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Gallstones (Cholelithiasis) Everything You Should to Know

Understanding Gallstones: Types, Pain, and More

Gallstones (Cholelithiasis) Everything You Should to Know

Gallstones are hardened deposits of digestive fluid that can form in your gallbladder. Your gallbladder is a small, pear-shaped organ on the right side of your abdomen, just beneath your liver. The gallbladder holds a digestive fluid called bile that’s released into your small intestine.

The gallbladder is a small sac located on the right-hand side of the body, on the underside of the liver. Some of the chemicals that exist in the gallbladder can solidify into either one large stone or several small ones.

Gallstones range in size from as small as a grain of sand to as large as a golf ball. Some people develop just one gallstone, while others develop many gallstones at the same time.

People who experience symptoms from their gallstones usually require gallbladder removal surgery. Gallstones that don’t cause any signs and symptoms typically don’t need treatment.

The gallbladder stores and releases bile to help digest fats. Gallstones, stone-like objects often made of cholesterol or bilirubin, can develop in the gallbladder or bile ducts. These stones can cause pain and other complications. Treatment options often involve minimally invasive surgery to remove the gallstones, and sometimes the gallbladder.

What Are Gallstones?

Gallstones are pieces of solid material that form in your gallbladder, a small organ under your liver. If you have them, you might hear your doctor say you have cholelithiasis.

Your gallbladder stores and releases bile, a fluid made in your liver, to help in digestion. Bile also carries wastes like cholesterol and bilirubin, which your body makes when it breaks down red blood cells. These things can form gallstones.

Gallstones can range from the size of a grain of sand to that of a golf ball. You might not know that you have them until they block a bile duct, causing pain that needs treatment right away.

Gallstone Types

The two main kinds of gallstones are:

  • Cholesterol stones. These are usually yellow-green. They’re the most common, making up 80% of gallstones.
  • Pigment stones. These are smaller and darker. They’re made of bilirubin.

Risk Factors

Factors that may increase your risk of gallstones include:

  • Being female
  • Being age 40 or older
  • Being a Native American
  • Being a Hispanic of Mexican origin
  • Being overweight or obese
  • Being sedentary
  • Being pregnant
  • Eating a high-fat diet
  • Eating a high-cholesterol diet
  • Eating a low-fiber diet
  • Having a family history of gallstones
  • Having diabetes
  • Having certain blood disorders, such as sickle cell anemia or leukemia
  • Losing weight very quickly
  • Taking medications that contain estrogen, such as oral contraceptives or hormone therapy drugs
  • Having liver disease

What Are the Symptoms of Gallstones?

At first, most gallstones do not cause symptoms. However, when gallstones become larger, or when they begin obstructing bile ducts, symptoms or “attacks” begin to occur. Attacks of gallstones usually occur after a fatty meal and at night. The following are the most common symptoms of gallstones. However, each individual may experience symptoms differently. Symptoms may include:

  • Steady, severe pain in the upper abdomen that increases rapidly and may last from 30 minutes to several hours
  • Pain in the back between the shoulder blades
  • Pain in the right shoulder
  • Nausea
  • Vomiting
  • Fever
  • Chills
  • Jaundice. A yellowing of the skin or eyes.
  • Abdominal bloating
  • Intolerance of fatty foods
  • Belching or gas
  • Indigestion

People who experience the following symptoms should consult their doctor immediately:

  • Sweating
  • Chills
  • Low-grade fever
  • Yellowish color of the skin or whites of the eyes
  • Clay-colored stools

Some people with gallstones do not have any symptoms. These stones are called “silent stones,” because they do not interfere with the function of the gallbladder, liver, or pancreas, and do not require treatment in most cases.

The symptoms of gallstones may resemble other conditions or medical problems, such as heart attack, appendicitis, ulcers, irritable bowel syndrome, hiatal hernia, pancreatitis, or hepatitis. Always consult your health care provider for a diagnosis.

Causes of Gallstones

Doctors aren’t sure exactly what causes gallstones, but they might happen when:

  • There’s too much cholesterol in your bile. Your body needs bile for digestion. It usually dissolves cholesterol. But when it can’t do that, the extra cholesterol might form stones.
  • There’s too much bilirubin in your bile. Conditions like cirrhosis, infections, and blood disorders can cause your liver to make too much bilirubin.
  • Your gallbladder doesn’t empty all the way. This can make your bile very concentrated.

How They’re Diagnosed

Your doctor will perform a physical examination that includes checking your eyes and skin for visible changes in color. A yellowish tint may be a sign of jaundice, the result of too much bilirubin in your body.

The exam may involve using diagnostic tests that help your doctor see inside your body. These tests include:

Ultrasound: An ultrasound produces images of your abdomen. It’s the preferred imaging method to confirm that you have gallstone disease. It can also show abnormalities associated with acute cholecystitis.

Abdominal CT scan: This imaging test takes pictures of your liver and abdominal region.

Gallbladder radionuclide scan: This important scan takes about one hour to complete. A specialist injects a radioactive substance into your veins. The substance travels through your blood to the liver and gallbladder. On a scan, it can reveal evidence to suggest infection or blockage of the bile ducts from stones.

Blood tests: Your doctor may order blood tests that measure the amount of bilirubin in your blood. The tests also help determine how well your liver is functioning.

Endoscopic retrograde cholangiopancreatography (ERCP): ERCP is a procedure that uses a camera and X-rays to look at problems in the bile and pancreatic ducts. It helps your doctor look for gallstones stuck in your bile duct.

Treatment

Gallstones are only treated if they have caused gallbladder inflammation, blockage of the bile ducts, or if they have moved from the bile ducts into the intestines.

Cholecystectomy

Cholecystectomy means the surgical removal of the gallbladder. This is usually performed with keyhole surgery. Keyhole surgery is not possible for about 10 percent of people who need open cholecystectomy. They will have open surgery instead.

With open cholecystectomy, a large cut is made in the abdomen. People who undergo open surgery require a longer hospital stay and recovery time. If a gallbladder is severely inflamed, open surgery will be needed.

For a large proportion of those who undergo a cholecystectomy, gallstones come back within a year. To help prevent this, many people with gallstones are given ursosdeoxycholic acid, which is the acid found in bile.

Ursosdeoxycholic acid lowers the cholesterol content of bile, making it less likely that stones will form.

Ursodeoxycholic acid

If the gallstone is made of cholesterol, it can sometimes be slowly dissolved with ursodeoxycholic acid. This type of treatment, known as dissolution, may take up to 24 months to be effective. It is not as effective as surgery but is sometimes the only choice for people who cannot have a general anesthetic.

Endoscopic retrograde cholangiopancreatolography

When a person with gallstones cannot have surgery or ursodeoxycholic acid, they may undergo endoscopic retrograde cholangiopancreatolography (ERCP), which requires a local anesthetic. A flexible fiber-optic camera, or endoscope, goes into mouth, through the digestive system, and into the gallbladder.

An electrically heated wire widens the opening of the bile duct. The stones are then removed or left to pass into the intestine.

Lithotripsy

Ultrasonic shock waves are aimed at the gallstones, which break them up. If gallstones become small enough, they can then pass safely in the stools. This type of treatment is uncommon and is only used when there are few gallstones present.

Prevention

Some factors that increase the risk of developing galls tones, such as age, sex, and ethnic origin, cannot be altered.

However, it is possible that following a vegetarian diet may reduce the risk of developing gallstones. Vegetarians have a significantly lower risk of developing gallstones, compared with people who eat meat.

Many experts say that a diet low in fat and high in fruit and vegetables, including plenty of dietary fiber, may help protect people from developing gall stones.

Controlling bodyweight may also help prevent the formation of gallstones. However, crash dieting and rapid weight loss increase the risk of developing gallstones. Moderation is advised.

Some lifestyle changes might lower your risk of gall stones.

  • Eat a healthy diet that’s high in fiber and good fats, like fish oil and olive oil. Avoid refined carbs, sugar, and unhealthy fats.
  • Get regular exercise. Aim for at least 30 minutes, 5 days a week.
  • Avoid diets that make you lose a lot of weight in a short time.
  • If you’re a woman at high risk of gall stones (for example, because of your family history or another health condition), talk to your doctor about whether you should avoid the use of hormonal birth control.
  • Don’t skip meals. Try to stick to your usual mealtimes each day. Skipping meals or fasting can increase the risk of gallstones.
  • Lose weight slowly. If you need to lose weight, go slow. Rapid weight loss can increase the risk of gallstones. Aim to lose 1 or 2 pounds (about 0.5 to 1 kilogram) a week.
  • Eat more high-fiber foods. Include more fiber-rich foods in your diet, such as fruits, vegetables and whole grains.
  • Maintain a healthy weight. Obesity and being overweight increase the risk of gallstones. Work to achieve a healthy weight by reducing the number of calories you eat and increasing the amount of physical activity you get. Once you achieve a healthy weight, work to maintain that weight by continuing your healthy diet and continuing to exercise.

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