[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Conditions](https://durgical.com/en/conditions/) › Gallstones (cholelithiasis)

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# Gallstones (cholelithiasis)

Gallstones (cholelithiasis) are hard stones that form in the gallbladder; most cause no symptoms, but some cause biliary colic or complications.

Updated 2026-10-29

## Structures involved

Tap one to see what it is and open it in 3D.

- [Gallbladder](https://durgical.com/en/anatomy/gallbladder/)
- [Cystic duct](https://durgical.com/en/anatomy/cystic-duct/)
- [Common bile duct](https://durgical.com/en/anatomy/bile-duct/)
- [Liver](https://durgical.com/en/anatomy/liver/)
- [Common hepatic duct](https://durgical.com/en/anatomy/common-hepatic-duct/)
- [Ampulla of Vater](https://durgical.com/en/anatomy/hepatopancreatic-ampulla/)
- [Pancreatic duct](https://durgical.com/en/anatomy/pancreatic-duct/)
- [Duodenum](https://durgical.com/en/anatomy/duodenum/)

## In biochemistry

- [Heme breakdown and bilirubin: Step 6 · Urobilinogen oxidation (colonic bacteria and kidney)](https://durgical.com/en/biochemistry/pathways/heme-breakdown-and-bilirubin/#paso-6)
- [Classic bile acid synthesis pathway: Step 1 · Cholesterol 7α-hydroxylase (CYP7A1)](https://durgical.com/en/biochemistry/pathways/classic-bile-acid-synthesis-pathway/#paso-1)
- [Cholesterol 7α-hydroxylase (CYP7A1)](https://durgical.com/en/biochemistry/enzymes/cholesterol-7-hydroxylase/)
- [Cholesterol](https://durgical.com/en/biochemistry/molecules/cholesterol/)
- [Cholic acid](https://durgical.com/en/biochemistry/molecules/cholic-acid/)
- [Bile acid synthesis](https://durgical.com/en/biochemistry/topics/bile-acid-synthesis/)
- [Bilirubin](https://durgical.com/en/biochemistry/molecules/bilirubin/)

## In histology

- [Gallbladder and bile ducts](https://durgical.com/en/histology/gallbladder-and-bile-ducts/)

## In the clinical exam

- [Murphy sign](https://durgical.com/en/clinical-exam/murphy-sign/)
- [Courvoisier sign](https://durgical.com/en/clinical-exam/courvoisier-sign/)

## In physiology

- [Gastrointestinal hormones](https://durgical.com/en/physiology/gastrointestinal-hormones/)
- [Bile and the enterohepatic circulation](https://durgical.com/en/physiology/bile-and-the-enterohepatic-circulation/)
- [Exocrine pancreatic secretion](https://durgical.com/en/physiology/exocrine-pancreatic-secretion/)

## Why it happens

- [Obesity: leptin, adipokines and its consequences](https://durgical.com/en/general-pathology/obesity-leptin-adipokines-and-its-consequences/)

## What it is

Stones (calculi) in the gallbladder, formed from cholesterol, bilirubin pigment or both. Most people have no symptoms; some develop biliary colic or complications.

## Who gets it

Very common worldwide and especially frequent in Latin America, including Colombia, where Amerindian ancestry is linked to a higher risk. More common in women and with age.

## Causes

- Bile supersaturated with cholesterol (cholesterol stones, the most common)
- Excess unconjugated bilirubin from haemolysis or cirrhosis (black pigment stones)
- Bile infection and stasis (brown pigment stones, often in the bile ducts)
- Gallbladder hypomotility (pregnancy, fasting, parenteral nutrition)

## Risk factors

- The classic «4 F's», described neutrally: female sex, forty or older, fertile (pregnancy, oestrogens), and fat (obesity)
- Rapid weight loss, including after bariatric surgery
- Family history and ethnicity (high risk in Indigenous and Hispanic populations)
- Haemolytic diseases, cirrhosis, Crohn disease or ileal resection
- Diabetes, metabolic syndrome and some drugs (for example oestrogens, fibrates)

## Pathophysiology

Stones form when bile holds more cholesterol than bile salts and lecithin can dissolve, when crystals nucleate, and when the gallbladder empties poorly. A stone that temporarily blocks the [cystic duct](https://durgical.com/en/anatomy/cystic-duct/) causes biliary colic; persistent blockage causes cholecystitis, and stones that pass into the [common bile duct](https://durgical.com/en/anatomy/bile-duct/) cause obstruction, cholangitis or pancreatitis.

## Classification

- Asymptomatic gallstones
- Symptomatic: biliary colic
- Complicated: acute cholecystitis, choledocholithiasis, cholangitis, gallstone pancreatitis, gallstone ileus
- By composition: cholesterol, black pigment, brown pigment, mixed

## Symptoms and signs

- Often none (found by chance on ultrasound)
- Biliary colic: steady right upper quadrant or epigastric pain, usually after meals, lasting from about 30 minutes to a few hours, then easing
- Pain radiating to the right shoulder blade
- Nausea and vomiting during attacks
- No fever and a soft [abdomen](https://durgical.com/en/anatomy/region/abdomen/) between attacks

## Red flags

- Pain lasting more than several hours or with fever (cholecystitis)
- Jaundice, dark urine or pale stools (stone in the bile duct)
- Fever with chills and jaundice (cholangitis)
- Severe pain radiating to the back (pancreatitis)

## Diagnosis

**Clinical**
A typical history of postprandial biliary-type pain. Uncomplicated colic causes no fever and no persistent tenderness.

**Tests**
Usually normal in simple colic. Blood count, [liver](https://durgical.com/en/anatomy/liver/) tests, bilirubin and lipase look for complications.

**Imaging**
Ultrasound is the test of choice: mobile echogenic stones with acoustic shadowing. Endoscopic ultrasound can find small stones (microlithiasis) when ultrasound is normal.

## Differential diagnosis

- Peptic ulcer disease or functional dyspepsia
- Gastro-oesophageal reflux disease
- Acute pancreatitis
- Irritable bowel syndrome
- Renal colic
- Angina or inferior myocardial infarction

## Goal of treatment

Relieve attacks and prevent complications; silent stones are usually left alone.

## Treatment

**Follow-up**
Asymptomatic stones are generally observed; preventive cholecystectomy is reserved for special cases (for example a porcelain [gallbladder](https://durgical.com/en/anatomy/gallbladder/) or very large stones), and criteria vary.

**Medical**
Biliary colic is treated with analgesia, often non-steroidal anti-inflammatory drugs; oral bile acids can dissolve small cholesterol stones in selected patients who cannot have surgery.

**Surgical**
Elective laparoscopic cholecystectomy is the definitive treatment for symptomatic gallstones.

**Lifestyle**
Healthy weight and avoiding very rapid weight loss; smaller, lower-fat meals may reduce attacks.

## Drugs for this condition

- [Ursodeoxycholic acid](https://durgical.com/en/pharmacology/ursodeoxycholic-acid/)

## Complications

- Acute cholecystitis
- Choledocholithiasis and obstructive jaundice
- Acute cholangitis
- Gallstone pancreatitis
- Gallstone ileus
- Mirizzi syndrome; long-standing stones are associated with gallbladder cancer

## Prognosis

Most people with silent stones never develop symptoms. Once colic appears, attacks tend to recur and the yearly risk of complications rises; cholecystectomy is curative for gallbladder stones.

## Prevention

- Healthy weight and regular physical activity
- Gradual rather than very rapid weight loss
- In selected patients after bariatric surgery, clinicians may use oral bile acids to prevent stones

## Test yourself

Think of the answer, then tap the question to see it.

## What are the classic «4 F's» risk factors for gallstones?

Female sex, forty or older, fertile (pregnancy or oestrogens) and fat (obesity). Ethnicity and rapid weight loss also matter.

## How is biliary colic different from acute cholecystitis?

Colic is pain that eases within a few hours, without fever or persistent tenderness; cholecystitis is longer pain with fever, Murphy sign and inflammation.

## What is the most common type of gallstone?

Cholesterol stones.

## What is the imaging test of choice for gallstones?

Abdominal ultrasound, which shows echogenic stones with posterior acoustic shadowing.

## What causes black pigment stones?

Excess unconjugated bilirubin, as in chronic haemolysis (for example sickle cell disease) or cirrhosis.

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/gallstones/)

## Related conditions

- [Acute cholecystitis](https://durgical.com/en/conditions/acute-cholecystitis/)
- [Choledocholithiasis](https://durgical.com/en/conditions/choledocholithiasis/)
- [Acute cholangitis](https://durgical.com/en/conditions/acute-cholangitis/)
- [Acute pancreatitis](https://durgical.com/en/conditions/acute-pancreatitis/)
- [Gastro-oesophageal reflux disease (GERD)](https://durgical.com/en/conditions/gastro-oesophageal-reflux-disease/)
- [Peptic ulcer disease](https://durgical.com/en/conditions/peptic-ulcer-disease/)
- [Irritable bowel syndrome](https://durgical.com/en/conditions/irritable-bowel-syndrome/)
- [Chronic pancreatitis](https://durgical.com/en/conditions/chronic-pancreatitis/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Gallstones (Cholelithiasis)](https://www.ncbi.nlm.nih.gov/books/NBK459370/) (StatPearls (NCBI Bookshelf), 2026).

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Source: https://durgical.com/en/conditions/gallstones/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/gallstones/