Cholelithiasis (gallstones)

What are gallstones?

Gallstones, medically known as cholelithiasis, are hardened deposits that form in the gallbladder when bile components crystallise. Bile is a digestive fluid produced by the liver, stored in the gallbladder, and released into the small intestine to aid fat digestion. When the chemical balance of bile is disrupted, its components can solidify into stones ranging from tiny grains to several centimetres in diameter.

Gallstones are classified by their composition:

• Cholesterol gallstones account for approximately 80% of gallstones in Western countries. They form when bile contains more cholesterol than bile salts and lecithin can keep dissolved, causing cholesterol to crystallise and accumulate.

• Pigment gallstones are composed of bilirubin calcium salts. They are subdivided into black pigment stones, associated with haemolytic conditions and cirrhosis, and brown pigment stones, associated with biliary infection and bile duct stasis.

• Mixed stones contain both cholesterol and pigment components and are common in clinical practice.

Gallstones are distinct from gallbladder polyps and from bile duct stones (choledocholithiasis), which have migrated from the gallbladder into the common bile duct and carry a higher risk of serious complications including jaundice, pancreatitis, and cholangitis.

Symptoms of gallstones

The majority of gallstones are silent, causing no symptoms for years or decades. When symptoms do occur they typically reflect gallstone obstruction of the gallbladder outlet or bile ducts:

• Biliary colic the most characteristic symptom, a sudden intense pain in the upper right abdomen or epigastrium, often radiating to the right shoulder or back, typically triggered by fatty meals and lasting 30 minutes to several hours before resolving spontaneously

• Nausea and vomiting during pain episodes

• Bloating and indigestion, particularly after fatty meals

• Upper right abdominal tenderness

• Acute cholecystitis when a stone persistently obstructs the gallbladder outlet, causing inflammation, fever, and severe pain requiring urgent medical care

• Jaundice and dark urine when a stone migrates into the common bile duct

• Acute pancreatitis when a migrating stone obstructs the pancreatic duct at the ampulla of Vater

Important: Severe upper right abdominal pain with fever, jaundice, or persistent vomiting may indicate acute cholecystitis, bile duct obstruction, or acute pancreatitis. These require urgent medical attention.

What causes gallstones?

Gallstones develop when bile composition, gallbladder motility, or both are disrupted in ways that favour crystal formation. Contributing causes include:

• Excess cholesterol in bile the primary driver of cholesterol stone formation, caused by obesity, high dietary fat intake, and reduced bile salt production

• Obesity and rapid weight loss obesity significantly increases biliary cholesterol secretion, while rapid weight loss from crash dieting or bariatric surgery causes the liver to secrete excess cholesterol into bile

• Female sex and estrogen estrogen increases biliary cholesterol secretion and reduces gallbladder motility. Pregnancy, the oral contraceptive pill, and hormone replacement therapy all raise gallstone risk

• Age gallstone prevalence increases progressively with age, with the majority of cases occurring in adults over 40

• Diabetes and insulin resistance impair gallbladder contractility and alter bile composition, promoting stone formation

• High triglycerides are associated with biliary sludge and pigment stone formation

• Haemolytic conditions including sickle cell disease and thalassaemia cause excess bilirubin production, promoting pigment stone formation

• Liver cirrhosis alters bile composition and promotes pigment stone formation

• Sedentary lifestyle reduces gallbladder emptying frequency, allowing bile to stagnate and concentrate

• Family history significantly raises individual gallstone risk, suggesting a genetic component

How are gallstones detected?

Gallstones are detected through abdominal imaging, with blood tests assessing liver and biliary function and the metabolic conditions most closely associated with their formation.

Abdominal MRI Ultrasound remains the standard first-line tool for detecting gallbladder stones, but Elfcare’s full body MRI can also identify gallstones incidentally as part of routine imaging, and it's particularly useful for evaluating the bile ducts, gallbladder wall changes, and any ductal obstruction that needs a closer look. Catching gallstones this way, before they cause a problem, means there's usually time to manage them through dietary changes or planned care rather than an emergency room visit.

Blood tests assess liver and biliary function and identify the metabolic conditions most closely associated with gallstone formation. Relevant markers in Elfcare's panel include:

• ALP and GGT characteristically elevated in biliary obstruction and chronic gallbladder inflammation, often before bilirubin rises significantly

• Bilirubin rises when a stone obstructs the common bile duct, causing cholestatic jaundice

• ALT and AST may be elevated when biliary obstruction causes secondary liver cell damage

• Total cholesterol, LDL, and triglycerides dyslipidaemia is closely associated with cholesterol gallstone formation and cardiovascular risk

• HbA1c and diabetes and insulin resistance impair gallbladder contractility and alter bile composition

• CRP and full blood count elevated in acute cholecystitis or cholangitis, reflecting active infection and inflammation

• Hemoglobin and reticulocyte count assess for hemolytic anaemia, an important cause of pigment gallstone formation

Why early detection matters

The natural history of gallstones is unpredictable. Many remain entirely silent throughout a person's lifetime. Others cause a sudden complication without warning, including acute cholecystitis, bile duct obstruction with jaundice, or acute pancreatitis, all of which require urgent treatment and carry real clinical risk. Gallstone-associated pancreatitis in particular can be severe and life-threatening. Identifying gallstones before a complication occurs allows for informed decision-making about elective cholecystectomy, dietary modification, and monitoring that keeps the person in control of the timing and nature of any intervention rather than being forced into emergency surgery.

How Elfcare can help

Elfcare's full body MRI can identify gallstones as an incidental finding and assess their consequences, including gallbladder wall changes, bile duct dilatation, and any pancreatic involvement, alongside ultrasound's role in detecting gallstones themselves. For a condition that is frequently silent until a painful or serious complication occurs, this incidental detection represents one of the most clinically valuable findings a full body health check can produce.

Our blood panel covers ALP, GGT, bilirubin, liver enzymes, lipids, and metabolic markers, providing the complete biliary and metabolic picture alongside the structural MRI findings.

If our MRI or blood tests identify gallstones or related biliary findings, we take care of further diagnostics or refer you to the appropriate specialist.