How Many Gallstones Do I Have?

August 20, 2019

The gallbladder stores and secretes bile produced by the liver. Bile aids your body in digesting and metabolizing fat we consume in our diet. After a meal, the gallbladder is triggered to shrink to release bile into the small bowel. As the gallbladder contracts, some people experience what is known as a gallbladder attack. This typically means a gallstone has formed and is being squeezed or is trapped in the passageway from the gallbladder and small intestine. Amazingly, a single gallstone could be tinier than a grain of sand to larger than a ping-pong ball. Gallstones vary greatly and can be hard or soft and some are even jagged. Pain does not necessarily correlate to the number of gallstones you have. Whether you have one or one hundred, you may or may not even be aware. Typically, patients do not experience symptoms until a complication from the gallstone is occurring.

What’s a “Normal” Sized Gallstone?

There is no standard by which a gallstone is sized normally. However, the threshold for a large gallstone is about 2cm in diameter. We pay particular attention to large gallstones as the relative risk of gallbladder cancer increases dramatically with larger stones. However, it is worth noting that the overall risk of a gallbladder cancer is very low.

What type of gallstones do I have?

There are different two types of gallstones. Cholesterol gallstones are more common, making up about 80% of all stones. These stones are typically yellow in color and are the result of undissolved cholesterol. Normally, bile is able to digest cholesterol excreted by the liver, but when cholesterol levels are elevated, it can overwhelm the bile acids and the excess cholesterol crystalizes into stones.

Pigment gallstones are dark brown or black and form when too much bilirubin builds up in the bile. Bilirubin is formed in the liver by the breakdown of hemoglobin, found in red blood cells. If the liver produces excess bilirubin, these stones can form. Excess bilirubin can be the byproduct of certain conditions including blood disorders, cirrhosis of the liver, or biliary tract infections.

If the gallbladder does not empty completely or correctly, bile can become concentrated. It can also result in a condition known as gallbladder sludge. Sludge is sometimes asymptomatic, but can also create symptoms similar to that of a stone. This sludge occurs when bile remains in the gallbladder for too long and cholesterol and calcium salts combine with the mucus in the gallbladder. Gallbladder sludge or stone can be a side effect of a very low fat diet, where the bile is less frequently used. Sludge sometimes resolves on its own, but can contribute to gallstones, gallbladder inflammation, or acute pancreatitis.


Often patients who are experiencing gallbladder issues will be encouraged to have their gallbladder removed surgically. There are medications that can be used for treatment; however, they often do not provide adequate relief. We recommend you discuss your symptoms with your healthcare provider and ask if surgery might be a good option for you.

So…How Many Gallstones Do I Have?

An ultrasound diagnostic will give you surgeon a good idea of what’s in your gallbladder, but it rarely tells us how many gallstones you have. We can usually tell you if you have a very large gallstone or lots of small stones, but not much more than that.

After surgery, your gallbladder is sent to pathology to examine it for malignancy (very rare). During this time, the gallbladder will be split open and inspected. Once again, however, we won’t get a report back about the exact number of gallstones unless there is something truly unusual that requires notation.

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