Gallstones

Gallstones are diagnosed and treated by the GI Division of Premier Medical Group.

What are gallstones?

Gallstones are defined as hard, pebble-like deposits that form inside the gallbladder, which itself is a small pear-shaped sac located below your liver in the right upper abdomen. The gallbladder stores liquid called bile, which helps the body digest fats. The bile is actually made in your liver, but it is stored in the gallbladder until the body needs it. When the gallbladder contracts the bile is pushed into the common bile duct. From there it moves down to the small intestine where it will help your digestion. Bile is made up of cholesterol, fats, bile salts, water, and bilirubin. Stones develop because cholesterol and pigments in bile sometimes form hard particles. The stones can be as large as a golf ball or as tiny as a grain of sand.

Gallstones are more common in women, people with a family history, Native Americans, Hispanics, and people over 40.

What causes gallstones?

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Gallstones form when there is an imbalance in the elements that make up bile. If there is too much cholesterol in the bile or if the bile does not empty correctly, stones may form. If you have high cholesterol levels in your blood, it does not mean that you will develop gallstones. This is not the reason stones form.

Even the smallest gallstones can cause discomfort. These tiny stones form what is called “biliary sludge.”

Studies show that the most common causes of gallstones are some combination of:

  • When the gallbladder lacks sufficient amounts of bile salts to break down fat
  • When the gallbladder fails to empty properly
  • When the bile holds more cholesterol than it is able to dissolve
  • When there is too much bilirubin or other matter in the bile causing the cholesterol to form hard crystals

The following conditions are risk factors for gallstones:

  • Diabetes (people with diabetes tend to have higher levels of triglycerides, which is a risk factor for gallstones)
  • Liver cirrhosis
  • Bone marrow or organ transplant
  • Sickle cell anemia or hemolytic anemia
  • Rapid weight loss (when a person loses weight too rapidly, the liver tends to discharge more cholesterol which again can lead to stones forming
  • Intravenous feedings
  • Obesity (one of the biggest risk factors, because people who are overweight tend to have a higher cholesterol level and obesity can hinder the gallbladder from emptying properly)
  • Gender and age (more common in women and older people)
  • Estrogen (pregnant women or women who take hormone replacement therapy or birth control pills have a higher level of estrogen which can cause cholesterol levels to elevate)
  • Cholesterol drugs
  • Ethnicity (Native Americans and Mexican Americans have a higher tendency toward gallstones)

What are the symptoms of gallstones?

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Most people with gallstones have no symptoms and require no treatment. These types of stones are referred to as “silent stones”, and are often discovered while the patient is checked for a different illness. Gallstone symptoms are sometimes similar to other conditions: IBS (irritable bowel syndrome), ulcers, a heart attack, appendicitis, hiatal hernia, pancreatitis, and hepatitis, so it is essential to get an accurate diagnosis.

It’s important to see you doctor if you experience any of the most common symptoms listed below:

  • Pain in the right upper part of the abdomen
  • Pain in the back between the shoulder blades
  • Pain under the right shoulder
  • Nausea
  • Vomiting
  • Bloating, indigestion, and gas
  • Clay-colored stools

More severe symptoms can include fever, jaundice, and persistent pain whether focused on the upper right side or not. Typical “gallbladder attacks” occur during the night following a fatty meal. Even if the attack passes, your gallbladder can become infected or rupture. These attacks can happen every few days, weeks, or even months. The pain generally lasts from 1 to 5 hours.

How are gallstones diagnosed?

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Most often, gallstones are discovered during an examination or tests for other health conditions. If your doctor suspects gallstones, he or she is likely to order an ultrasound, which is the most effective way to detect gallstones.

There is no blood test that detects gallstones, but a blood test can show if there is an infection, obstruction in the gallbladder, or inflammation in the liver or pancreas. A urine test can rule out kidney infection.

Other tests for upper right abdominal pain and gallstone symptoms include:

  • CT Scan
  • ERCP (endoscopic retrograde cholangiopancreatography)
  • HIDA scan (cholescintigraphy). A solution is injected into an IV line in your arm. If the gallbladder is inflamed, the solution, which is radioactive but harmless, will show on a special camera.
  • Chest X-ray. This is used to rule out other reasons for the pain.

 

What are the different types of gallstones?

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There are two types of gallstones, and they can be tiny as a particle of sand or as large as a golf ball:

  • Cholesterol gallstones: The most common stones, they have nothing to do with high cholesterol levels in the blood. These stones are commonly yellow-green and are made up of hardened cholesterol.
  • Pigment gallstones: These are small, dark stones made of the bilirubin.

How are gallstones treated?

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If you have no symptoms, you do not require treatment. If you have mild symptoms, diet and lifestyle changes may be recommended. If you are experiencing recurrent gallbladder attacks, your doctor may advise the surgical removal of your gallbladder, which is called a “cholecystectomy.”

Surgery

Most gallbladder operations today are performed through a laparoscope. Several very small incisions are made in the abdomen and the laparoscope, equipped with a tiny video camera, is inserted. The doctor sees the gallbladder on a video monitor and removes the gallbladder through one of the tiny incisions. The benefits of laparoscopic surgery are less hospital time, faster recovery, and less pain.

If the gallbladder shows infection, severe inflammation, or scarring from past surgeries, the surgeon may need to do open surgery. Occasionally these complications are revealed during the laparoscopy and the surgeon must make a larger incision. The most common obstacle is an injury to the bile ducts. If the bile duct leaks, it can be very painful and also cause infection. Open surgery generally requires 3-5 hospital days and a longer recovery time at home.

If surgery is indicated, but you are uncomfortable in the interim, you can try to relieve the symptoms by trying the following:

  • Intake of only clear fluids
  • Avoid fatty or greasy foods

Nonsurgical Treatment

Generally, nonsurgical approaches are not used, unless there is a medical condition preventing surgery. Two non-surgical approaches include:

  • Contact dissolution therapy: To date, this is an experimental procedure which involves injecting a drug into the gallbladder to dissolve cholesterol stones. Some irritations have been reported. This treatment approach is not often used.
  • Oral dissolutions therapy: Several oral drugs are given to dissolve gallstones. It could take months or years of treatment and there are some side effects such as mild diarrhea and higher cholesterol levels.

How are gallstones prevented?

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Healthy diet and exercise are recommended as the best way to prevent gallstones and to manage the symptoms of gallbladder attacks. Avoiding fatty and sugary foods is essential, but beware of intense, short-term diets. Rapid weight loss can exacerbate the formation of gallstones in the body. A high-fiber diet is generally recommended; increased exercise can also help.

What else causes upper right abdominal pain?

Gallstone symptoms are sometimes similar to other conditions linked to abdominal pain: IBS (irritable bowel syndrome), ulcers, a heart attack, appendicitis, hiatal hernia, pancreatitis, and hepatitis, so it is essential to get an accurate diagnosis.

FAQs about gallstones

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Q: How long after eating does a gallbladder attack happen?
Gallbladder attacks can occur at any time, but they most often occur 20 minutes to 1 hour after eating meals. Some attacks can take longer to develop, especially overnight.

Q: When should I seek medical attention?
A: If you have repeated attacks of abdominal pain 20 minutes to 1 hour after meals. If over-the-counter pain medications do not relieve the pain, and if you have fever, chills, vomiting, or look jaundiced.

Q: How do I know if I have gallstones?
A:The best way to diagnose gallstones is with an ultrasound.

Q: Who gets gallstones?
A: Older adults, women, American Indians, Mexican Americans, and people with diabetes are more likely to get gallstones. Also those with a family history of gallstones and people who are overweight, or people who lose weight very rapidly. Also people who take cholesterol-lowering medications have a greater chance for stones.

Q: Is it possible to have gallstones if the X-ray or ultrasound is negative?
A: Yes, sometimes the stones are surrounded by excess fatty tissue which can block the sound waves of the ultra sound. The scan can also miss stones in the liver, bile ducts, and stones that are fully packed in the gallbladder.

Q: Can gallstones come back after the gallbladder is removed?
A: Yes. Your liver produces the same bile and stones can still harden in the bile ducts and liver and present the same uncomfortable symptoms.

Q: What makes gallstones form?
A: Stones form because of a chemical imbalance that keeps the cholesterol in the bile from dissolving; instead, it crystallizes. Most commonly, this imbalance is due to a bad diet, unhealthy liver, ingested chemicals, or excessive drugs.