On top of the liver, the gallbladder releases bile to help digest food. If gallstones move from the gallbladder into the tubes that carry bile (the common duct and the hepatic duct), they can block these vital fluids, causing painful infections in your biliary tract or pancreas. These are called biliary colic, and they can be quite severe.
Gallstones can cause many dangerous complications
What Are Gallstones?
Gallstones are small, stone-like deposits in the gallbladder (a pear-shaped organ on the right side of the abdomen) when the digestive juice, bile, hardens. The liver makes bile to help digest fats and contains water, cholesterol, bile salts, and a yellowish pigment called bilirubin. Most gallstones are made of cholesterol, but some are made of other substances.
In most cases, gallstones don't cause any symptoms and don't need treatment. But if a gallstone gets stuck in a duct or opening in the gallbladder, it can cause painful abdominal pain that lasts from several minutes to several hours. This type of pain is called biliary colic and is most often felt after an extensive or rich meal.
Causes of Gallstones
The exact cause of gallstones isn't known, but some factors increase your risk of developing them. Being overweight increases your chance of having gallstones, especially if you have a lot of belly fat. Women are more likely to have gallstones than men. Having dramatic or frequent weight fluctuations also increases your risk for gallstones. The drug ursodiol, also known as ursodeoxycholic acid and sold under the brand name Actigall, reduces the formation of gallstones and is used to treat them.
People who are obese are more likely to have gallstones, as are women who have not completed childbearing. A family history of gallstones is also a risk factor. Having diabetes increases the risk of developing gallstones, as does taking certain medications, such as those used to treat epilepsy and depression. Infection of the common bile duct, known as cholecystitis, is another cause of gallstones.
Symptoms of Gallstones
Even though gallstones can cause serious complications, most people with them do not need treatment. They are asymptomatic, and their stones do not affect the functioning of their gallbladder, liver, or pancreas. In these patients, the stones are called silent gallstones (cholelithiasis). Painful episodes of cholecystitis occur after eating large or fatty meals and last about an hour or so. The attacks may occur several times a week or can come and go for years. The abdominal pain does not necessarily correspond to the location of the gallstones and might be caused by other conditions, such as peptic ulcer or gastroesophageal reflux disease.
The movement of the gallbladder is regulated by hormones such as cholecystokinin. When this substance is released, the gallbladder squeezes to push bile into the common duct. The bile is then carried into the small intestine, emulsifying fat molecules. This process lets the body absorb fat-soluble vitamins and minerals, such as vitamins A, D, E, and K.
When a gallstone blocks the passage of bile into the small intestine, it can cause an infection in the common bile duct (cholangitis). Symptoms of this condition include fever and shivering. If left untreated, the infection can spread to the pancreas and become life-threatening. The treatment for cholangitis is surgery or an endoscopic sphincterotomy to open the blocked common duct and drain the bile.
Diagnostics and Tests
About 90% of gallstones do not cause symptoms. Gallstones may need to be removed if they cause pain or other serious problems.
Healthcare professionals use lab and imaging tests to diagnose gallstones. They will ask about your medical history, symptoms, and what you usually eat. They will also examine you.
The most common imaging test is ultrasound. During an ultrasound, a technician uses an instrument that sends sound waves through your body to create pictures of the gallbladder and nearby structures. A radiologist then reads the images. An X-ray technique called computed tomography scan, or CT, may show more detailed information about the gallbladder and bile ducts. For this test, you lie on your back with a long, flexible tube (endoscope) inserted into your mouth and throat. It goes down your esophagus, stomach, and into the first part of your small intestine (duodenum). You are given anesthesia or medicine to keep you calm during this procedure.
Treatment
Some gallstones don't cause symptoms and may go away on their own. If you have symptomatic gallstones, treatment is needed to prevent complications. The most common treatment is surgery to remove your gallbladder (cholecystectomy). For most people, doctors use a minimally invasive surgical procedure called laparoscopic cholecystectomy. About 10 percent of patients need open surgery, where surgeons reach the gallbladder through a large abdominal cut.
Doctors can also try to dissolve gallstones with medicine. Ursodiol (Actigall) and chenodiol (Chenix) are medicines that can break up small cholesterol gallstones. These medicines work best in people with few gallstones and whose gallbladder is functioning normally. It can take months or years for the treatment to dissolve your gallstones.
Another way to break up gallstones is with a nonsurgical procedure called extracorporeal shock wave lithotripsy. In this treatment, a doctor uses an electrically heated wire to widen the opening of your bile duct, which lets bile escape. This causes the gallstones to pulsate and break up, so they can pass safely through your intestines. This is a rare treat. You'll need to be hospitalized for this treatment. The procedure can be painful. It can also cause side effects, such as a bile duct infection.
Complications of Gallstones
Gallstones often cause problems when they block the duct that carries bile from the gallbladder to the small intestine (the common bile duct). This is a severe condition called choledocholithiasis. Sometimes the stones also block a tube that connects to the small intestine from another place in the body. This fistula can lead to severe pain, fever, or infection in the abdomen (cholecystitis).
Backed-up bile may leak into your bloodstream. This can make you sick, causing jaundice (yellowing of the skin and whites of the eyes). It can also reduce the fat-soluble vitamins that your body absorbs from your food.
Infection in the gallbladder is rare but can be severe. People who develop gallstone pancreatitis almost always require surgery as soon as possible to remove the gallbladder.
Some people who have gallstones don't get any symptoms. In these cases, doctors recommend expectant management, where you wait to see if the gallstones disappear independently. However, this approach is only safe for people who have low-risk factors for developing gallstones. For most other people, it's better to have your gallbladder removed. Doctors can usually remove the gallbladder using a laparoscopic procedure, which doesn't require large incisions. But about 10 percent of people need an open cholecystectomy, which requires a more significant cut in the abdomen.
Prevention
Diet and nutrition can affect the risk of gallstones. Generally, eating three well-balanced meals each day, maintaining a healthy weight, and exercising regularly can help prevent gallstones. Avoiding fatty foods and drinking moderate alcohol can also reduce the risk of gallstones. In addition, eating more fiber and less sugar can lower your risk. A registered dietitian can help you change your diet based on your health and lifestyle. They suggest eating more fruits, vegetables, and whole grains while reducing sugar and choosing healthier fats, such as olive oil, canola oil, nuts, and fish. They can also advise on how to increase your water and fiber intake.
And talk to your doctor or a dietitian if you have symptoms of gallstones, such as pain in the upper right part of your abdomen (biliary colic) that grow in intensity for 20 minutes or more and doesn't go away after vomiting.
