Gallbladder stones

What are gallstones?

Gallstones are solid hard masses that form inside the gallbladder. Gallstones may be as small as tiny specks or as large as the gallbladder itself. The vast majority, however, are smaller than one inch (2.5 cm) and are one of two major types, cholesterol or pigment.

What is the gallbladder?

The gallbladder is a pear-shaped sac-like organ with a muscular wall that is about three to six inches long. It is located in the right upper side of the abdomen, under the liver. The gallbladder is connected to the liver and intestine through small tubes called bile ducts.

The primary purpose of the gallbladder is to store and concentrate bile, a greenish-brown fluid that is produced by the liver. Bile carries waste products out of the liver but it is also needed to digest and absorb fatty foods, and to absorb important fat-soluble vitamins. Between meals, the gallbladder is relaxed, allowing bile to flow into it, where bile is stored and concentrated. With meals, the fat content of foods in the small intestine cause the gallbladder to contract (squeeze) and partially empty into the intestine. A few hours later, the gallbladder relaxes and begins to store bile again.

Why do gallstones form?

Experts do not know for sure why gallstones are formed. However, many people have bile with an abnormally high concentration of cholesterol and/or calcium from which stones may develop. There are a number of factors that increase the risk of developing gallstones

  • Sex – Gallstones are more common in women.
  • Age – The risk of gallstones increases with age. The condition is extremely rare in children and becomes progressively more frequent over time, especially after the age of 40 years.
  • Family history and genetics – Gallstones are more common in certain families, suggesting that genetics has a role in gallstone development.
  • Other factors – Other conditions can increase the risk of developing gallstones, including:

         

    • Pregnancy
    • Use of medicines that contain estrogen (such as birth control pills
    • Obesity
    • Frequent fasting
    • Rapid weight loss, including patients who have surgical weight loss treatments.
    • Lack of physical activity
    • Diabetes mellitus
    • Sickle cell disease or other conditions associated with rapid destruction of red blood cells.
    • Cirrhosis or severe scarring of the liver
    • Certain medicines
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What are the symptoms?

The majority of people who have gallstones do not have symptoms; their stones remain “silent.” Silent gallstones are often found on an ultrasound or CT scan done for other reasons. Silent stones do not need to be treated since the initial symptoms of gallstones are usually mild.

Biliary colic, also known as gallstone pain or biliary pain, is the most common initial symptom of gallstones. It presents as attacks of abdominal pain, often located in the right upper belly just under the lower ribs. Sometimes it is felt in the upper center of the abdomen or even in the lower chest, causing it to be confused with angina or a heart attack. You may also feel nausea, and vomiting, and pain in the right shoulder or back.

Biliary colic usually happens when the gallbladder contracts in response to a fatty meal. This compresses the stones against the gallbladder outlet, blocking its opening. As the gallbladder relaxes several hours after the meal, the pain subsides. In some people, the pain happens without having eaten anything and many times it starts around or after midnight.

Once you have a first attack of biliary colic, there is a good chance you will have more symptoms in the future. Such recurrent symptoms are usually more severe and occasionally associated with complications.

Complications of gallstones

Acute cholecystitis refers to inflammation of the gallbladder. This happens when there is a complete blockage of the gallbladder, caused by a gallstone. Unlike biliary colic, which resolves within a few hours, pain is constant with acute cholecystitis and fever is common.

Acute cholecystitis is a serious condition that requires immediate medical treatment in the hospital. Treatment includes IV fluids, pain medicine, and usually antibiotics. Surgery to remove the gallbladder along with its contained stones is usually recommended during the hospitalization or shortly thereafter. If not treated, acute cholecystitis can lead to gallbladder rupture, a life-threatening condition.

Choledocholithiasis is a complication that can develop if one or more gallstones leave the gallbladder to the main bile ducts and block the area where bile exits into the intestine. It can then lead to Jaundice, which is a yellow discoloration of the skin and eyes or cause Acute cholangitis, which is an infection of the bile ducts

What are the available treatments?

There are three general options for people with gallstones; the best option depends upon your individual situation.
  • Expectant management: Do nothing, wait and watch
  • Non-surgical therapy: Eliminate the stones while preserving the gallbladder. This is mainly for those who cannot undergo cholecystectomy. These treatments get rid of the gallstones while preserving the gallbladder. The main disadvantage is that the stones can come back over time.
  • Surgical therapy: It is the preferred treatment since it remove the gallbladder and stones

Cholecystectomy is the name of the surgery that removes the gallbladder. The surgery is done in an operating room after you are given anesthesia.

The gallbladder is an important organ, but you can live without it. Removing the gallbladder does not usually cause serious complications. However, about half of people who have their gallbladder removed develop loose stools, gas, and bloating; in most people these symptoms are mild, do not require treatment, and improve with time.

Surgery may be done through an open incision (cut) in the skin and abdominal wall. However, in most people, the surgery is done using small instruments and a video camera, which are inserted into the abdomen through several small puncture holes in lieu of the larger cut. This is called laparoscopic cholecystectomy and is commonly known as laser surgery.

To help prevent gallstones try to stay at a healthy body weight by eating an appropriate number of calories and exercising for at least 30 minutes five days per week.