Risk factors

The following factors lead to an increase in the probability of gallstones:

Female sex
Overweight
Blonde = light-skinned skin type
Childbearing age
Age > 40 years.

Gallstones are in most cases asymptomatic, i.e. without symptoms. Symptoms usually only occur when there is an obstruction or inflammation of the bile ducts (cholecystitis). In about one third of cases, biliary colic occurs.

Biliary colic is characterized by wave-like, severe pain in the right and middle upper abdomen, often lasting for minutes or hours. The pain often radiates into the right shoulder or back. Other symptoms may be: In general terms, a more frequent familial occurrence can also be observed.

It can therefore be assumed that there is a hereditary component to this condition. You can find more information on this topic under:

Feel of pressure or fullness
Nausea and vomiting
As well as a yellowing of the skin (icterus) due to bile stasis, because a stone has blocked an exit route and the bile is now increasingly pressed into the blood.
SymptomsComplaints due to gallstones
Flank pain on the right
Pain in the back

Bile fluid ensures that dietary fats can be absorbed at all in the intestine. The gallbladder serves to store the bile acids produced by the liver and empties into the duodenum after (high-fat) meals.

If the outflow of bile is obstructed, for example by a stone, the fats cannot be absorbed or cannot be absorbed completely and remain in the stool: this results in so-called fatty stools (steatorrhea), which are usually considerably softer than normal stools and can smell strongly.This can lead to diarrhea, but the greatly increased stool volume can also cause constipation as a symptom. Those affected by gallstone disease often complain of unusually severe fatigue. The cause is bilirubin, a waste product that is produced when red blood cells are broken down.

Bilirubin is normally excreted with the bile and accumulates in the bloodstream and above it also in the tissue when bile flow is obstructed. This causes jaundice (icterus) on the one hand, and bilirubin acts on the central nervous system on the other. The influence on the brain is then usually manifested by the fatigue described by those affected.

In the context of gallstone disease, the entire skin can begin to itch. The cause is then a (partial) obstruction of the bile duct by a stone, which makes it harder or impossible for the bile to flow off (cholestasis). The exact biochemical mechanism is still unknown, however.

It is assumed that the problem is the accumulation of bile acids and the waste product bilirubin, which is caused by the obstructed outflow. These then lead to irritation of the nerve endings, which the body perceives as itching. Abdominal pain is probably the most common symptom of gallstones.

This can be due to a stone that has slipped into the bile duct, causing a bile stasis (cholestasis): the result is then usually a sudden, colicky (regularly recurring pain peaks) pain. However, gallstones lying in the gallbladder itself can also cause pain. These then occur after eating, especially after high-fat meals, as the gallbladder contracts to release the bile into the intestine and is then resisted by the stones.

The abdominal pain caused by gallstones is usually felt in the right upper abdomen and often radiates to the right shoulder blade. Gallstones become symptomatic in only a quarter of the so-called stone carriers, i.e. cause discomfort. Here, the pain is the most important factor.

Many affected persons only then become aware of possible gallstones and had not previously noticed any abnormalities regarding the gall bladder. On the one hand, there may then be a pressure pain in the upper right quarter of the abdomen, which can be provoked by palpation of the gallbladder below the right costal arch and simultaneous inhalation. On the other hand, the colicky pain typical of gallstones can also occur there.

These are characterized by the fact that they occur in attacks, initially increase sharply and then subside again. The pain is caused by the fact that the gallbladder muscles have to work against a high resistance when the gallstones come off, since the stones are usually larger than the exit of the gallbladder. The gallbladder contracts in waves in the direction of the gall bladder outlet and can cramp up due to the resistance.

The pain can also radiate into the shoulder or back. The occurrence of colic is related to the consumption of fatty food and the activity of the parasympathetic nervous system. If gallstones become symptomatic and cause pain, treatment is urgently needed.