Gallstones - Causes, Symptoms, Risk Factors, and Treatment

What Are Gallstones?

When the gastric juices become hardened and get deposited in the gallbladder, it gives rise to gallstones. They are made of cholesterol or bilirubin. The gallbladder is the small pear-shaped hollow organ located in the upper-right side of the abdomen and measures roughly around 4 inches. It contains bile, which is a yellowish-green digestive fluid that gets released in the small intestine.

You can develop a single gallstone or multiple gallstones at the same time, and it can be small as a grain or can be as big as a golf ball. Small gallstones usually do not result in any symptoms and might not require treatment. But when gallstones result in the blockage of bile ducts, it can result in sudden upper right abdominal pain, which is called gallbladder attack or biliary colic. If you experience symptoms, then you might need surgery to get the stones out.

What Are the Types of Gallstones?

Gallstones can be:

1. Cholesterol stones - They are yellowish-green in color and are composed of hardened cholesterol. It is the most common type of gallstones and accounts for almost 70 % of the cases.

2. Pigment stones - These are dark-colored stones composed of bilirubin.

You can also have a mix of both these types of stones.

What Are the Signs and Symptoms of Gallstones?

Gallstones do not themselves result in pain. But only when they get stuck and block gall ducts, pain occurs. The blockage prevents the movement of bile from the gallbladder. Around 80 % of patients have this silent or asymptomatic type of gallstones (according to the American College of Gastroenterology). In such cases, gallstones are discovered accidentally during an abdominal X-ray or surgery.

And in symptomatic cases, the symptoms of gallstones include:

• Pain on the right side of the upper abdomen.

• This pain comes and goes when you eat high-fat and fried foods.

• The pain usually lasts only for a few hours.

• Nausea and vomiting.

• Indigestion.

• Diarrhea.

• Dark-colored urine.

• Light-colored stools.

• Belching.

What Causes Gallstones?

Gallstones are believed to form due to one of the following reasons:

1. Too Much Cholesterol in Bile - Generally, the bile contains chemicals that are required to dissolve the cholesterol that gets excreted by the liver. But when the liver excretes too much cholesterol, then the excess cholesterol gets deposited as crystals, which eventually become stones.

2. Too Much Bilirubin in Bile - Bilirubin is the byproduct of red blood cell break down. Some conditions, such as liver cirrhosis, certain blood disorders, etc., can make your liver produce excess bilirubin, which gets converted to gallstones.

3. Incomplete Emptying of the Gallbladder - In case the gallbladder gets empty incompletely or does not get empty often enough, then bile becomes concentrated, resulting in gallstones.

Risk Factors:

The following factors might increase the risk of gallstones:

• Women are more susceptible than men.

• Adults older than 40 years.

• Native Americans and Mexican Americans.

• Obesity.

• Oral contraceptive pills and hormone replacement drugs.

• Liver disease.

• Diabetes.

• Sickle cell anemia, leukemia, and some other blood disorders.

• A sedentary lifestyle.

• Pregnancy.

• Consuming a diet high in fat and low in fiber.

• A family history of gallstones.

• Sudden weight loss.

How Does a Doctor Diagnose Gallstones?

The doctor will use the following tests and procedures to diagnose gallstones and its complications:

• Blood tests - To check for infection, pancreatitis, jaundice, etc.

• Abdominal ultrasound - High-frequency sound waves are used to produce images of the gallbladder and signs of gallstones.

• Endoscopic ultrasound (EUS) - This test is used to diagnose smaller stones that might have missed during an ultrasound. Here, a thin and flexible tube is inserted through the mouth, and then a small ultrasound device is used to get images of the surrounding structures.

Other tests may include oral cholecystography, magnetic resonance cholangiopancreatography (MRCP), a hepatobiliary iminodiacetic acid (HIDA) scan, endoscopic retrograde cholangiopancreatography (ERCP), or computerized tomography (CT).

How Does a Doctor Treat Gallstones?

If you do not have symptoms, gallstones do not need treatment. Based on your symptoms, the number of gallstones, and complications, the treatment options include:

Home Remedies:

If you do not have symptoms, then you can follow these home remedies and dietary tips:

1. Try to eat foods low in fat, and avoid greasy food items.

2. Include more fiber in your diet.

3. Do not consume caffeinated beverages, dairy, and sweet food items as it can cause diarrhea.

4. Preferably eat several small meals a day, making digestion easier.

5. Drink around 6 to 8 glasses of water per day.

Medications:

The doctor might suggest medicines to dissolve gallstones, which might take months to years. Gallstones are more likely to recur when you stop taking the medicines. In some cases, these medicines do not work. This treatment option is used only for people who cannot undergo surgery. Ursodiol is a commonly used drug.

Surgery:

Cholecystectomy is the procedure done to remove the gallbladder. As gallstones often recur, the surgeon removes your gallbladder surgically. After surgery, instead of the bile getting stored in the gallbladder, it flows from the liver directly into the small intestine. Getting your gallbladder removed does not affect digestion, but it can result in temporary diarrhea.

Nonsurgical:

This includes shock wave lithotripsy. Here, shock waves are used to break gallstones into smaller pieces.

What Are the Complications of Gallstones?

The possible complications of gallstones are:

1. Cholecystitis - When a gallstone gets stuck in the neck of the gallbladder, it results in inflammation of the gallbladder, which is otherwise called cholecystitis. The symptoms are pain and fever.

2. Common bile duct blockage - Gallstones can block bile ducts, which are the tubes that carry bile from the gallbladder and liver to the small intestine. It results in severe pain and jaundice.

3. Gallbladder cancer - Although the incidence of gallbladder cancer is very rare, a history of gallstones increases the risk of this cancer.

4. Pancreatic duct blockage - Gallstones can also block the pancreatic duct, which is the tube that connects the pancreas and the common bile duct. This can result in pancreatitis or inflammation of the pancreas. The symptoms include severe, constant abdominal pain.

Preventive Tips:

1. Avoid skipping meals and eat food at the right time.

2. Do not lose weight drastically. Rather, aim to lose around a kilogram of weight in a week.

3. Consume food rich in fiber, which includes vegetables, fruits, and whole grains.

4. Try to maintain a healthy weight.

5. Stay physically active.

6. Avoid fried and oily food items.

For more information on gallstones, consult a surgical gastroenterologist online!