CONDITIONS
Gall Stones (Cholelithiasis)
What are gallstones?
Gallstones are pieces of solid material that form in the gallbladder, a small organ under the liver. The medical term for this condition is cholelithiasis.
The gallbladder’s function involves both storing and releasing bile, a digestive fluid produced by the liver that aids in digestion. Bile also carries cholesterol and waste substances out of the liver, such as bilirubin (a byproduct of red blood cell breakdown). Gallstones may form when there is an imbalance in the composition of bile, leading to the accumulation of cholesterol or bilirubin particles.
Gallstones can vary in size, ranging from tiny particles resembling grains of sand to larger formations comparable to golf balls. They can occur as a single large stone or multiple smaller ones. Some individuals may have a combination of both large and small gallstones. Often, the presence of gallstones goes unnoticed until one or more obstructs a bile duct, leading to the pain.
What causes gallstones, and what are the types of gallstones?
Gallstones form when substances in bile, a fluid produced by the liver to aid digestion, become hardened and crystallized. The two main types of gallstones are cholesterol stones and pigment stones.
When bile contains too much cholesterol and not enough bile salts to keep it dissolved, cholesterol can form crystals and eventually gallstones. These stones are usually yellow-green in colour as they are made of undissolved cholesterol.
Pigment stones are primarily made of bilirubin, a waste product formed from the breakdown of red blood cells. These are brown or black. Liver conditions that increase bilirubin production can contribute to pigment stone formation. These conditions are cirrhosis, biliary tract infections, and haemolytic anaemias.
What are the risk factors for gallstones?
The suggested risk factors for gallstones include:
- Obesity: Obesity is a major risk factor, particularly in women.
- Excess oestrogen: Excess oestrogen from pregnancy, hormone replacement therapy, or birth control pills can increase cholesterol levels in bile and decrease gallbladder movement, leading to gallstones.
- Gender: Women are twice as likely as men to develop gallstones.
- Age: People over 60 are more prone to gallstones compared to younger individuals.
- Cholesterol-lowering drugs: Cholesterol-lowering drugs can increase cholesterol secretion in bile, raising the risk of gallstones.
- Diabetes: Individuals with diabetes often have high levels of triglycerides, increasing the risk for gallstones.
- Rapid weight loss: Rapid weight loss causes the liver to secrete extra cholesterol into bile, potentially causing gallstones
What are the symptoms of gallstone?
Gallstones generally do not cause any symptoms unless they become stuck and block the passage. This blockage results in symptoms, mainly characterized by discomfort in the upper abdomen and feelings of nausea. These symptoms can occur on and off or persistently. In instances of a severe or prolonged blockage, other symptoms may arise. In the case of a severe or prolonged blockage, additional symptoms may manifest, such as:
- excessive perspiration
- elevated body temperature
- rapid heartbeat
- abdominal swelling and tenderness
- yellowish hue in the skin and eyes
- dark urine and pale stools
How is the pain from gallstones typically described?
The pain caused by gallstones is often described as a sudden and intense cramping or stabbing sensation in the upper right abdomen, usually occurring after a meal, especially one high in fat. This pain can radiate to the back or right shoulder blade and may last for anywhere from 15 minutes to several hours. The pain can wake up an individual from the sleep.
How are gallstones diagnosed?
The doctor will perform a physical exam and might order tests including:
- Blood tests: These check for signs of infection or blockage and rule out other conditions.
- Abdominal ultrasound: This makes images of the inside of the body. The pictures can show gallstones outside of the bile duct or signs of gallbladder inflammation.
- CT scan: A CT scan is a diagnostic imaging procedure that combines X-rays and computer technology to produce detailed cross-sectional images of the body. This technique provides highly detailed images of different body parts, including bones, muscles, fat, and organs, than the level of detail provided by traditional X-rays.
- Magnetic resonance cholangiopancreatography (MRCP): This test utilizes a combination of magnetic fields and radio waves to generate detailed images of internal organs like the liver and gallbladder. This non-invasive diagnostic test provides clear visualization of the biliary and pancreatic ducts, aiding in detecting conditions such as gallstones, biliary strictures, and pancreatic disorders.
- Cholescintigraphy (HIDA scan): This examination can check the proper functioning of the gallbladder. The doctor injects a radioactive tracer, which travels to the gallbladder. Subsequently, a technician can observe its motion. This procedure aids in distinguishing between cholecystitis (inflammation of the gallbladder), gallbladder obstruction and gallstones.
- Endoscopic retrograde cholangiopancreatography (ERCP). A viewing tube called an endoscope is passed through the stomach and into the small intestine to visualize the ducts of the biliary system by injecting a specialized dye.
- Endoscopic ultrasound. This test combines ultrasound and endoscopy to identify gallstones in hard-to-see areas, like the common bile duct passing through the pancreas, which may not be visible with other imaging methods.
What is the treatment for gallstones?
Treatment of gallstones depends on the age, overall health, medical history, and severity of the condition of an individual. If gallstone causes no symptoms, treatment is not necessary; however, when the pain persists, treatment may include:
Medications: Certain medications may be prescribed to dissolve cholesterol gallstones, particularly if surgery is not an option or if the patient prefers nonsurgical treatment. These medications, such as ursodeoxycholic acid (UDCA), dissolve cholesterol in bile over several months to years. However, they are typically less effective for larger stones and may not prevent recurrence once treatment is stopped.
Laparoscopic cholecystectomy: The most common and effective treatment for symptomatic gallstones is surgical removal of the gallbladder, known as laparoscopic cholecystectomy. In this minimally invasive procedure, small incisions are made in the abdomen, and a tiny camera and surgical instruments are used to remove the gallbladder. This procedure is associated with faster recovery times and fewer complications compared to traditional open surgery.
Endoscopic Retrograde Cholangiopancreatography (ERCP): In cases where gallstones have migrated into the bile ducts and are causing complications such as obstruction or pancreatitis, an endoscopic procedure called ERCP may be performed. During ERCP, a flexible tube with a camera (endoscope) is inserted through the mouth and guided into the bile ducts. Specialized instruments can then be used to remove or crush gallstones, or a stent may be placed to relieve obstruction.
Extracorporeal Shock Wave Lithotripsy (ESWL): This non-invasive procedure may be used to break up gallstones into smaller pieces that can be passed naturally through the bile ducts without causing blockages.
How gallstone formation can be prevented?
Lowering the risk of gallstones can be achieved by following a healthy eating plan and engaging in regular physical activity to reach and maintain a healthy weight.
- Increase intake of fiber-rich foods, including fruits, vegetables, beans, and peas.
- Incorporate whole grains into diet, such as brown rice, oats.
- Reduce consumption of refined carbohydrates and sugar.
- Include healthy fats in meals, such as fish oil and olive oil, to promote regular contraction and emptying of the gallbladder.
- Avoid unhealthy fats commonly found in desserts and fried foods.
In summary, gallstones are solid particles that form in the gallbladder, a small organ located beneath the liver. These stones can vary in size and composition, with the two main types being cholesterol stones and pigment stones. While some people with gallstones may not experience any symptoms, others may develop pain and discomfort in the upper abdomen, particularly after eating fatty foods. This pain can be intense and may be accompanied by nausea, vomiting, and jaundice if the gallstone blocks the bile duct. Diagnostic tests such as ultrasound and ERCP can help confirm the presence of gallstones and assess any associated complications. Treatment options for gallstones depend on factors such as the severity of symptoms and the presence of complications. In many cases, surgical removal of the gallbladder, known as laparoscopic cholecystectomy, is recommended to prevent future gallstone-related problems. Other treatment options include medications to dissolve gallstones or procedures such as ERCP or ESWL to remove or break up stones.
References
- Johns Hopkins Medicine. Gallstones Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/gallstones. Accessed on May 10th, 2024
- Cleveland Clinic. Gallstones. Available from: https://my.clevelandclinic.org/health/diseases/7313-gallstones. Accessed on May 10th, 2024
- Gallstones (Cholelithiasis): What Are They? Available from: https://www.webmd.com/digestive-disorders/gallstones. Accessed on May 10th, 2024
- National Institute of Diabetes and Digestive and Kidney Diseases. Gallstones. Available from: https://www.niddk.nih.gov/health-information/digestive-diseases/gallstones#:~:text=Gallstones%20are%20hard%2C%20pebble%2Dlike,untreated%2C%20they%20can%20cause%20complications. Accessed on May 10th, 2024