Gallstones

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Gallstones are solid deposits that form inside the gallbladder and responsible for 90% of gallbladder and bile duct disease. It is the most common of all gallbladder problems.

Gallbladder is a small, pear-shaped sac in the upper right corner of the abdomen, just below the liver. It serves as a storage place for bile. Bile is a digestive fluid that is composed of various substances including bile pigments, bile salts, bilirubin, cholesterol and lecithin. It helps the body to absorb fat. Gallbladder receives bile from the liver through the hepatic duct. Here bile is concentrated and stored until needed by the body for digestion. Then, it's released into your small intestine. It holds about 32 mL of bile in an adult.

Sometimes people may develop just one gallstone and sometimes many gallstones at the same time. It is common to have many smaller stones. Gallstones vary in size from as small as a grain of sand to as large as a golf ball. Gallstones are mainly (about 80%) composed of cholesterol which is called cholesterol stones. Cholesterol stones are more common in the United States. When the liver produces more cholesterol than digestive juices can liquefy, they are formed. They may also be composed of calcium and bilirubin. It is called pigment stones.

Most gallstones cause no symptoms. But if they block a duct, treatment is required.

Why and How Do Gallstones occur?

Gallstones occur when bile forms stones or solid particles in the gallbladder. High amount of cholesterol or bilirubin in the bile Causes these stones. It occurs more in female than male. With increasing age, risks also increase. It usually develops in people between the ages of 20 and 50. It may also run in families. It is a common problem in Native Americans, American Indian, Hispanics and Mexican-American.

Gallstones are mainly (about 80%) composed of cholesterol which are called cholesterol stones. These stones often appear yellow in color. Usually cholesterol excreted by liver is dissolved by the help of bile. But when liver excretes more cholesterol than normal, bile can’t dissolve it. This undissolved cholesterol may convert into crystals and form stones. Cholesterol stones are more common in the United States.

Gallstones may also be composed of calcium and bilirubin. These stones are called pigment stones. These stones are dark brown or black in color. Bilirubin is the orange-yellow pigment that’s derived from the breakdown of hemoglobin during destruction of red blood cells. This destruction is a normal process. But, certain Medical Problems may cause abnormal destruction. Pigment stones form most often in liver diseases (e. g. Liver cirrhosis, Biliary tract infections etc) or blood disorders (e. g. Chronic hemolytic anemia) that increase bilirubin level.

If gallbladder doesn't empty completely or as it should, bile may become very concentrated and this leads to gallstones formation.

Other important causes that influence gallstones formation are-

• Being overweight
• Rapid weight loss
• Diabetes
• Intestinal disorders
• Eating a high-fat diet, high-cholesterol diet and low-fiber diet
• Medications- contain estrogen, such as hormone therapy drugs, birth control pills or cholesterol lowering drugs
• Smoking
• Heavy drinking
• Poor muscle tone
• Coronary artery disease or other recent illness
• Multiple pregnancies

What are the Gallstones Symptoms?

Usually people can not realize that they have gallstones. Many people with have never had any symptoms. Symptoms occur with complications. Common Symptoms are-

• The pain of a gallbladder attack begins in the right upper or middle upper side of abdomen. Sometimes pain may radiate to the chest, back, right shoulder or, between shoulder blades. It does not persist all times. So, it’s called as “attack”. Attack may come every few days, weeks or months. Sometimes it occurs after years since 1st attack. After a fatty or greasy meal, the pain may begin within 30 minutes. Pain can last for one to five hours constantly. It is usually dull and severe. It prevents from taking normal or deep breaths.
• Intolerance for fatty or greasy foods
• Nausea and vomiting
• Indigestion
• Gas and belching
• Clay-colored bowel movements
• Yellow discoloration of the skin and sclera of eyes (jaundice)
• Low-grade fever, chills and sweating
• Dark urine
• Light-colored stools

When to make an appointment with doctor?

If you have any signs or symptoms, you should see a doctor. Sometimes, abdominal pain can be a sign of a serious or even life-threatening condition. This risk is increased, if you have a heart condition or are older than 60. If you have following conditions, you need to call a doctor immediately-

• Sudden and severe abdominal pain that cannot be controlled
• Yellow discoloration of the skin and sclera of eyes (jaundice)
• Fever with chills
• Vomiting
• Having trouble breathing
• Loss of consciousness

How can Gallstones be Diagnosed?

The patient's symptoms will alert the doctor that this is likely to be gallstones. However, tests are sometimes needed to confirm gallstones and rule out other conditions such as stomach ulcers, irritable bowel syndrome and tumours.

Tests for gallstones are-

• Abdominal Ultrasound- It is the main test to confirm gallstones.
• Oral cholecystogram (OCG)- It is an alternative to ultrasound.

If doctor thinks that patient may have a gallstone in one of the ducts connecting liver with gallbladder, pancreas, and small intestine, doctor may request following tests-

• Abdominal CT scan
• Hepatobiliary iminodiacetic acid (HIDA) scan
• Magnetic resonance imaging (MRI)
• Endoscopic retrograde cholangiopancreatography (ERCP)

Blood tests may also be performed to find out an infection, jaundice, pancreatitis or other complications caused by gallstones.

What are the Gallstones Complications?

• Inflammation of the gallbladder/ Cholecystitis
• Gallbladder cancer
• Obstructive jaundice
• Blockage of the pancreatic duct and pancreatitis
• Blockage of the common bile duct resulting in Cholangitis
• Gallstone ileus/ obstruction of the small or large intestine

How can Gallstones be Treated?

• Gallstones that don't cause symptoms typically do not require treatment. But, you will have to be careful of gallstone complications. If gallstone signs and symptoms occur in the future, you can have treatment.
• If gallstones do cause symptoms, surgical removal of the gallbladder is the best Treatment. Laparoscopic surgery is the best method to remove the gallbladder. Because it is a safe, effective procedure that involves less pain and a shorter recovery period than traditional open surgery. Almost all patients who have the surgery do not have their symptoms return.
• Medication is another treatment option. Certain medicines are used to dissolve gallstones. It may take months or years to dissolve your gallstones, though the stones may return after treatment ends. It is useful for people who can't undergo surgery.
• LITHOTRIPSY is another non-surgical approach. It takes months or years for this method to dissolve stones. Even gallstones may come back in many patients. So, this treatment is not used very often now a day.

What is the way of Prevention?

It is not known why some people have stones and others do not. But, following tips may help you to reduce the risk-

• Maintain ideal body weight.
• Avoid rapid weight loss and consult your doctor before trying to lose weight.
• Try not to skip meals. Eat on a regular schedule and maintain a diet that is high in fiber and low in fat and cholesterol.
• Exercise regularly. Study suggests that vigorous exercise may lower the risk of developing gallstones.
• If you are taking hormones such as estrogen, talk with your doctor.