A large proportion of people who have gallstones have no idea they are there.
The stones are found by accident. Someone has an ultrasound for acidity or a routine health check, and the report comes back mentioning “cholelithiasis.” The word sounds serious. The first question is almost always the same: does this have to come out?
Very often, the answer is no.
The gallbladder is a small pouch tucked underneath the liver, and it is part of the same system. The liver produces bile continuously, the gallbladder stores it, and it squeezes that bile down the bile duct into the intestine when you eat something fatty. When the chemistry of bile shifts, usually with an excess of cholesterol, crystals form and slowly grow into stones.
Gallstones are common. Indian community estimates have generally sat around 4 percent, lower than the 10 to 15 percent reported from Western countries, but the figure varies enormously between regions of the country. Women are affected two to three times more often than men, and tend to develop stones about a decade earlier.
Being overweight, having diabetes, losing weight very rapidly, and having a parent or sibling with stones all raise the risk. That last one surprises many patients. Gallstones run in families far more than people expect.
“The question is never simply whether you have stones. It is whether the stones are doing anything.”
When gallstones actually matter
Silent stones, found by chance and causing no trouble, are usually left alone. Operating on every stone seen on a scan would mean subjecting a great many people to surgery for a problem they were never going to develop.
Symptoms change the picture entirely. The typical one is biliary colic, a heavy gripping pain high in the right side of the abdomen, often an hour or two after a rich meal, sometimes travelling to the back or the right shoulder blade. It builds, holds for a while, then eases.
Pain accompanied by fever, or by yellowing of the eyes, is a different matter and needs assessment the same day.
The reason is that a small stone can slip out of the gallbladder and lodge in the bile duct, the drainage channel carrying bile away from the liver. When that duct blocks, jaundice appears, liver enzymes climb sharply, and infection can follow quickly. A stone sitting at the same junction can also obstruct the pancreatic drainage and set off pancreatitis.
There is a longer view as well. In certain parts of India, long-standing gallstone disease is associated with gallbladder cancer, and that risk differs sharply from region to region. This is one reason two doctors may reasonably take different views of the same scan, depending on your age, your background, and the size and number of stones.
Most of the gallstones I see in Kerala are picked up incidentally, in people who feel perfectly well.
Which doctor should look at your scan
Many people assume that a gallstone report means a trip to a surgeon. It is worth knowing that the gallbladder and the bile ducts sit within hepatology, the medical speciality that covers the liver, biliary system and pancreas. The decisions about gallstones are medical ones before they are surgical ones.
Whether the stones need removing at all, whether the pain is even coming from the gallbladder, whether a stone has escaped into the bile duct and has to be cleared endoscopically first, and whether jaundice or pancreatitis has complicated matters, are all questions answered by a physician. Once the answer is that the gallbladder should come out, a surgeon takes over and does that part, and does it well.
The order matters. Removing a gallbladder while a stone is still sitting in the bile duct is a real and avoidable problem.
“Most people with gallstones will go their entire lives without incident. The whole skill lies in recognising the few who will not.”
If your scan has shown gallstones, there is no need to panic, and equally no case for ignoring it. Take the report to a doctor who can read it alongside your liver function tests and your actual symptoms. That decision should be made for you individually, not applied automatically.
Frequently Asked Questions
Do gallstones without any symptoms need to be removed?
Usually not. Stones that have never caused pain are generally kept under observation rather than operated on. Certain situations are treated differently, such as very large stones, a calcified gallbladder wall, or particular regional and family risk factors, so this should be decided by a doctor who knows your full picture.
Can gallstones be dissolved with medicines or diet?
For the great majority of patients, no. Dissolution therapy works only for a small, specific subset of cholesterol stones and takes a long time, with stones frequently returning afterwards. Diet does not dissolve existing stones, though sensible weight management and avoiding crash diets can reduce the chance of forming new ones.
What warning signs should I not ignore with gallstones?
Severe or persistent upper abdominal pain, fever with pain, yellowing of the eyes or skin, or dark urine all need prompt medical attention. These suggest the stone may have moved into the bile duct or that infection has set in. Do not wait for these to settle on their own.
Should I see a surgeon or a liver specialist in Kochi for gallstones?
See a physician specialist first, meaning a hepatologist or a gastroenterologist. The gallbladder and bile ducts fall within hepatology, and the decision about whether an operation is needed at all, and in what order, is a medical one. A surgeon is the right person once that decision has been made, not before it.
Can I review my gallstone scan in an online consultation?
Yes. An ultrasound report along with your liver function tests can be reviewed well in an online consultation, which is often useful for deciding whether surgery is genuinely needed or whether observation is reasonable. Severe pain, fever or jaundice, however, should be seen in person without delay.