Digestive health
Patient education · Reviewed by the treating clinician · Last reviewed January 2026
Where the stones are, and why it matters
- Gallstones sit inside the gallbladder. They may cause pain when the gallbladder contracts, but many are silent and never cause a problem. Treatment depends mainly on symptoms, not on the mere presence of stones.
- Common bile duct stones have moved into the tube that carries bile from the liver and gallbladder into the intestine. Once there, they obstruct the flow of bile and can block the pancreatic duct as well. This is a more serious situation and is usually treated endoscopically.
Gallstones: what the symptoms mean
The classic symptom is biliary colic — a steady, severe pain in the upper right abdomen or upper middle abdomen, often radiating to the right shoulder or back. It typically comes on within an hour of a fatty meal, builds over 15–60 minutes, lasts from one to several hours, and then settles.
Important features that distinguish it from simple indigestion:
- The pain is steady and severe, not a burning sensation.
- It lasts hours, not minutes.
- It is often worse after a heavy or fatty meal, or at night.
- There may be nausea and vomiting, but fever is not typical of uncomplicated gallstones.
- It recurs in episodes rather than being constant for weeks.
If the gallbladder itself becomes inflamed — acute cholecystitis — the pain becomes continuous rather than episodic, and is usually accompanied by fever and tenderness in the right upper abdomen. This needs prompt hospital assessment.
Bile duct stones: the warning signs
These symptoms need urgent assessment
- Jaundice — yellowing of the eyes or skin, dark urine, pale stools.
- Fever with shivering, especially with abdominal pain and jaundice. This suggests cholangitis — infection in an obstructed bile duct — and can progress to sepsis within hours.
- Severe upper abdominal pain radiating to the back, with vomiting — possible pancreatitis.
- Persistent pain lasting more than six hours, or pain with fever.
- Confusion, drowsiness or a rapid pulse.
A helpful way to remember the classic combination for cholangitis is pain, jaundice and fever. If all three are present, seek urgent care. Call the hospital on (phone) before arriving so the team can prepare, or go to the nearest emergency department.
Who gets gallstones?
Gallstones become more common with increasing age, and are more frequent in women, particularly around and after pregnancy. Other contributing factors include obesity, rapid weight loss, a family history of gallstones, certain blood disorders with increased red cell breakdown, and some medicines. Many people with gallstones have no risk factors at all.
How the diagnosis is made
| Test | What it shows |
|---|---|
| Abdominal ultrasound | The first and best test for gallstones, gallbladder wall thickening and dilated bile ducts. Often enough to make the diagnosis. |
| Liver function tests | A raised bilirubin, alkaline phosphatase and GGT pattern suggests obstruction of the bile duct. |
| Amylase or lipase | Raised in pancreatitis. |
| MRI / MRCP | Detailed non-invasive imaging of the bile ducts, used to look for duct stones or narrowing. |
| Endoscopic ultrasound (EUS) | Highly sensitive for small duct stones, used when other imaging is inconclusive. |
| ERCP | Both diagnostic and therapeutic — used when a duct stone needs to be removed. |
Treatment: a stone in the gallbladder
Silent gallstones found incidentally generally need no treatment. Surgery on a gallbladder that has never caused symptoms is not automatically indicated, and the decision depends on your age, other conditions and the appearance of the stones.
Where stones have caused symptoms, the standard treatment is laparoscopic cholecystectomy — keyhole removal of the gallbladder. This is performed in our operation theatre by the gastrointestinal surgical team, and an open operation is possible in the same theatre if keyhole surgery is not safe for your case. Removing the gallbladder does not cause digestive problems in the long term for most people; the liver continues to produce bile, and it simply flows directly into the intestine.
Medicines to dissolve gallstones exist, but they take many months, work only for certain small stones, and the stones often recur once treatment stops. They are therefore used only in selected patients who cannot have surgery.
Treatment: a stone in the bile duct
A stone stuck in the bile duct is treated endoscopically by ERCP. The endoscope is passed to the duodenum, the opening of the bile duct is enlarged slightly with a controlled cut (sphincterotomy), and the stone is removed with a balloon or basket. If the stone is too large to remove directly, it is broken up first using mechanical lithotripsy. A stent may be placed temporarily if the duct is infected or if complete clearance is not immediately possible.
After ERCP, the gallbladder is usually dealt with too, because a gallbladder that has produced one duct stone can produce another. The timing depends on how unwell you were and whether there is inflammation. Full details are on the ERCP page.
What you can do
- Do not ignore jaundice. Yellowing of the eyes is never something to watch at home.
- Do not ignore fever with abdominal pain, which can indicate infection in the bile duct or gallbladder.
- Keep to a lower-fat diet if fatty meals provoke your pain — this reduces symptoms but does not remove stones.
- Avoid rapid crash diets, which can actually promote gallstone formation.
- If you have had pancreatitis, make sure the cause was established. If it was caused by a gallstone, the gallbladder needs to be dealt with to prevent recurrence.
- Tell the hospital about blood thinners before any procedure, so the schedule can be planned safely.
The bottom line
Gallstones in the gallbladder commonly need nothing, or a planned laparoscopic operation. A stone in the bile duct is a different matter and usually needs ERCP, often urgently. Pain with jaundice or fever means seeking care immediately — that combination is the one that must not wait.
Please remember
This article is general health information, not personal medical advice. It cannot account for your individual circumstances. Do not start, stop or change any medicine based on it. If you are worried about your symptoms, please book a consultation, and in an emergency seek care immediately.