Gallstones
What is it?
Gallstones are small, hard deposits, primarily made
up of cholesterol, calcium salts, and bile pigments
called bilirubin, that form in the gallbladder. The
gallbladder is a small, muscular, pear-shaped organ
located under the liver. The gallbladder stores a
greenish-yellow fluid secreted by the liver, called
bile, until it is needed to help the body digest and
absorb fats. When needed, bile flows from the
gallbladder into the small intestine through a passage
called the common bile duct, part of a series of bile
ducts. Gallstones can also form in or pass into the
bile ducts. Gallstones in the gallbladder are called
cholelithiasis. Gallstones in the common bile duct are
called choledocholithiasis, or common-duct stones.
Who gets it?
Gallstones are a common gallbladder problem.
Gallstones usually occur in adults between the ages of
20 and 50, and are more common in women in this age
group. However, the risk for developing gallstones in
both men and women increases with age. They are most
common in Native Americans. People who are obese, have
a family history of gallstones, consume a diet high in
fats, or have high levels of estrogen or insulin are at
a higher risk for gallstones.
What causes it?
Normally, bile contains dissolved cholesterol.
However, if the bile contains too much cholesterol, it
is unable to dissolve it all and the excess cholesterol
crystallizes. These tiny crystals move around in the
gallbladder, gradually joining together to form
gallstones. Sometimes gallstones form because the
gallbladder is not functioning as it should. Conditions
that contribute to gallstones include diseases such as
diabetes, celiac disease, pancreatitis, or coronary
artery disease; rapid weight loss; high estrogen levels
from pregnancy or birth control pills; alcoholism;
smoking; and obesity.
What are the symptoms?
In many cases, gallstones are so small that they
cause no symptoms. Larger gallstones can get stuck in a
bile duct, where they obstruct the passageway and can
cause infection. When gallstones do cause symptoms,
they often follow a high-fat meal, begin suddenly, and
include severe abdominal pain, which can spread to the
back, chest, or between the shoulder blades, as well as
belching, indigestion, heartburn, and gas. Pain usually
lasts anywhere from minutes to several hours. A
gallstone blocking a bile duct may cause nausea,
vomiting, chills, and fever, which is a sign of
infection. A yellowish tone to the skin and whites of
the eyes is called jaundice and is a sign that
infection has progressed to the liver. An excess of the
bile pigments called billirubin causes jaundice. If a
gallstone blocks the duct that connects the gallbladder
with the common bile duct, called the cystic duct, the
gallbladder can become inflamed. This condition is
called cholecystitis, and causes symptoms including
fever and upper right side abdominal and shoulder pain.
If a larger gallstone enters the small intestine, it
can block the entrance to the large intestine and
create a condition called gallstone ileus, which must
be corrected with surgery. Severe pain, high fever, and
jaundice require immediate medical attention. A severe
infection can cause the gallbladder to burst, which can
result in death.
How is it diagnosed?
Gallstones are diagnosed through a thorough physical
examination and a series of diagnostic tests. Your
doctor will examine your abdomen for tenderness and
swelling and look for signs of jaundice in your eyes
and skin. Diagnostic tests include blood tests,
ultrasound scans, and x-rays of the gallbladder called
cholecystograms. A dye test called endoscopic
retrograde cholangiopancreatoscopy (ERCP) or a
radioisotopic scan may be necessary to diagnose
gallstones in the bile ducts.
What is the treatment?
Gallstones that cause no symptoms require no
treatment. If you have had just one gallstone attack or
have occasional mild attacks, your doctor may recommend
following a low-fat, high fiber diet to prevent further
episodes. Recurring attacks are treated by surgically
removing the gallbladder, called a cholecystectomy. In
many cases, cholecystectomies can be performed with
laparoscopic surgery. The surgeon makes a small
incision in the abdomen and inserts the laparoscope.
The laparoscope is like a tiny video camera that gives
the surgeon a clear view of the abdominal area. Other
small incisions are made to insert tubes used to remove
the gallbladder. You may need additional surgery to
remove gallstones in the bile ducts. The same procedure
used to diagnose gallstones in the bile ducts,
endoscopic retrograde cholangiopancreatoscopy (ERCP),
can be used to remove bile duct gallstones without an
incision. In simple terms, a flexible viewing tube
called an endoscope is inserted into the mouth, where
it can be passed down into the small intestine. A small
tube called a catheter is passed through the endoscope
and into the common bile duct. A dye injected into the
catheter fills the bile ducts and reveals any stones.
After the stones are located, they can be removed
through another tube passed through the endoscope.
Gallstones can also be destroyed by dissolving them
with ursodeoxycholic acid, also called bile salt
therapy. This oral medication that can take anywhere
from months to years to dissolve the stones and is more
effective with small gallstones. This medication can
also be injected directly into the gallbladder through
a catheter inserted in the abdomen. This procedure is
called contact dissolution. However, the only way to
prevent gallstone recurrence is by surgically removing
the gallbladder. The digestive system can function
normally without the gallbladder.
Self-care tips
You can help prevent gallstones by maintaining a
healthy weight and lifestyle, including a low fat,
high-fiber diet, and exercise. Do not consume large
amounts of alcohol, and avoid smoking.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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