Is it gallstones? Signs, causes, and when to see a doctor

What are gallstones?

Gallstones are hardened deposits that form inside the gallbladder—a small, pear-shaped organ beneath the liver that stores bile, a digestive fluid. Bile contains cholesterol, bilirubin, and bile salts; when these components become imbalanced, they can crystallize and form stones ranging from the size of a grain of sand to a golf ball.¹

There are two main types:

• Cholesterol gallstones: The most common type (about 80% of cases), formed when bile contains too much cholesterol relative to bile salts.
• Pigment gallstones: Formed from excess bilirubin, more common in people with certain blood disorders or liver disease.

Gallstones are common—approximately 10–15% of adults in the United States have them—but most never cause symptoms.²

Symptoms of a gallstone attack

When a gallstone blocks a bile duct, even temporarily, it triggers a gallbladder attack (biliary colic). Symptoms include:³

• Sudden, intense pain in the upper right abdomen or center of the stomach (epigastric area)
• Pain that radiates to the right shoulder or between the shoulder blades
• Nausea and vomiting
• Pain that typically peaks within an hour and lasts 1 to 5 hours
• Pain that often begins 30–60 minutes after eating a fatty meal

Between attacks, most people feel completely well. The pain is not gradual—it comes on quickly and can be severe enough to be mistaken for a heart attack or appendicitis.

Warning signs: when it's an emergency

Some gallstone complications are serious and require emergency care. Go to the ER immediately if you have:⁴

• Abdominal pain lasting more than 5 hours
• Fever or chills accompanying the pain (may indicate cholecystitis or cholangitis—infection of the gallbladder or bile duct)
• Jaundice: yellowing of the skin or whites of the eyes (suggests a stone is blocking the common bile duct)
• Clay-colored stools or dark urine alongside jaundice
• Severe nausea and vomiting you cannot manage
• Pain so severe you cannot sit still or find a comfortable position

Untreated gallbladder infection (acute cholecystitis) or bile duct blockage (choledocholithiasis) can become life-threatening within hours.

Can urgent care help with gallstones?

Urgent care can be appropriate for mild to moderate gallstone symptoms—particularly a first episode of abdominal pain that is not accompanied by fever, jaundice, or unbearable pain. At urgent care, a provider can:

• Evaluate your symptoms and take a history
• Order bloodwork to check for signs of infection or liver enzyme elevation
• Arrange or order an abdominal ultrasound if available
• Prescribe anti-nausea medication and pain management for mild symptoms
• Refer you to a gastroenterologist or general surgeon for follow-up

If your symptoms include fever, jaundice, or severe unrelenting pain, skip urgent care and go directly to the emergency room.

Causes and risk factors

Gallstones form when bile chemistry is out of balance. Known risk factors include:⁵

• Sex: Women are twice as likely as men to develop gallstones, partly due to estrogen's effect on bile composition
• Age: Risk increases significantly after age 40
• Obesity or rapid weight loss: Excess cholesterol in bile and rapid changes in bile composition both raise risk
• Pregnancy: Hormonal changes slow gallbladder emptying
• Family history: A first-degree relative with gallstones doubles your risk
• Diet: High-fat, high-cholesterol, low-fiber diets increase risk; so does prolonged fasting or crash dieting
• Diabetes: Associated with higher triglyceride levels, a risk factor for gallstones
• Certain medications: Cholesterol-lowering drugs (fibrates), hormone therapy, and oral contraceptives can increase gallstone risk

How gallstones are diagnosed

The standard first-line test is an abdominal ultrasound, which detects gallstones with greater than 95% accuracy and is painless and radiation-free.⁶ Additional tests may include:

• Blood tests: Liver function tests (ALT, AST, bilirubin, alkaline phosphatase) detect bile duct obstruction; CBC checks for infection
• CT scan: More detailed imaging for complicated cases or suspected bile duct stones
• MRCP (magnetic resonance cholangiopancreatography): Non-invasive imaging of the bile and pancreatic ducts
• ERCP (endoscopic retrograde cholangiopancreatography): Both diagnostic and therapeutic; can remove stones from the common bile duct

Treatment options

Treatment depends on whether your gallstones are causing symptoms:⁷

• Watchful waiting: Recommended for silent (asymptomatic) gallstones. No intervention needed unless symptoms develop.
• Dietary changes: Reducing fat intake can decrease the frequency of attacks while awaiting surgery or if surgery is not an option.
• Laparoscopic cholecystectomy: Surgical removal of the gallbladder through small incisions. The standard treatment for symptomatic gallstones. Most people go home the same day or after one overnight stay.
• Open cholecystectomy: Required when laparoscopic surgery is not possible, usually due to complications or extensive adhesions.
• ERCP with stone removal: For stones lodged in the common bile duct, endoscopic removal is performed before or instead of cholecystectomy.

The gallbladder is not essential for digestion. Most people adapt normally after it is removed and can eat a regular diet.

Prevention

You can lower your gallstone risk with these evidence-based habits:

• Maintain a healthy weight and avoid rapid weight loss or crash dieting
• Eat a diet high in fiber (fruits, vegetables, whole grains) and moderate in healthy fats
• Stay physically active—regular exercise lowers gallstone risk by up to 30%⁸
• Do not skip meals, as prolonged fasting concentrates bile and promotes stone formation
• Talk to your doctor if you are considering hormone therapy, as estrogen increases gallstone risk