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Having cirrhosis of the liver doubles the risk of gallstones.
Your liver is located in the upper right side of your abdomen. One of your liver's important functions is to produce bile, a fluid that helps your body digest fats. Your gallbladder stores the bile made by the liver and empties it into your small intestine during digestion. Many people have pebble-like deposits of bile called gallstones in their bodies that do not bother them unless the stones block the flow of bile. Gallstones are twice as likely to form in people who have severe scarring in the liver, a condition called cirrhosis.
Many conditions and diseases can damage the liver, including infections and drinking too much alcohol. During the early stages of cirrhosis, people generally feel fine. Over time, though, scar tissue forms and symptoms such as loss of appetite, nausea, vomiting, fatigue, weakness, abdominal pain, weight loss and itching occur. Eventually, the organ shrinks, hardens and loses its ability to function normally. Fluid begins to accumulate in the abdomen, a condition called ascites, and the individual becomes seriously ill. By that point, the person's survival depends on a liver transplant, if possible.
Gallstones are hardened bits of bile, the fluid that is produced by the liver and stored in the gallbladder until needed for digestion. Gallstones occur in about 5 percent of the general population, but the risk of developing gallstones is approximately 5 to 14 percent in people with cirrhosis. Many people with gallstones are unaware of the condition because they have no symptoms. If a stone obstructs the flow of bile, though, the person may experience a sudden attack of nausea, vomiting and abdominal pain, called biliary colic. The exact relationship between cirrhosis and gallstones is unknown, but the nature of the stones typically found in individuals with cirrhosis, called pigment gallstones, suggest that the process is related to the breakdown of red blood cells.
Cirrhosis and gallstones can both cause abdominal symptoms such as pain, nausea and vomiting. The health-care provider may suspect that gallstones have developed if a person with cirrhosis has a sudden attack of nausea, vomiting and right upper quadrant abdominal pain, a condition called biliary colic. If gallstones are suspected, based on the person's medical history and a physical examination, the most reliable test is an abdominal ultrasound. A few gallstones may be visualized on an x-ray, but most are not. Laboratory tests are not useful in diagnosing gallstones.
If a person with cirrhosis has gallstones that are not causing symptoms, no treatment is needed. If, on the other hand, the person is experiencing pain, nausea or vomiting from gallstones, the treatment of choice is surgical removal of the gallbladder. People with cirrhosis have a higher risk of complications and death from gallbladder removal than other people. The risk of complications, such as bleeding, infection, liver failure and worsening of cirrhosis, may be reduced if the surgeon is able to use a minimally invasive technique called laparoscopic cholecystectomy instead of operating through a large abdominal incision. Gallbladder surgery may be too risky for people with advanced cirrhosis of the liver, so treatment may be limited in those situations to supportive therapy such as intravenous fluids, antibiotics and medication for pain and nausea.