Editor’s note: This blog post was medically reviewed by Va’Ronda Varnado, FNP-C and the Ezra medical team.
Gallstones form due to imbalances in bile composition which may result in abdominal pain, bile duct infections, and other health issues.
What you might not know, however, is that gallstones can still form outside of the gallbladder.
We’ll explore why in this article, as well as what symptoms look for, how gallstones are diagnosed, and what you can do today to prevent gallstone formation.
Table of contents
- What Are Gallstones
- How Gallstones Typically Form in the Gallbladder
- How Gallstones Form Without a Gallbladder
- Where Do Gallstones Go Without a Gallbladder?
- Types of Gallstones
- Gallstone Formation: Risk Factors To Look Out For
- Symptoms of Gallstone Formation
- How Gallbladder Stones are Diagnosed
- Management and Treatment of Gallstones
- Your Next Steps
What Are Gallstones
Gallstones are small, hard deposits of cholesterol and bile salts that form inside the gallbladder or other parts of the biliary tract, disrupting normal bile flow.
The gallbladder is a tiny organ on the right side of your abdomen, just below your liver. Its main role is to store and concentrate bile, a digestive liquid produced in the liver.
When gallstones are present in the gallbladder, it is called cholelithiasis. Meanwhile, choledocholithiasis develops when stones form in the common bile duct.
Gallstones can form outside the gallbladder. The liver, pancreas, and surrounding bile ducts are other areas where gallstones are sometimes found.
They range in size and number, and can cause complications if left untreated. For example, blocked bile ducts can lead to severe or life-threatening infection of the pancreas, liver, or the bile ducts themselves.
How Gallstones Typically Form in the Gallbladder
Gallstones form due to imbalances in cholesterol levels, bilirubin, or salts in the bile. Stones may form over time as cholesterol or bilirubin accumulates in the gallbladder or bile ducts.
Researchers are still unsure of the exact cause of gallstones. Lifestyle factors like being overweight, having an unhealthy diet, or not exercising, can increase the risk of developing gallstones.
Certain diets or surgeries that cause rapid weight loss may also lead to gallstone formation. If you don’t eat for a long period or you lose weight quickly, your liver tends to release extra cholesterol into the bile.
Gallstones may also form if the gallbladder is not emptied fully or often enough.
Gallstones usually form in the bile duct, sometimes passing through into the organ. As more gallstones accumulate, they can block the flow of bile, causing inflammation and pain.
The incidence of symptomatic gallstones is relatively low — 1 to 2 out of 10 Americans will have gallstones at some point in their lives, but up to 80% will not experience any symptoms. However, the number of people living with the condition is increasing due to an aging population, changes in lifestyle, and a rise in obesity rates.
How Gallstones Form Without a Gallbladder
A gallbladder is removed if it is affected by certain diseases like gallstones, tumors, and inflammation of the gallbladder. Gallstones may form even after the removal of the gallbladder.
When a gallbladder is removed, the bile produced by the liver cannot be stored. For this reason, gallstones can form anywhere along the bile duct system.
When a gallstone blocks the flow of digestive fluid through the bile ducts, inflammation or infection of the liver or one of the bile ducts can occur. This can cause intense pain in the upper right side of your abdomen.
It can also lead to complications, such as pancreatitis (inflammation of the pancreas) or cholangitis (inflammation of the bile duct system).
Potential Complications of Gallstones Without a Gallbladder
Potential complications of bile duct stones (also known as choledocholithiasis) include:
- acute pancreatitis
- blockage of the bile ducts and infection
Other potential complications include jaundice, increased risk of cancer of the bile ducts, cysts, and formation of granulomatous tissue.
In rare cases, the bile ducts may become completely blocked and require surgery to repair. In serious cases, sepsis and/or death may result.
Where Do Gallstones Go Without a Gallbladder?
Without a gallbladder, gallstones may form in other organs connected to the bile ducts, such as the pancreas. In some cases, the stones may pass from one area to another and cause complications.
Gallstones can also form in the liver, but this is rare. When stones form in the liver, they are called intrahepatic stones. They are common in people with cirrhosis or other diseases of the liver.
The formation of gallstones outside of the gallbladder is usually linked to elevated levels of cholesterol and bile salts in the digestive system, as well as other diseases such as diabetes, obesity, and pancreatitis.
If gallstones form in other organs, surgery or medications may be recommended to reduce the stones’ size or even prevent the stones from forming in the first place.
Types of Gallstones
Yes, there is more than one type of gallstone. Stones from any of the following types can vary in size, from a few millimeters to several centimeters in diameter.
- Cholesterol gallstones: The most common type of gallstones, and are primarily made up of cholesterol.
- Pigment gallstones: Made from bilirubin and other pigments from the breakdown of red blood cells. These stones are more common in people with liver diseases, such as cirrhosis, or those with a blood disorder.
- Mixed gallstones: These are a combination of cholesterol and pigment stones.
- Resident gallstones: Rare and made of calcium salts or proteins that stay in the gallbladder, these stones can increase in size and cause complications if left untreated.
- Calcium bilirubinate stones: These stones form when there is an excess amount of bilirubin in the bile, which binds to calcium.
- Recurring gallstones: As the name suggests, these stones form and dissolve frequently.
Gallstone Formation: Risk Factors To Look Out For
Several factors may increase the risk of gallstone formation, even without a gallbladder.
- Age: Gallstones are more likely to form as you age, especially after the age of 40, due to changes in bile salt level over time.
- Weight: Being obese is associated with a higher risk of gallstones, as increased fat in the body can lead to changes in the levels of cholesterol in the bile.
- Diet: Eating high-fat and high-cholesterol foods can lead to gallstones. Diets high in cholesterol and fats can cause gallstones to form even if you don’t have a gallbladder.
- Gender: Women are more likely to develop gallstones than men due to changes in sex hormones (like estrogen) that can potentially increase biliary cholesterol secretion.
- Family history: Having a family member with gallstones (or history of gallstones) increases your risk.
- Medications: Certain medications, such as some cholesterol-lowering drugs, can increase your risk of developing gallstones.
- Ethnicity: People from certain ethnic groups, such as Native Americans, are at a higher risk for cholelithiasis or gallstones.
- Pregnancy: During pregnancy, estrogen and progesterone levels increase, which can increase the risk of gallstones.
If you have any of the risk factors listed above and are concerned about developing gallstones, reach out to your doctor about the best way to reduce your risk.
Symptoms of Gallstone Formation
Gallstones create blockages within the biliary system, either in the ducts or inside organs. As such, symptoms often appear as gallstones develop and grow in size.
These include the following:
- Abdominal pain/discomfort: Gallstones can cause intense abdominal pain and discomfort. The pain can occur anywhere in the abdomen and may be sharp or dull. The pain may last for just a few minutes or several hours.
- Bloating/Cramping: As the stones block bile from entering the small intestine, bloating and cramping may accompany pain in the upper abdominal region.
- Nausea: Gallstones can cause nausea and vomiting, as bile may be blocked by the stones, leading to acid reflux. There is also a loss of appetite, abdominal pain, and a feeling of fullness.
- Vomiting: Severe nausea and vomiting can lead to dehydration and electrolyte imbalances.
- Fever: Gallstones can lead to an infection in the gallbladder, which can cause a fever.
- Dark urine: Due to bile in the urine, gallstones may cause a patient to produce darkly-colored urine.
- Yellowish skin/eyes (jaundice): This occurs due to bile being blocked by the stones and unable to reach the intestine.
- Indigestion: Gallstones can cause indigestion, as they can interfere with the digestion of food. Other symptoms may include abdominal pain, nausea, and vomiting.
Some patients may also experience asymptomatic or silent gallstones, where gallstones form without distinct symptoms. These stones may remain undetected until imaging tests for other issues reveal their presence.
Imaging tests such as abdominal CT scans or ultrasound are ordered to detect asymptomatic gallstones. MRI scans can also detect gallstones in the ducts of the biliary tract.
Treatment for asymptomatic gallstones is not necessary unless the patient begins to experience symptoms or if the patient is at risk of complications.
Important note: Gallstone symptoms may often be confused with other disorders like appendicitis, irritable bowel syndrome, or gastroenteritis.
How Gallbladder Stones are Diagnosed
A clear diagnosis by a health practitioner is crucial for proper treatment once symptoms have been confirmed.
Here are several diagnostic methods used to examine gallstones:
- Ultrasound imaging utilizes sound waves to produce an image of the gallbladder and the surrounding organs to detect inflammation, disease, or abnormal growth.
- Lab tests to measure the levels of alkaline phosphatase and bilirubin in the blood to identify the chemical composition of gallstones.
- Endoscopic retrograde cholangiopancreatography (ERCP) combines endoscopy and x-ray imaging to visualize the gallbladder and its duct. This is a test in which a small camera is inserted into the body to get a detailed view of the interior of the gallbladder and to detect any blockages or abnormalities.
- Blood tests to measure the level of certain bile acids and other substances which can indicate issues in the gallbladder. These tests can also detect cancer, infection, or other diseases.
- Magnetic resonance imaging (MRI) involves magnetic fields and radio waves to get detailed images of the gallbladder and its surrounding organs.
- Computed tomography (CT) scan utilizes a combination of x-rays and a computer to get detailed images of the gallbladder and its surrounding organs to diagnose any blockages, inflammation or tumors.
- Magnetic resonance cholangiopancreatography (MRCP) is an MRI exam that takes detailed pictures of the liver, gallbladder, pancreas, bile ducts, and pancreatic duct. The detailed images can help identify gallstone formation and inflammation of the bile ducts.
Did you know?
In less than an hour, Ezra’s full-body MRI screens up to 13 organs for potential cancers or other abnormalities such as the presence of gallstones.
Management and Treatment of Gallstones
Gallbladder stones that do not produce symptoms or complications may not need to be treated.
Otherwise, treatment options for gallstones may include the following:
Medication for gallstones may be prescribed, including medications that dissolve the stones or medications to help them pass. Specific medications include Ursodiol and Chenodiol, which helps in dissolving cholesterol gallstones.
Dietary changes, such as reducing fat and cholesterol intake, can help reduce the formation of gallstones. Balancing cholesterol, salts, and bilirubin levels in the bile fluid reduces the chances of gallstones forming in the body.
Open surgery for gallstones involves removing the gallbladder where the stones are located, called a cholecystectomy.
A traditional or open cholecystectomy is a medical procedure where a surgeon makes a 6-inch cut along your right abdomen below the ribs, exposing your liver and gallbladder. The gallbladder is then removed.
Laparoscopic cholecystectomy is a minimally invasive procedure that uses a thin tube with a camera. This tube is inserted into the abdomen, where the surgeon removes the gallbladder.
When gallstones are formed outside of the gallbladder, open surgery is still necessary to remove the stones and any tissue that has been damaged. A surgeon makes small incisions into your abdomen to assess and treat the areas where gallstones have formed.
Your Next Steps
The good news? You don’t have to wait until painful symptoms appear to prevent gallstones from forming, whether you have a gallbladder or not.
You can stay one step ahead of gallstones by managing risk factors and regular screening for abnormalities.
At Ezra, our full-body MRI scan examines your organs for signs of abnormalities, including the presence of any forming gallstones. This non-invasive whole-body screening helps you understand where you are on your health journey, and may help guide you to making long-term changes toward better health.
Recommending reading: How — and Why — an MRI of the Gallbladder May Help Catch Early Cancer
Book a full-body MRI scan today, or gift one to a loved one.
You can also schedule a call with our team to learn more. Contact us at (888) 402-3972 or email@example.com