Gallstones
Also called: cholelithiasis, gallbladder stones, gallstone disease, biliary colic
Gallstones are small hard lumps that form in the gallbladder. Most cause no trouble, but a stone can block the flow of bile and cause sudden, severe upper belly pain. Stones that cause symptoms are usually treated by removing the gallbladder with keyhole surgery.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
The gallbladder is a small pouch that sits under the liver. It stores bile, a digestive juice made by the liver, and squeezes it into the gut after meals. Gallstones form when the chemicals in bile get out of balance. Most stones are made mainly of cholesterol. Others, called pigment stones, are made from bilirubin (a yellow substance released when red blood cells break down). Stones can be as small as a grain of sand or as big as a golf ball, and they can grow slowly over many years.
Gallstones are very common. UK guidance estimates that about 15 in every 100 adults have them, and most of these people never get any symptoms. Stones found by chance on a scan, in an otherwise normal gallbladder, usually do not need treatment.
Trouble starts when a stone gets stuck in the narrow tube that drains the gallbladder or in the main bile duct. This causes attacks of pain called biliary colic, and can lead to infection or swelling of the gallbladder, jaundice (yellow skin and eyes) or pancreatitis (inflammation of the pancreas). Only a small number of people with stones have symptoms each year. When symptoms do appear, removing the gallbladder by keyhole surgery is the usual treatment, and people live normally without it.
In Pakistan
A hospital-based study from Larkana, Sindh, linked gallstone disease with being female, being a housewife, an inactive lifestyle, high blood pressure and stress.
Symptoms
- Sudden, severe pain in the upper middle part of the belly or just under the right ribs (biliary colic)
- Pain that may spread to the back or the right shoulder blade
- Pain that often lasts from about half an hour to a few hours, then settles
- Attacks that may come after a fatty meal, or at night, and may be weeks or months apart
- Pain that is not relieved by passing wind, opening the bowels or vomiting
- Feeling sick, vomiting or sweating during an attack
- Fever, shivering or pain that does not go away, which can mean infection
- Yellow skin or eyes, itchy skin or pale, clay-coloured stools, which can mean a stone is blocking the bile duct
- Many people have no symptoms at all and only find out from a scan done for another reason
Causes and risk factors
Causes
- Too much cholesterol in the bile, which forms crystals that slowly grow into stones (the most common type)
- Too much bilirubin in the bile, often because red blood cells are breaking down faster than normal, which forms pigment stones
- A gallbladder that does not empty properly, so bile sits still and thickens
- Infection in the bile ducts or narrowing of the ducts, which can lead to brown pigment stones
- Liver conditions that affect the flow of bile, such as cirrhosis (scarring of the liver)
What makes it more likely
- Being female, especially after having children, or taking medicines that contain oestrogen such as the combined pill or hormone replacement therapy
- Age over 40
- Being overweight or obese, diabetes and insulin resistance
- Losing weight quickly, for example on a very low-calorie diet or after weight-loss surgery
- Lack of physical activity
- Pregnancy, when the gallbladder empties more slowly
- A close relative with gallstones
- Conditions that destroy red blood cells, liver cirrhosis, Crohn's disease, long-term feeding through a drip, and certain medicines such as ceftriaxone (an antibiotic) and somatostatin-type medicines
Complications
If a stone blocks the gallbladder outlet for a long time, the gallbladder can become inflamed and infected (acute cholecystitis). This causes constant pain, fever and a fast heartbeat, and rarely leads to an abscess or a burst gallbladder. A stone that moves into the main bile duct can cause jaundice and a dangerous infection of the bile ducts (cholangitis). A stone that blocks the opening of the pancreas can cause acute pancreatitis, with severe pain spreading to the back, which usually needs hospital care. Rare problems include a stone blocking the bowel (gallstone ileus) and gallbladder cancer. Surgery itself has small risks, such as injury to the bile duct or a stone left behind in the duct.
When to see a doctor
- Yellowing of the skin or the whites of the eyes (jaundice), with or without itching
- Belly pain that lasts longer than eight hours, or is so bad that you cannot get comfortable
- High fever with shivering or chills together with belly pain
- Severe pain in the upper belly spreading to the back with repeated vomiting, which may be pancreatitis
- Confusion, fainting or feeling very unwell with fever and belly pain: go to the emergency department straight away, as this can be a serious bile duct infection
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Diagnosis
The doctor asks about the pain and examines the belly. Pressing under the right ribs while you breathe in may cause sharp pain if the gallbladder is inflamed (Murphy's sign). Blood tests are usually done, including liver function tests and a full blood count. Tests for pancreatic enzymes (amylase or lipase) are added if pancreatitis is possible.
An ultrasound scan of the upper belly is the main test. It is painless, quick and finds most gallbladder stones. If the scan does not show stones in the bile duct but the duct is widened or the liver tests are abnormal, an MRCP (a special MRI scan of the bile ducts) may be done. If that still does not give an answer, an endoscopic ultrasound (a scan done through a thin tube passed down the throat) may help. A CT scan is often used in emergencies to look for complications such as pancreatitis.
Treatment
- If stones were found by chance and cause no symptoms, treatment is usually not needed. Watch for symptoms and report them.
- For an attack of biliary colic, pain relief is given. Anti-inflammatory painkillers are usually tried first, sometimes with a medicine that relaxes gut spasm. Stronger painkillers may be needed for severe pain.
- Avoid foods and drinks that you notice bring on pain until the gallbladder or stones are removed.
- If stones cause symptoms, the usual treatment is keyhole surgery to remove the gallbladder (laparoscopic cholecystectomy). Many people go home the same day.
- If the gallbladder is inflamed (acute cholecystitis), surgery is best done early, usually within a week of diagnosis. People who are too unwell for surgery may have a thin tube placed through the skin to drain the gallbladder.
- Stones in the main bile duct are removed, either during surgery or with ERCP (a camera tube passed through the mouth into the bile duct), and the gallbladder is usually removed as well.
- Infection of the bile ducts or a badly infected gallbladder is treated in hospital with antibiotics and drainage of the blocked bile.
Medicines in Pakistan
Medicines a doctor may use, by group. Read the role: some are only for special cases. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| Analgesics / NSAIDs | preferred first choice to relieve biliary colic pain; your doctor decides the dose and checks if they are safe for you | Diclofenac (26 brands) |
| Antispasmodics | may be added to relax spasm and ease colic pain | Hyoscine butylbromide (6 brands) |
| Opioid analgesics | for severe pain that other painkillers do not control | Buprenorphine (5 brands) |
| Antiemetics | to ease nausea and vomiting during an attack | Ondansetron (256 brands), Metoclopramide (51 brands) |
| Antibiotics | for bile duct infection (cholangitis), severe gallbladder infection or sepsis; chosen and given in hospital, not needed routinely for mild cases | Chosen by your specialist |
| Bile acids | rarely used to dissolve small cholesterol stones because they often fail and stones come back; sometimes used to prevent stones during rapid weight loss | Chosen by your specialist |
Also used (not yet in our price list): Ursodeoxycholic acid (bile acid; limited use)
Self-care and prevention
Self-care
- Note which foods or drinks bring on your pain and avoid them until your stones or gallbladder are treated
- Eat a balanced diet with plenty of fruit, vegetables and wholegrains, and less saturated fat
- Eat regular meals rather than going for long periods without food
- If you need to lose weight, do it slowly and avoid crash diets
- Stay physically active
- Keep alcohol low or avoid it
- Do not keep taking painkillers for repeated attacks without seeing a doctor; frequent attacks usually need surgery
- After gallbladder removal, most people can return to their normal diet
Prevention
- Keep a healthy weight, and lose extra weight gradually rather than quickly
- Be physically active on most days
- Eat a diet high in fibre, with fruit, vegetables, wholegrains and nuts, and limit saturated fat and refined sugar
- Do not skip meals for long periods
- Medicines to prevent gallstones are not advised for most people; a doctor may suggest one only during very rapid weight loss
Common questions
Do gallstones always need an operation?
No. Most people with gallstones have no symptoms, and stones found by chance in a normal gallbladder usually do not need treatment. Surgery is offered when stones cause pain or complications.
Can medicine dissolve gallstones?
There are tablets that can dissolve some small cholesterol stones, but they often do not work, may take up to two years, and stones often return after stopping. For this reason they are rarely used, and European guidance does not recommend them for dissolving stones.
Can I live normally without a gallbladder?
Yes. The liver still makes bile, which then flows straight into the gut instead of being stored. After recovery, most people do not need to avoid any foods, but see your doctor if eating triggers new symptoms.
Does a very low-fat diet cure gallstones?
No. A healthy, balanced diet can help with pain and general health, but no diet removes stones. Very strict diets that cause fast weight loss can actually make gallstones more likely.
How long does recovery from keyhole gallbladder surgery take?
Many people go home the same day. Full recovery after keyhole surgery usually takes around ten days, but it is longer after open surgery.
Sources
- NICE. Gallstone disease: diagnosis and management (CG188) (2014).
- European Association for the Study of the Liver (Journal of Hepatology). EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones (2016).
- StatPearls (NCBI Bookshelf). Gallstones (Cholelithiasis) - StatPearls - NCBI Bookshelf (2026).
- MedlinePlus. Gallstones: MedlinePlus Medical Encyclopedia (2025).
- NHS 111 Wales. NHS 111 Wales - Health A-Z : Gallstones (2022).
- Rawal Medical Journal. Incidence and risk factors of gallstone disease in Larkana, Pakistan (2019).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.
Related conditions
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