Gallstones

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. Most gallstones don't cause any symptoms and don't need treatment. However, if a gallstone lodges in a duct and causes a blockage, the resulting signs and symptoms may include sudden and rapidly intensifying pain.

The gallbladder stores bile, a greenish-brown fluid that helps with digestion. Most gallstones form when there's too much cholesterol in the bile. Other types form when there's too much bilirubin in the bile or when the gallbladder doesn't empty properly.

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 good news is that you can live normally without your gallbladder, as bile can flow directly from your liver to your small intestine.

Many people with gallstones have no symptoms at all. These are called "silent" gallstones. When symptoms do occur, they may include:

Primary Symptoms

• Biliary colic: Sudden and intense sharp abdominal pain in the upper right portion of your abdomen
• Pain in the center of your abdomen, just below your breastbone (upper abdominal pain)
• Pain that spreads to your right shoulder or between shoulder blades (back pain)
• Pain lasting several minutes to a few hours
• Pain occurring after fatty meals

Associated Symptoms

• Nausea and vomiting
• Heartburn and indigestion
• Burning abdominal pain
• Bloating and gas
• Side pain on the right
• Pain in the lower body

Complications Symptoms

• Fever and chills (indicating infection)
• Yellowing of skin and eyes (jaundice)
• Clay-colored stools
• Dark urine
• Persistent severe pain
• Sharp chest pain (referred pain)

When to Seek Emergency Care

Seek immediate medical attention if you have:

• Abdominal pain so intense that you can't sit still
• Yellowing of your skin and the whites of your eyes
• High fever with chills
• Persistent vomiting

It's not clear what causes gallstones to form. Doctors think gallstones may result when:

Bile Chemistry Imbalances

• Too much cholesterol: Normally, bile contains enough chemicals to dissolve cholesterol. But if your liver excretes more cholesterol than your bile can dissolve, the excess may form into crystals and eventually stones.
• Too much bilirubin: Bilirubin is produced when your body breaks down red blood cells. Certain conditions cause your liver to make too much bilirubin, including liver cirrhosis, biliary tract infections, and certain blood disorders.
• Concentrated bile: If your gallbladder doesn't empty completely or often enough, bile may become very concentrated, contributing to gallstone formation.

Factors that may increase your risk of gallstones include:

Demographic Factors

• Female gender: Women are twice as likely to develop gallstones
• Age over 40: Risk increases with age
• Native American or Mexican heritage: Higher genetic predisposition
• Family history: Gallstones often run in families

Medical Conditions

• Obesity or being overweight
• Diabetes
• Liver disease
• Crohn's disease
• Sickle cell anemia
• High cholesterol
• High triglycerides
• Low HDL cholesterol

Lifestyle Factors

• Diet high in fat and cholesterol: Increases cholesterol in bile
• Diet low in fiber: May increase risk
• Rapid weight loss: Causes liver to secrete extra cholesterol
• Sedentary lifestyle: Lack of physical activity
• Pregnancy: Hormonal changes increase risk
• Hormone therapy: Estrogen increases cholesterol in bile
• Birth control pills: May increase risk

Complications of gallstones may include:

Gallbladder Complications

• Acute cholecystitis: Inflammation of the gallbladder when a stone blocks the cystic duct
• Chronic cholecystitis: Long-term inflammation from repeated episodes
• Empyema: Pus in the gallbladder
• Gangrene: Tissue death in the gallbladder
• Perforation: Hole in the gallbladder wall

Bile Duct Complications

• Choledocholithiasis: Stones in the common bile duct
• Cholangitis: Infection of the bile ducts
• Biliary obstruction: Blockage preventing bile flow
• Jaundice: Yellowing from bile backup

Other Complications

• Pancreatitis: Inflammation of the pancreas from blocked pancreatic duct
• Gallbladder cancer: Rare but more common in people with gallstones
• Gallstone ileus: Intestinal obstruction from large gallstone

Tests and procedures used to diagnose gallstones and complications include:

Imaging Tests

• Abdominal ultrasound: The most common initial test, highly accurate for gallstones
• CT scan: Can detect complications and stones in bile ducts
• HIDA scan: Traces bile flow to check gallbladder function
• MRCP: Magnetic resonance imaging of bile ducts
• Endoscopic ultrasound: Detects small stones missed by other tests

Blood Tests

• Liver function tests
• Bilirubin levels
• Pancreatic enzymes
• Complete blood count
• C-reactive protein (inflammation marker)

Other Procedures

• ERCP: Can both diagnose and remove bile duct stones
• Cholescintigraphy: Nuclear medicine scan of gallbladder function

Treatment depends on whether gallstones are causing symptoms:

Surgical Treatment

Cholecystectomy (Gallbladder Removal)

• Laparoscopic: Minimally invasive, most common approach
• Open surgery: For complicated cases
• Recovery: Usually same day or overnight for laparoscopic
• Success rate: Permanently cures gallstones

Non-Surgical Options

• Ursodeoxycholic acid: Medication to dissolve cholesterol stones (takes months to years)
• ERCP with sphincterotomy: To remove bile duct stones
• Lithotripsy: Shock waves to break up stones (rarely used)
• Percutaneous drainage: For acute cholecystitis in high-risk patients

Watchful Waiting

• For asymptomatic gallstones
• Regular monitoring
• Lifestyle modifications
• Surgery if symptoms develop

Most people live normal lives without a gallbladder. After surgery:

• Bile flows directly from liver to small intestine
• May have more frequent bowel movements initially
• Some people experience diarrhea (usually temporary)
• Most can eat normally after recovery
• Some benefit from limiting fatty foods initially
• Digestive system usually adapts within weeks

Post-Surgery Diet Tips

• Start with bland, low-fat foods
• Gradually reintroduce other foods
• Keep a food diary to identify triggers
• Eat smaller, more frequent meals
• Stay well hydrated