Severe abdominal pain with fever and jaundice needs emergency care immediately. This triad suggests cholangitis — an infected blocked bile duct — which requires urgent drainage. Also seek urgent care for severe pain lasting more than six hours.
Stones forming in the gallbladder are extremely common and most cause no trouble at all. The problems arise when one blocks the outlet, or escapes into the bile duct.
Most gallstones found by accident need nothing done. Symptomatic stones are a different matter, and a stone in the bile duct with fever is an emergency.
Bile is made by the liver, stored and concentrated in the gallbladder, and released after meals to help digest fat. Stones form when its components crystallise — most commonly cholesterol stones, though pigment stones occur in conditions where red cells break down excessively, including thalassemia and sickle cell disease.
They are very common, and the majority cause no symptoms at all. Silent stones found incidentally on an ultrasound performed for another reason generally require no treatment, because the chance of them ever causing trouble is modest.
Symptoms appear when a stone temporarily blocks the gallbladder outlet — biliary colic, a severe constant pain in the upper right abdomen, often radiating to the back or right shoulder blade, typically after a fatty meal, lasting from thirty minutes to a few hours.
The complications are what make gallstones important. Persistent blockage causes cholecystitis, an inflamed and infected gallbladder. A stone escaping into the bile duct causes obstructive jaundice, and if that duct becomes infected, cholangitis — a genuine emergency. And a stone lodging near the pancreatic duct causes acute pancreatitis, which is among the most serious complications of all.
This combination — severe upper abdominal pain, fever, and yellowing of the eyes — suggests cholangitis, an infection in a bile duct blocked by a stone. Bacteria multiply behind the obstruction and can enter the bloodstream rapidly, causing sepsis. It requires antibiotics and urgent drainage of the duct, usually by ERCP, within hours rather than days. Mortality without prompt treatment is substantial. This is treated at the nearest capable hospital, not after arranging travel. If confusion or low blood pressure develop alongside, the patient is already seriously unwell and needs an ambulance.
Ultrasound finds the stones; blood tests reveal whether the duct is blocked.
The ultrasound tells us whether there are stones in the gallbladder; the liver function tests tell us whether one has moved into the bile duct, which changes the treatment completely. Send both, along with any amylase or lipase result, and describe the pain — where it is, how long each episode lasts, and what brings it on. If you have thalassemia or sickle cell disease, mention it, because pigment stones are common in both.
Silent stones are left alone. Symptomatic stones are treated definitively.
Stones found incidentally in someone with no symptoms generally require no treatment, because the likelihood of them ever causing trouble is modest and surgery carries its own small risks. Exceptions include very large stones, a calcified gallbladder, and patients with certain blood disorders where the threshold is lower.
Removal of the gallbladder through small incisions. It is the definitive treatment for symptomatic gallstones — removing the stones alone is not done, because they simply re-form. Most patients go home within a day or two and return to normal activity within two weeks. Digestion continues normally without a gallbladder.
An endoscope passed to where the bile duct opens into the duodenum, allowing the duct to be opened and stones removed with a basket or balloon, and a stent placed if needed. It treats duct stones and obstructive jaundice without an incision, and it is the urgent treatment for cholangitis.
Acute cholecystitis is treated with antibiotics and usually early surgery, or drainage where the patient is too unwell to operate on. Gallstone pancreatitis requires supportive care first, with the gallbladder removed during the same admission or shortly after to prevent recurrence.
Silent stones usually need nothing. Attributing vague indigestion to incidental stones leads to operations that do not help.
Liver function tests and MRCP answer this, and it means ERCP is needed as well as surgery.
Cholecystitis, pancreatitis or jaundice all raise the case for definitive surgery rather than continued observation.
If your stones were found by accident and you have no symptoms, we will tell you that no operation is needed. Vague indigestion is frequently blamed on incidental gallstones and surgery does not resolve it.
Cholangitis and acute pancreatitis are emergencies measured in hours. Both are treated where you are, and neither is safe to fly with.
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Usually not. Silent gallstones found incidentally cause trouble in only a minority of people, and prophylactic surgery is generally not recommended. Exceptions include very large stones, a calcified gallbladder, and patients with certain blood disorders. If you have no symptoms, observation is typically the right answer.
Rarely in practice. Dissolution tablets work only for small cholesterol stones in a functioning gallbladder, take many months, and stones frequently return once treatment stops. Shock wave treatment has largely been abandoned for gallstones. Removing the gallbladder remains the definitive treatment for symptomatic stones.
Because the gallbladder that formed one set of stones will form another. Removing stones alone leads to recurrence within a few years in most patients. Digestion continues normally without a gallbladder — bile simply flows continuously from the liver rather than being stored between meals.
Most people eat normally after recovery. Some notice looser stools or urgency after fatty meals in the first weeks or months, which usually settles as the body adapts. A minority have persistent loose stools, which can be treated. Long-term dietary restriction is not usually needed.
Infection in a bile duct blocked by a stone. The classic combination is severe upper abdominal pain, fever, and yellowing of the eyes, sometimes with confusion and low blood pressure. It requires antibiotics and urgent drainage of the duct within hours, and it is an emergency — go to the nearest hospital immediately.
Yes, considerably. Conditions where red cells break down excessively — thalassemia, sickle cell disease and hereditary spherocytosis among them — produce pigment stones, often from a young age. Gallstones are common enough in these patients that the gallbladder is sometimes removed at the same time as another planned operation.
Send the abdominal ultrasound together with your liver function tests. Those two tell us whether the stones are confined to the gallbladder or one has moved into the bile duct.
Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.
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