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Gallstones

Introduction

Gallstones are hard deposits of digestive fluid formed inside the gallbladder. Your gallbladder is a small, pear-shaped organ located just behind your liver. On the right side of your abdomen, the gallbladder stores bile, then discharged into the small intestine. Gallstones can be the size of a grain of sand or a golf ball. Some people only have one gallstone, whereas others develop multiple gallstones simultaneously. Gallstones that don't cause any symptoms don't usually require the immediate need to be treated.

Epidemiology

Gallstones aren't known to have a cause. Gallstones are thought to form when:

Too much Cholesterol in Your Bile.  Your bile contains enough chemicals to break down the cholesterol released by your liver. If your liver excretes more cholesterol than your bile can break down, the excess cholesterol can crystallize and form stones.

Too Much Bilirubin in Your Bile. Bilirubin is a chemical produced by your body when red blood cells are broken down. Cirrhosis of the liver, biliary tract infections, and some blood disorders cause your liver to produce excess bilirubin, which may develop Gallstones.

Your Gallbladder is not Emptying Properly. Bile can get very concentrated if your gallbladder isn't emptying entirely or frequently enough, which can lead to gallstone formation.

Types

Gallstones are divided into two types: 

Cholesterol Gallstones:  These are the most common type of gallstones. Gallstones are mainly yellow and made of undissolved cholesterol but may contain other substances unrelated to blood cholesterol levels. The majority of the time, CT scans do not reveal them.

Pigment Gallstones:  They are comprised of bilirubin and are also known as bilirubin stones which are dark brown or black. They develop when red blood cells are destroyed, and the bile contains too much bilirubin.

Signs and Symptoms

Gallstones can appear without causing any symptoms. It is usually identified during a standard x-ray, ultrasound, abdominal surgery, or other medical procedure. A cramping ache in the middle to the right upper abdomen may occur if a multiple stone plugs a tube or duct drains the gallbladder. Biliary colic is the medical term for this. If the stone passes through the first part of the small intestine, the pain goes away. The following signs and symptoms may occur if a gallstone deposits in a duct and causes a blockage:

  • Rapid sharp or dull pain in the correct upper or middle abdomen for at least 30 minutes could be persistent or cramping
  • Fever with chills
  • Yellow discoloration of the sclera( white portion) of eyes and skin (jaundice)
  • Clay-colored stools
  • Vomiting and nausea
  • Back pain between your shoulder blades

Risk Factors

Gallstones are more prone to develop if you have the following factors:

  • Transplantation of solid organ or bone marrow
  • Diabetes
  • Being a woman
  • Being a Native American and being beyond the age of 40
  • Being a Mexican-born Hispanic who is overweight or obese
  • Sedentary lifestyle
  • Eating a high-fat diet while pregnant
  • Eating a high-cholesterol diet
  • Consumption of a low-fiber diet
  • Having a history of gallstones in your family
  • Have Sickle cell anemia or leukemia
  • Having a liver problem
  • Gallbladder failure to drain bile appropriately
  • Billary tract infections and liver cirrhosis
  • Medical conditions that destroy red blood cells

Rapid weight reduction results from a highly low-calorie diet or weight loss surgery.

Intravenous feedings:  Receiving nutrients  through the vein for an extended period

Using contraceptive pills

Diagnosis

The following tests and procedures are used to identify gallstones and related complications:

Ultrasound Abdomen: This is the most common test for detecting signs of gallstones.

Endoscopic Ultrasound (EUS): This method can assist detect tiny stones that an abdominal ultrasound may miss.

Gallbladder Radionuclide Scan is a test that examines gallbladder function using radioactive material. It's also used to check for bile duct obstructions or leaks.

Magnetic Resonance Cholangiopancreatography (MRCP): The biliary and pancreatic ducts are visualized non-invasively using magnetic resonance imaging. This test can see if gallstones are trapped in any ducts surrounding the gallbladder.

Percutaneous Transhepatic Cholangingram(PTCA) is an x-ray test that can show whether the liver or the bile ducts that drain it are blocked.

Blood Tests:  Gallstones can lead to infection, jaundice, pancreatitis, and other complications, all of which can be diagnosed using blood tests such as:

  • Bilirubin Tests
  • Liver Function Tests (Hepatic Function Panel)
  • Complete Blood Count (CBC)
  • Pancreatic Enzyme (Amylase)

Complications

Gallstones can induce swelling or infection in the following areas:

  • Gallbladder (cholecystitis)
  • Bile duct tube (cholangitis)
  • Pancreas (pancreatitis)

Treatment

Gallstones that don't cause any symptoms might not need to be treated. Your doctor will decide whether or not you need gallstone treatment based on your symptoms and the results of diagnostic tests. Gallstones can be treated in a variety of ways, including:

Cholecystectomy: Your doctor may prescribe surgery to remove your gallbladder because gallstones frequently recur. After surgical removal of the gallbladder, the bile flows directly from your liver into your small intestine instead of being stored in the gallbladder. You don't need your gallbladder to live, and removing it does not affect your ability to digest food. On the other hand, gallbladder removal can cause diarrhea, usually only temporary.

Lithotripsy: For those who cannot undergo surgery, s the gallbladder's shock wave lithotripsy (ESWL) s also used. As gallstones often reappear, thus this procedure isn't utilized as frequently as it formerly was.

Medications

Gallstones can be dissolved with the help of oral medicines. However, this procedure may take months or years to clear your gallstones completely, and if treatment is stopped, gallstones will most certainly develop again. Medication isn't always practical. Gallstones medications are rarely used and are only prescribed to people who cannot have their gallstones removed surgically.

Prevention

You can lower your risk of developing gallstones if you do the following:

Don't Forget to Eat your Meals:  Make an effort to eat at the same time every day. Gallstones can be exacerbated by skipping meals or fasting.

Reduce Weight Slowly: Do it gradually if you're trying to reduce weight. Gallstones can be exacerbated by rapid weight loss.

Increase your Intake of High-Fiber Foods: Increase your intake of fiber-rich foods like fruits, vegetables, and whole grains.

Maintain a Healthy Body Mass Index (BMI): Obese or overweight people are more likely to develop gallstones. To achieve a healthy weight, reduce your calorie intake and increase your physical activity. Maintain a healthy weight by eating a well-balanced diet and exercising regularly once you've achieved it.

Prognosis

Following treatment, you may need to follow a liquid diet or make other efforts to rest your gallbladder. When you leave the hospital, your provider will give you instructions. Gallstones surgery has a low risk of causing symptoms or complications. Almost everyone who has gallbladder surgery does not experience a recurrence of symptoms.

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