Gallstones: Symptoms, Ultrasound and When to Operate
Patient Guide · Reviewed by a Specialist · Colombia 2026
Gallstones: Symptoms, Ultrasound Diagnosis, and When Surgery Is Needed
Everything You Need to Know About Gallstones (Cholelithiasis) — What They Are, What Causes Them, How They Are Detected with Ultrasound, and When Your Doctor Recommends Surgery
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Reviewed by the GSMED Imaging Medical Team
Content Based on the MSD Manual (Merck) Professional Version 2026, Fundación Santa Fe de Bogotá, Hospital Internacional de Colombia HIC/FCV (2025), Clínica Medellín QuirónSalud, and the Ocronos Clinical Journal (Cholelithiasis: Diagnosis, August 2025).
ℹ️ Medical Notice: This guide is for informational purposes only. If you have symptoms of biliary colic, fever with abdominal pain, or yellowing of the eyes, consult your doctor immediately. This information is not a substitute for an individual medical diagnosis.
You had an ultrasound for another reason, and the report says "hyperechoic images with posterior acoustic shadowing compatible with cholelithiasis." Or you have pain on your right side after eating fatty foods that no one has properly explained to you. In either case, this guide tells you exactly what gallstones are, what can happen if you have them, and what decision you should make with your doctor.
1. What Are Gallstones, and Why Do They Form?
Gallstones are solid deposits that form inside the gallbladder — the small pear-shaped organ located below the liver on the right side of the abdomen. Its function is to store the bile produced by the liver and release it into the small intestine when we eat, especially fatty foods.
Gallstones form when the components of bile become unbalanced. In Colombia and the Western world, the vast majority of gallstones are composed primarily of cholesterol, which crystallizes because the bile contains more cholesterol than it can dissolve. A minority are made of bilirubin (pigment stones), which are more common in people with hemolytic diseases or liver cirrhosis.
95%
Accuracy of abdominal ultrasound in detecting gallstones (MSD Manual 2026)
70%
Of people with gallstones are completely asymptomatic
20–40%
Of patients with biliary colic will have another episode in the following year
5R
Classic risk factors: Female, Fat, Forty, Fertile, Fair (women, overweight, 40+, fertility, fair skin)
The Most Common Risk Factors in Colombia Being a woman (the prevalence is 2–3 times higher than in men), being overweight or obese, being over 40 years old, having a family history of cholelithiasis, eating a diet high in fat and low in fiber, and losing weight very rapidly (highly restrictive diets increase the risk because they alter the composition of bile). In Colombia, the condition is highly prevalent in adults over 40.
2. Symptoms: Most Are Painless, But When Pain Occurs, You Need to Take Action
The most important thing to know about gallstones is that most do not cause symptoms. According to the MSD Manual, between 70 and 80% of people with cholelithiasis will never have any symptoms related to their gallstones — they discover them incidentally during an ultrasound ordered for another reason. But when gallstones do cause symptoms, they have very specific characteristics:
🟡 Typical Symptoms of Biliary Colic
- Severe pain in the upper right quadrant of the abdomen, especially after eating fatty or large meals
- The pain may radiate to the right back or right shoulder
- Starts between 30 minutes and 2 hours after eating
- Nausea and vomiting that do not relieve the pain
- Persistent feeling of fullness, indigestion, or "gas"
- The pain subsides spontaneously within minutes or a few hours (if it does not, suspect a complication)
🔴 Warning Signs — Seek Emergency Care
- Pain that does not subside after several hours — may be acute cholecystitis
- Fever with chills and abdominal pain — gallbladder or bile duct infection
- Yellowing of the skin and eyes (jaundice) — gallstone obstructing the bile duct
- Dark urine (tea- or beer-colored) and pale or white stools — biliary obstruction
- Pain in the upper central abdomen radiating to the back — possible biliary pancreatitis
The Myth of "Fat Intolerance" and Gallstones Many patients are convinced that their intolerance to fatty foods or chronic dyspepsia is due to gallstones. The MSD Manual is clear on this: gallstones do not cause dyspepsia or intolerance to fatty foods as a primary symptom. The characteristic symptom is biliary colic — severe, acute pain, not vague discomfort. If your problem is only flatulence, heaviness, or indigestion, talk to your doctor about other causes.
3. Diagnosis: Why Ultrasound Is the Definitive Test
Abdominal ultrasound is the test of choice for diagnosing gallstones. With 95% accuracy, no other imaging test matches its diagnostic performance for this specific condition, and it is also fast, affordable, radiation-free, and available in virtually all diagnostic centers in Colombia.
🔊 What the Radiologist Sees on a Gallbladder Ultrasound
Diagnostic Sign of a Gallstone
Hyperechoic image with posterior acoustic shadowing. The gallstone appears as a bright (hyperechoic) focus because it reflects almost all of the ultrasound energy. Behind it appears a dark area (acoustic shadow) because the waves do not penetrate the stone. It is the most specific and reliable sign — when present, the diagnosis is virtually certain.
Normal Gallbladder on the Report
Normal fasting size: 7–10 cm long · Normal wall: <3 mm thick · Contents: anechoic bile (black, without echoes) · No visible gallstones
Signs of Complications the Sonographer Can Detect
Thickened wall (>3–4 mm) + perivesicular fluid + sonographic Murphy sign = acute cholecystitis. Dilated common bile duct (>6–7 mm) = possible choledocholithiasis (gallstone in the main bile duct)
Essential Preparation for a Gallbladder Ultrasound
At least 8 hours of fasting — preferably 12 hours. A fasting gallbladder is distended and full of bile, making gallstones much more visible. After eating, the gallbladder contracts, and a gallstone may be "hidden" in the folds of the wall. This is the most common preparation error that causes a gallstone to be missed.
When Are Additional Tests Needed Besides Ultrasound?
Ultrasound is sufficient in most cases of uncomplicated cholelithiasis. However, your doctor may order additional tests in these situations:
| Clinical Situation | Additional Test | Purpose |
|---|---|---|
| Suspected common bile duct stone (choledocholithiasis) | MRCP (Magnetic Resonance Cholangiopancreatography) | Visualizes the entire biliary tree without radiation or IV contrast |
| Jaundice, high fever, suspected cholangitis | Abdominal CT scan + lab tests | Evaluates complications, abscesses, and biliary sepsis |
| Biliary pancreatitis | Contrast-enhanced abdominal CT scan | Stages the severity of pancreatitis |
| Gallbladder with polyps or suspicious masses | Endoscopic ultrasound (USE) | Higher resolution for characterizing gallbladder wall lesions |
| Complex preoperative planning | Intraoperative cholangiography | Verifies the biliary tree during surgery |
4. Complications You Need to Know
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Acute cholecystitis
Inflammation and infection of the gallbladder when a gallstone obstructs the cystic duct. Pain that does not subside + fever. Requires hospitalization and urgent or semi-urgent surgery.
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Choledocholithiasis
A gallstone that migrates from the gallbladder to the common bile duct (choledochus), obstructing the flow of bile. Jaundice + pain + dark urine. Requires ERCP to remove it.
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Cholangitis
Serious infection of the bile duct due to common bile duct obstruction. Charcot's triad: fever + jaundice + pain. Medical emergency — high mortality without urgent treatment.
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Biliary pancreatitis
A gallstone obstructs the ampulla of Vater and inflames the pancreas. Severe epigastric pain radiating to the back. The most common cause of acute pancreatitis in Colombia.
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Porcelain gallbladder
Chronic calcification of the gallbladder wall. Historically associated with a higher risk of gallbladder cancer (although the association is debated depending on the calcification pattern).
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Biliary fistula
In very chronic cases, the gallbladder may perforate and form a fistula with the intestine (biliary ileus). A rare but serious complication that requires open surgery.
⚠️ Seek emergency care IMMEDIATELY if you have any of these signs
Severe abdominal pain that does not subside after 4–6 hours
Fever over 38°C with pain in the right side
Yellowing of the skin or sclerae (the white part of the eyes)
Very dark urine (cola-colored) with pale or white stools
Uncontrollable vomiting that prevents hydration
Very severe pain in the pit of the stomach radiating to the back
5. Treatment: When Is Surgery Needed, and When Is It Not?
| Situation | Recommendation | Justification |
|---|---|---|
| Asymptomatic gallstones discovered incidentally | Expectant management (do not operate) | Most will never cause symptoms. The risks of elective surgery do not justify operating on someone who has no discomfort |
| First confirmed biliary colic | Evaluation by a surgeon | 20–40% will have another episode that year. The doctor will evaluate whether preventive surgery is recommended |
| Recurrent biliary colic | Laparoscopic cholecystectomy | Repeated episodes impact quality of life, and the risk of complications increases |
| Acute cholecystitis | Urgent or delayed surgery | Immediate hospitalization + antibiotics + cholecystectomy within the first 72 hours or delayed depending on severity |
| Choledocholithiasis or cholangitis | ERCP + cholecystectomy | First remove the common bile duct stone via ERCP, then perform gallbladder surgery |
| High-risk surgical patient with symptomatic cholelithiasis | Percutaneous cholecystostomy | Temporary gallbladder drainage as an alternative to surgery in patients who cannot tolerate general anesthesia |
Laparoscopic cholecystectomy — the standard surgery in Colombia The removal of the gallbladder by laparoscopy is the most commonly performed surgery in general surgery departments in Colombia. It is done with 3–4 incisions less than 1 cm long, under general anesthesia. Hospitalization is 1 day in most uncomplicated cases, and full recovery takes 1–2 weeks. Without a gallbladder, the liver continues to produce bile, which flows directly into the intestine — the vast majority of people experience no change in their digestion after the operation.
6. Frequently Asked Questions About Gallstones
Can gallstones be dissolved with medication or diet?
There is a medication — ursodeoxycholic acid (ursodiol) — that can dissolve small cholesterol stones in well-functioning gallbladders. However, the process is very slow (months to years), works only in a specific subgroup of patients, and the stones frequently reappear when the medication is discontinued. In Colombian clinical practice, this treatment is rarely used because laparoscopic cholecystectomy is more effective, definitive, and safer. Regarding diet, no food or supplement dissolves stones that have already formed — a low-fat diet reduces the frequency of biliary colic but does not eliminate the stones.
What is the difference between gallstones and kidney stones?
They are two completely different conditions. Gallstones (cholelithiasis) form in the gallbladder and are composed primarily of cholesterol or bilirubin. They are detected with abdominal ultrasound and treated with gallbladder surgery (cholecystectomy). Kidney stones (nephrolithiasis, renal lithiasis) form in the kidneys and are composed primarily of calcium oxalate, urate, or phosphate. They are also detected with ultrasound or CT scans, and treatment varies — from lithotripsy to minimally invasive surgery. Gallstone pain is in the upper right side of the abdomen. Kidney stone pain is in the flank (side) with radiation toward the groin. Abdominal ultrasound can see both in the same exam.
Can I live without a gallbladder after surgery?
Yes, completely. The gallbladder is not a vital organ—it is a temporary reservoir for bile. After a cholecystectomy, the liver continues to produce bile, which flows continuously directly into the small intestine. Most people do not notice any change in their digestion. A small percentage (5–10%) may have more frequent or looser stools in the first few weeks due to continuous exposure of the intestine to bile—which generally normalizes on its own over time. If symptoms persist, the doctor may recommend dietary adjustments or temporary medications.
How much does a gallbladder ultrasound and surgery cost in Colombia?
The abdominal ultrasound for the diagnosis of gallstones is covered by the PBS (Health Benefits Plan) when ordered by the treating physician—at no additional cost to the EPS/EPS-S member. In the private sector, it ranges from $80,000 to $200,000 COP. Laparoscopic cholecystectomy is also covered by the Colombian healthcare system when medically indicated. In the private sector, the cost of the complete surgery (surgery + anesthesia + hospitalization) can range from $3,000,000 to $10,000,000 COP depending on the level of the clinic, the city, and whether there are complications.
Does your clinic need a high-resolution ultrasound machine for abdominal diagnosis?
At GSMED, we have high-definition ultrasound machines with convex transducers for abdominal diagnosis available in Colombia—with local technical support and specialized advice.
Accurate abdominal diagnosis starts with the right ultrasound machine
Ultrasound machines for abdominal diagnosis with high-sensitivity gallstone detection—available in Colombia.
View ultrasound machines →Related articles
Sources and references
- Merck Manual (MSD) professional version. Cholelithiasis. msdmanuals.com/es/professional. 2026. Ultrasound sensitivity 95%, treatment of asymptomatic stones. MSD Manual 2026
- Merck Manual (MSD) consumer version. Gallstones. msdmanuals.com/es/hogar. 2025. MSD Manual 2025
- Santa Fe de Bogotá Foundation. Cholelithiasis—prevalence, risk factors, and management in Colombia. fundacionsantafedebogota.com. Colombia
- International Hospital of Colombia (HIC/FCV). Choledocholithiasis: when stones affect the bile duct. hic.fcv.org. October 2025. Colombia 2025
- Medellín Clinic—Grupo QuirónSalud. Symptoms of gallstones and the most common treatments. clinicamedellin.com. Colombia
- Ocronos—Medical Journal. Cholelithiasis: diagnosis. revistamedica.com. August 2025. Diagnostic pillars, laboratory, and differential diagnosis. Ocronos 2025
- Hospiten. Cholelithiasis: symptoms, diagnosis, and treatment. hospiten.com. 2023. Clinical reference
