Gallstones in the gallbladder – cholesterol and pigment

Almost everyone has gallstones in the gallbladder, but not everyone suffers from them. They are there, you usually don’t know anything about them and you don’t feel anything about them either. These are the ‘silent gallstones’ and in that case there is not much to worry about. Gallstones only become a problem if they cause a bile attack. They are not real stones but thickened bile juice or deposits in the gallbladder that look stony: the thickened juice is fossilized. They are useless elements in the body, which can sometimes cause severe pain. In the latter case, gallbladder surgery offers a solution. Gallstones come in the form of grit, marbles up to the size of an apricot.

Gallstones in the gallbladder – cholesterol and pigment

  • Gallstones in the gallbladder
  • Cholesterol and pigment
  • How do you get gallstones?
  • Risk factors
  • Symptoms
  • How can gallstones be seen?
  • What to do with the gallstones?

Gallstones in the gallbladder

Gallstones are not true stones; it is hard material that has formed in the gallbladder. The gallbladder sits beneath the liver and is the reservoir of bile that the liver produces. The bile fluid supply is used when we eat fat: bile is a digestive juice that plays a role in the breakdown of fat and fulfills its function with every meal. Over the years, gallstones can form due to thickening and crystallization of the bile and the fossilization of particles of calcium, blood and cholesterol. This can also happen because the gallbladder does not always empty completely. The bile in the bladder becomes overconcentrated and fossilizes.

Grain of sand and marble

The stones can differ in shape and size, from a grain of sand to marbles and even larger and elongated in shape.

Cholesterol and pigment

There are two types of stones: cholesterol stones and pigment stones.

Source: Stell98, Wikimedia Commons (Public domain)

stones Cholesterol stones are the most common gallstones and usually yellow-green in color: 80 percent of gallstones are cholesterol stones. These gallstones form when there is too much cholesterol in the bile that is secreted by the liver. Bile breaks down cholesterol, but if the liver makes more cholesterol than the bile can dissolve, hard stones can develop.

Pigment stones

Pigment stones are smaller and darker and made of calcium salts and bilirubin from the bile: 20 percent of gallstones are pigment stones. Bilirubin is a chemical that the liver produces when it destroys old red blood cells. In some

Source: Jeanet de Jong

conditions, such as liver cirrhosis and certain blood diseases, the liver produces more bilirubin than intended. If the gallbladder cannot break down the excess bilirubin, pigment stones form.

How do you get gallstones?

There is often not much you can do about getting gallstones, although there are a number of risk factors that you could take into account. There are several causes of gallstone formation:

  • It is genetically determined;
  • overweight;
  • problems with the gallbladder;
  • cholesterol in the bile;
  • the gallbladder does not empty completely.

Risk factors


There are some factors that increase the risk of gallstones. Obesity is such a factor. With obesity, there is a good chance that the cholesterol level is elevated and cholesterol in the bile increases the formation of stones. In addition, it is more difficult to completely empty the gallbladder in obese people.

The pill

Women who use birth control pills, take hormone replacement therapy for menopausal symptoms, or are pregnant have extra estrogen in the blood that can increase cholesterol and make it more difficult for the gallbladder to empty.


There is also a link between diabetes and gallstones. Diabetics usually have more triglycerides (a type of blood fat), which can contribute to the formation of gallstones.


People who lose weight too quickly have an increased risk of gallstone formation because the liver produces extra cholesterol that can lead to stone formation. In people who fast regularly, the gallbladder does not want to contract well enough, which means that the gallbladder is not emptied.


Gallstones can be a family ailment, with more women than men suffering from them and more often the elderly than the young. There are some ethnic groups in which gallstones are a well-known ailment. For example, it is known that it often occurs among Indians in America.


In most cases, the person who has gallstones does not notice it at all. There are a few symptoms that indicate the presence of troublesome gallstones:

  • Pain in the upper abdomen;
  • nausea;
  • yield;
  • bloated feeling;
  • indigestion;
  • heartburn;
  • flatulence.

How can gallstones be seen?

The diagnosis of ‘gallstones’ can be made after various types of examination.

Blood tests

To start, other conditions can be ruled out and the doctor can check the blood for infections and blockage. A gallstone can wander and end up in a bile duct and cause a blockage. This blockage is painful and can cause inflammation that can be detected via the inflammatory value of the blood.


Discoloured stools may indicate blockage of the bile ducts. Bile fluid gives stool its brown color. Without bile, the poop becomes grayish.


The doctor can make an ultrasound of the upper abdomen and see the stones as white spots in the gallbladder.


Using specialized X-rays, the doctor can look inside the body, including the gallbladder, and determine the presence of gallstones.


Magnetic resonance cholangiopancreatography (MRCP) uses a magnetic field and pulses of radio wave energy to take pictures of the inside of your body. Injuries such as gallstones then stand out.


This HIDA scan checks whether the gallbladder is compressing properly. The patient is injected with a fluid that makes the path to the gallbladder visible. The expert can then look at the movement of the gallbladder.

Endoscopic ultrasound

This test combines ultrasound and endoscopy to look for gallstones.

Endoscopic retrograde cholangiopancreaticography

During an ERCP, the doctor inserts an endoscope through the mouth into the small intestine and injects a dye to show the bile ducts. He can remove gallstones that have moved into the ducts using the same technique.

What to do with the gallstones?

The gallstones can be removed if they cause problems in the form of bile attacks and inflammation of the bile ducts, gallbladder or pancreas. The gallbladder including stones is then removed from the abdomen.

read more

  • Gallstones, bile attack and gallbladder surgery
  • Biliary pancreatitis – inflammation of the pancreas caused by gallstones
  • Bile – bitter digestive juice from the liver
  • Laparoscopic gallbladder surgery – keyhole surgery