What to know about bile duct stones

What are bile duct stones? 

In some people, gallstones form in the gallbladder. Gallstones, which are often made of cholesterol, are common, affecting an estimated 9% of females and 6% of males in the United States.

Many people with gallstones have no symptoms, but when the gallstones move or grow, they can cause intense pain.

Some gallstones move toward the bile duct, which connects the gallbladder and liver to the small intestine. Occasionally, the body removes these stones without a problem. However, in some cases, they can get stuck, meaning that a person has bile duct stones.

Bile duct stones are a problem because they block the bile duct, preventing enzymes from the liver and pancreas from supporting digestion. The impairment of this process can cause serious health issues. It is also very painful.

Causes of bile duct stones

Bile duct stones happen when gallstones, which often cause no symptoms, move out of the gallbladder and into the bile duct, blocking the duct.

Anyone can develop gallstones that lead to bile duct stones. However, certain groups of people are more vulnerable. They include those who:

• have a family history of gallstones
• are pregnant
• are female
• are over the age of 60 years
• have obesity
• eat a very high fat diet
• have a sedentary lifestyle

Can you get bile duct stones without a gallbladder?

Although gallbladder removal reduces the likelihood of gallstones and bile duct stones, it does not eliminate the risk. This is particularly true for people whose doctors only remove a portion of their gallbladder.

Symptoms of bile duct stones

For the minority of people with gallstones who become symptomatic, the most common symptoms include:

Pain

The pain usually appears in the upper right abdomen, around the ribs, and it is often extremely intense. Some people find that it radiates to the back or shoulder. It usually appears suddenly, without warning, and it may come and go in waves or last for many hours.

Jaundice

When bile duct stones interfere with liver function, a person may develop jaundice, which may cause their skin or eyes to look yellow. In some cases, the yellow might be very faint, but in others, it can be quite dramatic.

Changes in bathroom habits

Many people with gallstones or bile duct stones have dark urine, even if they drink enough water.

Pancreatitis

When bile duct stones block the flow of pancreatic enzymes to the small intestine, a person may develop pancreatitis. This condition can cause fever, pain in the upper right abdomen, intense nausea, or white or clay-colored bowel movements.

Diagnosing bile duct stones

A doctor can usually tell from a person’s symptoms when bile duct stones are a possibility. The following tests can rule out other potential causes and help the doctor confirm the diagnosis:

• medical history review, including any recent symptoms
• a physical examination during which a doctor may press on the abdomen to identify tender areas
• blood tests to look for markers of pancreas or liver inflammation
• imaging tests to look for stones trapped in the bile duct

People should not try to self-diagnose bile duct stones. Instead, they should speak with a doctor as soon as they suspect bile duct stones so that they can receive treatment as soon as possible.

Treating bile duct stones

While some gallstones pass or resolve on their own, bile duct stones are trapped in the bile duct. These stones can cause immediate health issues, including pancreatitis — a potentially life threatening inflammation of the pancreas.

Treatment almost always requires surgery to remove the stones, and there are several different procedures. A doctor may also recommend removing the gallbladder to reduce the risk of developing additional stones.

Before surgery, it is important to stabilize a person as much as possible. A doctor may recommend additional treatments, including:

• pain medication
• intravenous fluids for pancreatitis
• antibiotics
• monitoring in the hospital to ensure that the person is stable enough for surgery

Sometimes, a doctor will recommend immediate emergency surgery. In other cases, a person may wait anywhere from a few hours to a few days.

Preventing bile duct stones

There is no way of fully preventing gallstones, which even very healthy, young, or active people can develop.

However, people can take steps to reduce the risk. Taking these measures is especially important for people who have a family history of gallstones or other risk factors, such as obesity.

Preventive measures include:

• Eating a lower fat diet: People can focus on eliminating foods that are high in fat and low in nutritional value, such as potato chips and fried foods, from their diet. They can replace these foods with more healthy fats, such as avocado and fish oil.
• Adding more fiber: People can do this by eating more whole grains, fruits, and vegetables.
• Attaining a moderate body weight: A combination of diet and exercise, with an emphasis on being more physically active, can help people lose weight, if necessary.
• Avoiding crash diets and extremely low calorie diets: These diets may actually increase the risk of gallstones.
• Talking with a doctor about medications: Some drugs, such as birth control pills, may increase the risk of gallstones.
• Seeking excellent prenatal care during pregnancy: People should also make a doctor aware if they experience any unusual or new abdominal pain during pregnancy.

Summary

Bile duct stones can be worrying and intensely painful. However, they are treatable, and most people who receive treatment feel better quickly.

People should not self-diagnose bile duct stones or delay care, as waiting longer to see a doctor increases the risk of serious complications, such as pancreatitis. Most people with bile duct stones will need to go to the emergency room.