I live normally without a gallbladder, and when should I follow up?

Yes. Bile still flows from the liver into the bowel after gallbladder removal. Most people return to a normal diet within weeks. Some notice looser stools for a while, which usually settles. Many return to desk work within one to two weeks after keyhole surgery.

After surgery, a follow-up visit checks wounds and the pathology report on the removed gallbladder. Seek prompt review for fever, increasing abdominal pain, jaundice or wound discharge. If you chose not to have surgery, return if attacks become more frequent or any warning sign appears.

• Gradual return to normal diet
• Wound review and pathology report discussion
• Prompt contact for fever, jaundice or worsening pain
• Periodic review if stones are being monitored