The gallbladder, a little pear-shaped organ beneath the liver in the right upper abdomen, can develop small, hard deposits known as gallstones or cholelithiasis. Gallstones can range in size from tiny specks to as big as golf balls and are made of calcium, bilirubin, or cholesterol.
Gallstones that do not produce symptoms do not require treatment. However, those causing pain and discomfort may necessitate medical attention and treatment.
What are the symptoms of gallstones?
Some people may have gallbladder stones without knowing it because they may not show any symptoms at all. When symptoms do occur, they may include:
- sudden pain in the upper right abdomen.
- sharp and escalating pain in the middle of the abdomen.
- pain that may radiate to the back or shoulder blade.
- nausea and vomiting.
- jaundice (yellowing of the skin and eyes).
- fever and chills.
- bloating, indigestion, gas, and diarrhea.
What are the types of gallstones?
There are two types of gallstones:
- Cholesterol gallstones: These gallstones are typically yellow. They are made of undissolved cholesterol but could also contain other substances.
- Pigment gallstones: These gallstones are darker and smaller and develop when your bile has an excessive amount of bilirubin.
What are the causes of gallstones?
Gallbladder stones form when there is an imbalance in the composition of bile (a digestive fluid produced by the liver and stored in the gallbladder). Bile is a fluid that contains substances like cholesterol and bilirubin. This fluid can crystalize and create stones when it contains too much cholesterol or bilirubin.
What are the risk factors for gallstones?
Risk factors for developing gallbladder stones include:
- Age: Women are more likely than men to get gallbladder stones,
- Gender: Gallstones are more common in adults over 40.
- Obesity: Being overweight or obese can result in higher cholesterol levels in bile, which raises the risk of gallbladder stones.
- Diet: A diet low in fiber and high in saturated fats can raise the risk of gallbladder stones.
- Rapid weight loss: Gallbladder stones are more likely to form if weight is lost too quickly, whether through crash diets or bariatric surgery.
- Genetics: A family history of gallbladder stones increases the risk of developing them.
- Estrogen: Increased cholesterol levels in bile and decreased gallbladder activity, both of which can result in gallstones, appear to be caused by excess estrogen from pregnancy, hormone replacement medication, or birth control pills.
- Certain medical disorders: Diabetes, liver disease, and inflammatory bowel disease can raise the risk of gallbladder stones.
How are gallstones diagnosed?
During your appointment, the doctor will review your medical history, ask about your symptoms, and perform a physical examination to check for discomfort or swelling in your abdomen.
The following methods are frequently used to identify gallbladder stones:
- Imaging tests: To view the gallbladder and look for stones, imaging tests like an abdominal ultrasound or MRI may be used.
- Blood tests: Blood tests may be performed to assess liver function or look for indications of infection or inflammation.
- Magnetic resonance cholangiopancreatography (MRCP): A magnetic field and radio wave pulses are used in this test to create images of your internal organs, including your liver and gallbladder.
- Endoscopic retrograde cholangiopancreatography (ERCP): The doctor inserts an endoscope (a small, flexible tube) into your mouth and guides it down to your small intestine. They will inject a dye to view your bile ducts and can frequently remove any gallstones that have entered the ducts.
- Endoscopic ultrasound (EUS): This test combines ultrasonography and endoscopy to find gallstones that may be difficult to spot with other imaging techniques, such as in the common bile duct as it travels through the pancreas. During EUS, an endoscope is passed through your mouth and digestive tract.
How are gallstones treated?
The method used to treat gallbladder stones depends on the severity of the symptoms and the risk of complications. Treatment may not be required if gallbladder stones are asymptomatic. If you have persistent or severe symptoms, your doctor may recommend one of the following treatment options:
Some lifestyle modifications can help manage gallbladder stones. This can entail following a low-fat diet, avoiding trigger foods, maintaining a healthy weight, and exercising regularly. Moreover, gallstone production can be reduced by avoiding foods heavy in fat or grease.
To treat gallbladder stone symptoms, your doctor may prescribe medication. Non-steroidal anti-inflammatory medicines (NSAIDs) may be used to treat abdominal pain. If the gallstones are made of cholesterol, certain medications, such as ursodeoxycholic acid (UDCA), may be recommended to dissolve them. However, not all types of gallstones respond well to this treatment, and it can take months or even years for gallstones to dissolve.
Endoscopic procedures may be recommended for the removal of gallstones that are causing symptoms or complications. These procedures include ERCP or percutaneous transhepatic cholangiography (PTC), which involve using a scope to remove or dissolve stones from the bile ducts.
In some cases, cholecystectomy (the surgical removal of the gallbladder) may be recommended. Given that gallstones usually return, your doctor may advise surgically removing your gallbladder. It is the most effective treatment for gallbladder stones and can be performed under general anesthesia through traditional open surgery or minimally invasive laparoscopic surgery.
- During laparoscopic surgery, the doctor will make small incisions and insert a laparoscope through one of the incisions. They will then use specialized tools to remove the gallbladder through another incision. In comparison to open surgery, it typically requires less time for recovery and leaves fewer scars.
- During open surgery, the doctor will make bigger cuts in your abdomen to remove your gallbladder. This technique may be required if you are significantly overweight, pregnant, or have gallbladder disease.
After your gallbladder is removed, bile no longer needs to be stored in your gallbladder and instead flows directly from your liver into your small intestine. Gallbladder removal doesn’t damage your ability to digest food, although it can induce diarrhea, which is typically only temporary.
What are the complications of gallstones?
Gallstones can result in serious issues, such as:
- Gallbladder inflammation. This occurs when a stone prevents your gallbladder from emptying and results in fever and ongoing pain. If you don’t seek treatment immediately, your gallbladder could rupture or burst.
- Blocked bile ducts. This may result in a fever, chills, and jaundice. Your pancreas may get pancreatitis if a stone blocks the duct leading to it.
- Infected bile ducts. An infection is more prone to develop in a clogged duct.
- Gallbladder cancer. Although it is uncommon, gallstones can increase your risk of developing gallbladder cancer.
How are gallstones prevented?
Although gallbladder stones cannot always be prevented, several precautions may lower the risk of getting them. Some preventive measures include:
- Eating a healthy diet high in fiber and low in saturated fats and cholesterol.
- Avoiding skipping meals.
- Losing weight slowly if you are overweight.
- Staying hydrated to encourage healthy bile flow and prevent gallstone formation.
- Exercising regularly to keep your weight in check and encourage healthy digestion.
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