Gallstones

Gallstones are lumps of solid material that form in gallbladder. They are also called cholelithiasis. They are made when the digestive juice called bile turns hard and stone-like.

The gallbladder is a small organ under liver. It stores bile made by the liver. Bile is made of several things such as cholesterol, bile salts, and a yellowish pigment (bilirubin).

Gallstones can be as small as a grain of sand or as big as a golf ball. Gallbladder may form a single large stone, hundreds of tiny stones, or both sizes at the same time. Gallstones often don't cause any Symptoms. But in some cases, gallstones block the tubes that carry bile (bile ducts). This can lead to a life-threatening infections of the bile ducts, pancreas, or liver.

There are two types of gallstones: cholesterol and pigment.

Cholesterol stones

These stones are:

  • Most common type of stone
  • Often a yellow-green color
  • Made mainly of hardened cholesterol

Pigment stones

These stones are:

  • Less common
  • Dark color
  • Made of a yellowish pigment called bilirubin

Cholesterol stones form when gallbladder doesn’t empty the way it should. They also form when bile has:

  • Too much cholesterol
  • Too much of a yellowish pigment called bilirubin
  • Not enough bile salts

There is no known Causes of pigment stones but these are more common in people who have:

  • A liver disease (cirrhosis) where scar tissue replaces healthy liver tissue
  • An infection in the vessels that transport bile (biliary tract infection)
  • Blood disorders that are passed from parent to child (hereditary) such as sickle cell anemia

Some people have a higher Risk for gallstones. These include:

  • Native Americans - They have the highest rates of gallstones in the U.S. This may be genetic as they have very high levels of cholesterol in their bile.
  • Mexican Americans - They have higher than average rates of gallstones.
  • Women - They are twice as likely to have gallstones as men.
  • People over age 60 - Risk for gallstones increases with age.
  • People with a family history of gallstones - Gallstones seem to run in some families (inherited). There may be a genetic link.

Health issues that may raise Risk for gallstones include:

  • Obesity. This is a major Risk factor, mainly for women.
  • Estrogen. Women may have extra estrogen from pregnancy, hormone replacement therapy, or birth control pills. This seems to raise cholesterol levels in bile and slow down gallbladder movement. Both can lead to gallstones.
  • Diet. Eating a high-fat, high-cholesterol, or low-fiber diet raises Risk. They lead to more cholesterol in the bile and reduced gallbladder emptying.
  • Cholesterol-lowering medicines. These medicines can increase the amount of cholesterol in bile.
  • Diabetes. People with diabetes often have high levels of fatty acids (triglycerides). This raises the Risk for gallstones.
  • Very fast weight loss. As the body processes fat during very fast weight loss, the liver sends out extra cholesterol into bile.
  • Not eating for a few days (prolonged fasting). Fasting slows down gallbladder movement. Over time, bile has too much cholesterol.

Some people with gallstones don't have any Symptoms. These stones are called silent stones. They don't stop the gallbladder, liver, or pancreas from working properly. In most cases they don't need to be treated. Most gallstones don’t cause Symptoms right away.

Gallstone Symptoms (also called a gallbladder attack) may happen very suddenly. They often:

  • Begin when gallstones get bigger
  • Happen when the stones start to block bile ducts
  • Occur after a fatty meal or at night

Each person’s Symptoms may vary. Symptoms may include:

  • Steady, severe pain in  upper belly (abdomen) that quickly gets worse
  • Pain in  back between the shoulder blades
  • Pain in  right shoulder
  • Nausea
  • Vomiting
  • Fever
  • Chills
  • Yellowing of the skin or eyes (jaundice)

See healthcare provide ifhave any of these Symptoms during or after a gallbladder attack:

  • Pain that lasts more than 5 hours
  • Sweating
  • Chills
  • Low-grade fever
  • Yellowish color of the skin or whites of the eyes
  • Clay-colored stools

Gall bladder stones may cause swelling and infection of gall bladder (acute cholecystitis),blockage of outflow (mucocoele) and rupture of GB. Stone may pass into bile ducts to cause jaundice and intestinal obstruction.

 

How is it diagnosed?

Many people have gallstones but don’t know it because they don’t have Symptoms. In some cases, gallstones are found by incident.

But if pain that doesn’t go away, need past health and physical exam.  And some tests to check for gallstones such as:

  • Ultrasound. This imaging test uses high-frequency sound waves to create images of internal organs on a computer screen. It is used to see the gallbladder and gallstones.
  • HIDA or PIPIDA scan (hepatobiliary scintigraphy or cholescintigraphy). This scan checks for any abnormal contractions of the gallbladder and blockages in bile ducts. A radioactive chemical or tracer is shot (injected) into vein. The amount of radiation is very small. It is not harmful. It collects in liver and flows into gallbladder. A special scanner is used to watch the tracer move through organs.  A medicine is given to make gallbladder contract.
  • Blood tests. These look for signs of infection, blockage, liver problems, jaundice, and inflammation of the pancreas (pancreatitis).
  • CT scan. A CT scan is an imaging test that uses X-rays and a computer to make detailed pictures of any part of the body. It can show gallstones. It can also show infection or bursting of the gallbladder or bile ducts.
  • MRCP (magnetic resonance cholangiopancreatography). This is a special MRI test that creates images using magnetic fields and pulsed radio wave energy.
  • EUS (endoscopic ultrasound). This internal ultrasound (sonogram) is done with a flexible lighted scope. A medicine is given to help relax and then a scope is passed through mouth. It creates internal images using sound waves.
  • ERCP (endoscopic retrograde cholangiopancreatography). ERCP uses both X-ray and a long flexible lighted tube with a camera near the end (catheter). While sedated, the tube is put in mouth and throat. It goes down food pipe (esophagus), through stomach, and into the first part of small intestine (duodenum). We can see the inside of these organs on a video screen and check for any problems. A dye is put into bile ducts through the tube. The dye lets the bile ducts be seen clearly on the X-ray.

How is it treated?

If gallstones don’t cause any Symptoms, often don’t need Treatment.

Gallstones that do cause Symptoms should be treated right away. They may lead to damage or infection if bile ducts are blocked for a long time.

If Symptoms don’t go away, Treatment may include:

  • ERCP (endoscopic retrograde cholangiopancreatography). ERCP uses both X-ray and a long flexible lighted tube (endoscope). Small stones can be taken out through the scope.
  • Sphincterotomy. This can also be done through the tube during an ERCP. Tight rings of muscle (called sphincters) are around the openings of the bile ducts. They can block gallstones. Cutting these rings lets the ducts open wider so that stones can pass into intestine.
  • Gallbladder removal (cholecystectomy). If stones are in gallbladder, gallbladder must be removed. These stones cannot be taken out with ERCP. Gallbladder removal is a common surgery. Body will work well without gallbladder. It is not essential for a healthy life.
  • Percutaneous drainage/cholecystostomy. If stones in gallbladder cause a blockage of bile acid and subsequent infection, gallbladder will have to be removed. But if too sick to have surgery or there are other Complications, a drainage tube may be inserted into gallbladder through the skin of abdomen. This will temporarily bypass the blockage and drain any infection.
  • Oral dissolution therapy. The stones are dissolved using medicines made from bile acid. But, it can take a couple of years to completely dissolve the stones. They also tend to come back when the medicine is stopped.
  • Methyl-tert-butyl ether. This solution or a similar chemical can be shot (injected) through the skin into gallbladder to dissolve stones. This is an uncommon procedure.

Most people respond very well once their stones are dissolved or taken out.

Consult with experienced Doctors

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