Cholelithiasis - Types, Risk Factors, Causes, Signs, Symptoms, Diagnosis, Prevention and Treatment

What Is a Gallbladder?

The gallbladder is a small pear-shaped organ on the right side of your abdomen located just beneath the liver. The gallbladder contains a digestive fluid known as bile, released into the small intestine.

What Are Gallstones?

Cholelithiasis or gallstones is the presence of one or more stones in the gallbladder. Cholelithiasis comprises cholesterol, bilirubin, and calcium salts, with small amounts of protein and other materials. Gallstones can range from as small as a grain to as large as a golf ball. Some people develop a single gallstone, while others develop many gallstones simultaneously. Gallstones are primarily seen in females over 40 years of age.

What Are the Types of Gallstones?

The three main types of gallstones are:

• Cholesterol Stones: These gallstones are mainly composed of undissolved cholesterol and contain many other components. They are the most common, making up to 80 % of gallstones. These are usually yellow-green.

• Pigment Stones: They are made up of bilirubin. These are smaller and darker and can be black or dark brown in color.

• Mixed Composition Stones: They contain varying proportions of cholesterol, bilirubin, and other substances such as calcium carbonate, calcium phosphate, and calcium palmitate.

What Are the Risk Factors of Gallstones?

Factors that raise the risk of gallstones include:

• Being overweight, obese and inactive.

• Eating a high-fat diet, high cholesterol diet, low fiber diet.

• Having a family history of gallstones.

• History of diabetes.

• Having a history of certain blood disorders such as sickle cell anemia or leukemia.

• History of liver disease.

• Taking medications containing estrogens, such as oral contraceptives or hormone therapy drugs.

• Pregnant ladies.

• Losing weight in a short time.

What Are the Causes of Gallstones?

It is unclear how gallstones are formed, but they can result when:

• Your Bile Contains Too Much Cholesterol: Naturally, bile dissolves the cholesterol excreted by the liver. However, when the liver excretes more cholesterol, the extra cholesterol which the bile cannot dissolve forms into gallstones.

• Your Bile Contains Too Much Bilirubin: Bilirubin is a chemical produced when the body breaks down red blood cells. Some conditions such as liver cirrhosis, biliary tract infections, and certain blood disorders cause the liver to make too much bilirubin. The excess bilirubin contributes to gallstone formation.

• Your Gallbladder Does Not Empty Thoroughly: If the gallbladder does not empty thoroughly or often enough, bile may become very concentrated, contributing to the formation of gallstones.

What Are the Signs and Symptoms of Gallstones?

Gallstones sometimes may cause no signs and symptoms. They are called "silent stones" and require no treatment. If the gallstone lodges in the duct and causes blockages, it shows symptoms such as:

• Pain in the upper belly, often on the right side, just under the ribs.

• Pain in the right shoulder or back.

• Stomach upset.

• Vomiting.

• Indigestion, heartburn, and gas.

The attacks occur particularly after a fatty meal and mostly happen at night.

Some severe signs of gallstone obstruction include:

• Belly pain that lasts several hours.

• High fever and chills.

• Yellow skin or eyes (jaundice).

• Dark urine and light-colored poop.

What Are the Tests Used for the Diagnosis of Gallstones?

• Positive Murphy’s Sign on Physical Examination: This test is done when the examiner places his hand at the coastal margin in the right upper abdominal area and asks the patient to breathe deeply. The patient stops breathing because of pain when the examiner touches the inflamed gallbladder.

• Abdominal Ultrasound: Ultrasound remains the first line and best technique to diagnose gallstones. This test is most commonly used. The test is done by moving the device (transducer) back and forth across the stomach area. While doing so, the transducer takes images of the abdomen.

• Endoscopic Ultrasound (EUS): This procedure helps identify smaller stones that are missed on an abdominal ultrasound. A thin, flexible tube (endoscope) is passed through the mouth and digestive tract. A small ultrasound device (transducer) in the endoscope produces sound waves that create images of the stomach.

• Computed Tomography (CT) Scan: CT scan is taken to view stones of the gallbladder.

• Magnetic Resonance Cholangiopancreatography (MRCP): This test uses a magnetic field and radio waves to take pictures of the internal organs, including the liver and gallbladder.

• Cholescintigraphy: This test checks whether the gallbladder squeezes correctly.

• Endoscopic Retrograde Cholangiopancreatography (ERCP): This procedure is done with an endoscopy tube in which a camera is inserted, and a dye is injected to see the bile ducts on the camera. Gallstones in the ducts can be removed while doing this procedure.

• Complete blood count, liver function tests, and bilirubin levels are tested.

How Can We Prevent Gallstones?

Maintaining a healthy weight by doing regular exercise and eating a healthy diet rich in fiber may help prevent gallstone formation.

How Are Gallstones Treated?

Most people with asymptomatic gallstones will never need treatment. Small gallstones can pass through the body on their own. Treatment options for gallstones include:

• Cholecystectomy: Removal of the gallbladder is called a cholecystectomy. Cholecystectomy is the most common surgery for gallstones. It is performed through laparoscopy or open surgery. Once the gallbladder is removed, bile flows directly into the small intestine. Gallbladder removal does not affect digestion.

• Sometimes oral medications are given to dissolve gallstones for people who cannot undergo surgery. They can cause mild diarrhea. But it may take months or years of treatment. Ursodiol and Chenodiol are oral medications.

• The gallbladder's shock wave lithotripsy has also been used for people who cannot have surgery. This treatment is not used commonly.

What Are the Complications of Gallstones?

• Acute Cholecystitis: It is an inflammation of the gallbladder. It causes high fever and pain.

• Gallbladder cancer.

• Block of the bile duct and pancreatic duct.

Conclusion:

The prognosis of the gallstones is good since they mostly do not cause any symptoms. The most common treatment is the removal of the gallbladder. Fortunately, we can live without the gallbladder. Bile has other ways to reach the small intestine.