Ask the Doctors: Gall stones — what causes them, when you need to do something

Dear Doctors: I had stabs of pain in the upper right side of my abdomen, so I did a telehealth session. The nurse said it might be gallstones and to see my doctor if it repeats. So far, it hasn’t. What are gallstones? How do you get them? What is the treatment?

Dear Reader: The gallbladder — a hollow, flexible organ in the upper right of the abdomen, below the liver and next to the pancreas — stores a digestive fluid called bile that the liver produces.

Bile breaks down fatty foods into smaller components so they can be absorbed and used by the body. Bile also plays an important role in eliminating certain waste products, including bilirubin, excess cholesterol and hemoglobin from aging red blood cells.

When empty, the gallbladder looks a bit like a deflated balloon. Filled with bile, it becomes roughly the shape and size of a small pear. When someone eats foods that contain fat, the gallbladder contracts. This forces the thick, sticky fluid into tiny tubules known as bile ducts. They direct the bile to the small intestine, where nutrients are absorbed.

When someone has gallstones, it means some of the bile in the gallbladder has formed into hard, pebblelike deposits. The most common cause is an overabundance of cholesterol, with a corresponding deficit of bile salts. These are an important component of bile and aid in dismantling fats.

An estimated 20% of adults over 65 have gallstones. In most cases, they don’t cause symptoms, which is known as “silent gallstones.” Silent gallstones don’t require treatment.

When gallstones block the bile ducts, it can cause a gallbladder attack. Symptoms include sudden and ongoing pain in the upper right abdomen or sometimes in the central abdomen, just below the breastbone. Less often, the pain occurs between the shoulder blades or in the right shoulder. This pain can be accompanied by nausea or vomiting. The motion of the gallbladder can shift the gallstones, relieve the blockage and end the attack. But an ongoing blockage can result in inflammation and infection of the gallbladder, liver and pancreas.

It’s important to seek medical care for a gallbladder attack.

Risk factors for developing gallstones include being female, being overweight, eating a fatty diet, not getting enough fiber and rapid weight loss.

When gallstones cause ongoing complications, diagnostic imaging tests might be required. Treatment options include surgery to remove the gallbladder or medications to dissolve existing gallstones. These can take months to work and aren’t always effective.

Dr. Eve Glazier and Dr. Elizabeth Ko are internists at UCLA Health.