Gallstones
Stones in the gallbladder that may cause biliary colic, infection or pancreatitis.
Overview
Most gallstones are asymptomatic. When a stone obstructs the cystic or bile duct, classic biliary colic occurs — severe right upper-quadrant pain after fatty meals. Complications include cholecystitis, cholangitis and gallstone pancreatitis.
Symptoms
- • Right upper-quadrant pain after fatty meals
- • Pain radiating to right shoulder
- • Nausea and vomiting
- • Jaundice (if duct obstruction)
Risk factors
- • Female sex
- • Age >40
- • Obesity
- • Pregnancy
- • Rapid weight loss
- • Family history
Causes
- • Cholesterol stones (most common)
- • Pigment stones (haemolysis)
🚨 Red flags — seek urgent care
- • Fever with jaundice (cholangitis) — emergency
- • Severe epigastric pain (pancreatitis)
- • Persistent vomiting
When to seek care
- • Recurrent biliary colic
- • Any red flag — urgent
- • New jaundice
Diagnosis
- • Transabdominal ultrasound — first-line, >95% sensitive for gallbladder stones
- • LFTs and amylase for suspected ductal stones or pancreatitis
- • MRCP if ductal stones suspected; EUS where MRCP equivocal
- • CT for complications (perforation, abscess) and to exclude other diagnoses
Treatment
- • Asymptomatic stones: usually no treatment unless high-risk (sickle disease, large stones, porcelain gallbladder)
- • Symptomatic biliary colic / cholecystitis: laparoscopic cholecystectomy (early in admission for acute cholecystitis)
- • Choledocholithiasis: ERCP with sphincterotomy and stone extraction, then cholecystectomy
- • Acute pancreatitis: supportive, then cholecystectomy in same admission for mild disease
- • Conservative management with antibiotics if surgery contraindicated
Prevention
- • Healthy weight; avoid rapid weight loss (>1.5 kg/week)
- • Balanced diet rich in fibre and unsaturated fats
- • Regular physical activity
- • Limit refined carbohydrates
Complications
- • Acute cholecystitis and gallbladder gangrene/perforation
- • Ascending cholangitis (Charcot triad / Reynolds pentad)
- • Acute pancreatitis (gallstone aetiology most common in UK)
- • Gallstone ileus, Mirizzi syndrome
- • Gallbladder carcinoma (rare; associated with chronic disease)
Education & self-care
This guidance is reviewed by Dr. Handel Emery, MD, FRCP (UK) and last updated 2026-06-08. It is educational and not a substitute for professional medical advice.
Frequently asked questions
Do I need surgery?
Symptomatic gallstones are usually treated with laparoscopic cholecystectomy. Asymptomatic stones often need no intervention.
Do all gallstones need treatment?
No. Stones found incidentally with no symptoms usually need no treatment. Surgery (laparoscopic cholecystectomy) is offered once stones cause biliary colic, cholecystitis, pancreatitis or jaundice.
What does biliary colic feel like?
Severe right upper abdominal pain — often after a fatty meal — lasting 30 minutes to several hours, sometimes radiating to the right shoulder, with nausea and vomiting.
Can I prevent gallstones with diet?
Maintaining a healthy weight, eating regular meals, including fibre and unsaturated fats, and limiting rapid weight loss reduce risk. Coffee and statins are also associated with lower stone formation.