Gallstones are small clusters of crystals that form in the gallbladder. If they become large or numerous enough, they can block the organ’s ducts and prevent digestive bile from reaching the small intestine. Most gallstones are tiny and cause no harmful effects, but stones that are large enough to warrant removal cause symptoms such as indigestion, bloating, nausea, and pain. Severe symptoms of gallstones, which include chills, fever, and intense pain, indicate an emergency situation.
How Gallstones Form
Stored in the gallbladder, bile is made up of water, cholesterol, salts, and bilirubin, a substance formed from the breakdown of red blood cells. In some cases, the cholesterol or bilirubin can stick together, forming small "stones" and becoming trapped in the mucus within the organ. Worldwide, between 10% and 20% of adults have gallstones, but fewer than half will ever experience any effects because they never grow large enough to cause harm. Stones that do get bigger over time may block the ducts of the organ, causing pain and other forms of discomfort. People are more likely to experience these symptoms as they grow older, because the stones continue to form and grow throughout life.
When the signs of gallstones first appear, they may include indigestion, bloating, nausea, gas, and abdominal pain, which is known as biliary colic. Collectively, these are referred to as a gallbladder attack. Symptoms usually develop within an hour of eating a fatty meal, and occur when stones block the cystic duct of the gallbladder. Fatty foods provoke an attack because bile is what allows fat digestion to occur in the stomach. The gallbladder contracts as it secretes bile, increasing the likelihood that stones will become trapped in the cystic duct.
The abdominal pain associated with this disease is typically felt in the upper right quadrant of the abdomen, and sometimes radiates to the right shoulder. Usually, the pain will go away within 60 to 90 minutes, but it can sometimes last for several hours. Mild pain can be relieved by over-the-counter medications. Pain and other effects gradually fade as the gallbladder stops contracting, allowing the stones to move out of the duct.
People who experience mild symptoms of gallstones during an attack have a 3% to 9% chance of the disease progressing to a more severe state. Anyone who experiences these symptoms regularly should seek medical advice so that the condition can be monitored. Diagnosing the problem early allows for more treatment options, including non-surgical procedures.
As stones grow larger or more numerous, the gallbladder often becomes inflamed and irritated, worsening the effects of an attack. The range of symptoms includes all of those in the mild category, as well as vomiting, chills, and fever. In an acute attack, the pain is more severe, and might extend to cover the mid-abdominal area, the right shoulder, and the upper back.
This level of pain does not always respond to common pain medications, but should respond to analgesics prescribed by a medical professional. People with severe pain are usually unable to find a comfortable sitting or lying position, and tend to shift positions repeatedly as a coping mechanism. These symptoms do not necessarily signify an emergency situation, but someone who experiences them is most likely a candidate for gallbladder removal in the future.
Contributing Factors and Treatments
For someone who progresses beyond the mild symptoms of gallbladder disease, the effects he or she experiences will worsen with age, simply because stones grow larger over time. Most people with major symptoms will eventually require some kind of medical treatment. Laparoscopic cholecystectomy, a procedure for removing the gallbladder, is quite common and typically relieves all symptoms, but it's not always required.
Most symptoms of gallstones develop after eating fatty foods, making diet one of the most important ways to control them. The more fat there is in any single meal, the greater the likelihood of an attack, and the worse the effects are likely to be. Adopting a reduced-fat diet won’t eliminate the disease altogether, but it will usually reduce the frequency and severity of painful episodes.
The effects of an attack, particularly the level of pain, can be made worse by exercise, because deep breathing and vigorous movement can put additional pressure on the contracting organ. Regular exercise does improve a person’s general health, but physical exertion during or after an episode should be avoided. Any movement during an attack should be slow and careful, not only to avoid worsening the pain, but because the symptoms of a severe attack can be slightly disorienting.
While there is no hard evidence to prove a connection, some women find that their symptoms worsen during menstruation, to the point where minor gallbladder pain is sometimes felt in the absence of any other symptoms. Women have a higher risk of developing stones than men, because estrogen promotes cholesterol secretion in the bile. If there is a connection between menstruation and gallbladder attacks, it might be due to the effect that estrogen levels have on stone formation. When this phenomenon does occur it is no cause for alarm unless the symptoms are at emergency level.
When Do Symptoms Indicate an Emergency?
In extreme cases, nausea, sharp upper abdominal pain, and vomiting might occur in conjunction with a high fever, violent chills, or excessive perspiration. These symptoms indicate an emergency situation where immediate medical attention is required. This is especially true when symptoms are accompanied by jaundice, a condition in which the skin and the whites of the eyes appear yellowish in color. These very severe symptoms develop when the gallbladder has stopped working correctly, leading to the build-up of high toxin levels in the body and bloodstream. This can occur as a result of gallbladder disease alone, or in conjunction with complications, such as an infection.