By Medical Edge July 19, 2011 12:00 AM

Dear Mayo Clinic: I have heard that sometimes people have gallstones and don’t even know it, while others have severe pain because of them. am I at greater risk if some of my family members have had them? How will I know if I have gallstones?

Reply: It is true that even if you develop gallstones — a condition in which digestive fluid hardens into pebble-like deposits — you might not even notice. in fact, many are discovered by chance during an abdominal X-ray or ultrasound exam for some other reason. That’s because in most patients, gallstones do not cause symptoms.

In other cases, though, you know all too well something’s wrong. Gallstones can cause attacks of pain, known as gallbladder attacks, in your upper abdomen or chest.

Your gallbladder is a pear-shaped sac that sits beneath your liver. The gallbladder’s main job is to store bile — a thick, greenish-brown liquid that’s produced by the liver. after you eat, your gallbladder contracts, pushing bile through a small tube called the common bile duct into the upper portion of your small intestine.

There, the bile helps your body absorb fats, cholesterol and certain vitamins. Gallstones form when components of bile harden into crystals. Most gallstones are made of cholesterol. It is possible to have just one gallstone or hundreds, ranging in size from a grain of sand to a golf ball.

Gallstones may form because of changes in the composition of bile, such as an increased amount or proportion of cholesterol. in other cases, the gallbladder muscle loses some of its squeezing power, so it doesn’t empty completely. Infection and inflammation also can damage the gallbladder and trigger the development of gallstones.

Factors that may increase your risk of cholesterol gallstones include: Obesity and excess weight, pregnancy, high-fat, high-cholesterol or low-fiber diet, family history of gallstones, diabetes, liver disease, Crohn’s disease, rapid weight loss, certain cholesterol-lowering medications and medications that contain estrogen.

Gallstones usually settle at the bottom of your gallbladder, where they’re unlikely to cause problems. Symptoms may arise if a stone migrates up the neck of the gallbladder and blocks the flow of bile out of the gallbladder or through the bile duct. a blocked gallbladder or bile duct can cause intense pain in your abdomen that may extend to your shoulder blade, chest or arm. The pain is sometimes accompanied by nausea and vomiting.

A gallbladder attack often subsides as the stones move. But if the blockage persists, your gallbladder can become inflamed or infected. This condition is called acute cholecystitis and requires treatment in a hospital where you’ll likely receive fluids, pain relievers and antibiotics intravenously. Treatment also includes surgery to remove the gallbladder (cholecystectomy), usually within 24 to 48 hours.

If you think you’ve had a gallbladder attack, see your doctor. Seek medical attention immediately if the pain is persistent and severe, if you have a fever or chills, or if your skin or the whites of your eyes are yellowish. if your gallstones aren’t causing any symptoms, you do not need treatment. if you have frequent attacks, your doctor will likely recommend that you have your gallbladder removed.

After your gallbladder is removed, bile flows directly from your liver into your small intestine. You’ll still be able to digest food. and you’ll be able to get back to your usual activities, with or without a gallbladder. — John Poterucha, M.D., Gastroenterology, Mayo Clinic

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Exclusion of other disorders

Irritable bowel syndrome (IBS) has some common symptoms as gallbladder disease, including difficulties with digestion of fatty foods. However, in IBS, a pain usually occurs in the lower abdomen. Acute appendicitis, inflammatory bowel disease (Crohn’s disease or ulcerative colitis), pneumonia, ulcer of the duodenum or stomach, pancreatitis, hepatitis, kidney stones, urinary tract infections, diverticulitis, even complications of pregnancy and heart attack may be similar to gallbladder attacks.

Clinical examination

Physical examination often reveals pain in the upper right abdomen in acute cholecystitis and sometimes in biliary colic. Chronic cholecystitis is usually without pain.

Laboratory testing

Results of laboratory tests are usually normal in people with simple biliary pain or chronic cholecystitis. However, with acute cholecystitis, especially with stones in the main bile duct, liver blood tests show elevated enzyme, alkaline phosphatase and bilirubin. Bilirubin is an orange-yellow pigment contained in bile. High levels cause jaundice, which gives a yellowish skin color. Doctors will also check blood levels of liver enzymes known as aspartate (AST) and alanine (ALT) aminotransferase, which are increased when stones are present in the main bile duct. the high number of white blood cells (leukocytosis) is a common finding, but does not appear in significant minority of patients with cholecystitis.

The job of the gallbladder, which lies under the liver, is to store and thicken bile to help with digestion, said Jackson. Gallstones, which cause most gallbladder problems, result from excess cholesterol that collects in the bile. Experts believe estrogen accounts for the increased incidence in women. Hormone replacement therapy increases the risk. so does pregnancy. Other risk factors include obesity, diabetes, rapid weight loss (including in some patients with gastric bypass), getting older and having a first degree relative troubled by it.

The most common gallbladder problem, biliary colic, shows up as pain, typically in the upper right abdomen near the rib cage. It’s caused by temporary obstruction. Don’t be fooled by the location, though, Jackson warned. It can be felt elsewhere, as well — high or low in the back, left or right side (left is unusual). Nausea and vomiting are common and it usually gets worse after you eat fatty foods. Limiting cholesterol intake may reduce gallbladder attacks. But it won’t make the stones go away.

Biliary colic is uncomfortable, but not dangerous. The treatment, if needed, is typically elective laparoscopic surgery, Jackson said.