Gallstones

Cholesterol Gallstones

• Most common type (80% of gallstones)
• Yellow-green in color
• Composed mainly of hardened cholesterol
• Form when bile contains too much cholesterol
• Not related to blood cholesterol levels

Pigment Gallstones

• Dark brown or black stones
• Made of bilirubin
• More common in people with:
  • Liver cirrhosis
  • Biliary tract infections
  • Hereditary blood disorders (sickle cell anemia)

Mixed Stones

Contain both cholesterol and pigment components, accounting for about 20% of gallstones.

Silent Gallstones

About 80% of people with gallstones have "silent stones" that cause no symptoms and are often discovered incidentally during imaging for other conditions.

Gallbladder Attack (Biliary Colic)

When a gallstone blocks a bile duct, it causes sudden and intense pain:

• Location: Right upper or center abdomen
• Duration: 30 minutes to several hours
• Character: Steady, severe pain
• Timing: Often after fatty meals
• Associated symptoms:
  • Nausea and vomiting
  • Pain between shoulder blades
  • Right shoulder pain
  • Indigestion
  • Belching

Complications Symptoms

Seek immediate medical attention for:

• Acute cholecystitis:
  • Prolonged pain (>5 hours)
  • Fever and chills
  • Tenderness over gallbladder
• Choledocholithiasis:
  • Jaundice (yellow skin/eyes)
  • Dark urine
  • Clay-colored stools
  • Itching
• Pancreatitis:
  • Severe abdominal pain radiating to back
  • Fever
  • Rapid pulse
  • Oily stools

Formation Mechanisms

• Bile imbalance: Too much cholesterol or bilirubin
• Gallbladder emptying problems: Incomplete or infrequent emptying
• Bile concentration: Becomes too concentrated

Major Risk Factors (The "5 F's")

• Female: Women 2x more likely than men
• Forty: Risk increases with age
• Fertile: Pregnancy increases risk
• Fat: Obesity major risk factor
• Family history: Genetic predisposition

Additional Risk Factors

• Diet:
  • High-fat, high-cholesterol diet
  • Low-fiber diet
  • Rapid weight loss
  • Prolonged fasting
• Medical conditions:
  • Diabetes
  • Metabolic syndrome
  • Crohn's disease
  • Cirrhosis
• Medications:
  • Hormone replacement therapy
  • Birth control pills
  • Cholesterol-lowering drugs
• Ethnicity: Higher in Native Americans and Mexican Americans

Physical Examination

• Murphy's sign: Pain when pressing on gallbladder area
• Abdominal tenderness
• Jaundice assessment
• Fever check

Imaging Tests

• Abdominal ultrasound:
  • First-line imaging test
  • 95% accurate for gallstones
  • Shows gallbladder inflammation
• CT scan:
  • Better for complications
  • Shows bile duct stones
• HIDA scan:
  • Assesses gallbladder function
  • Diagnoses acute cholecystitis
• MRCP:
  • Detailed bile duct imaging
  • Non-invasive
• Endoscopic ultrasound:
  • For small stones
  • Very accurate

Blood Tests

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

Observation

For asymptomatic gallstones:

• No treatment needed
• Regular monitoring
• Lifestyle modifications
• Watch for symptom development

Surgical Treatment

Laparoscopic Cholecystectomy

• Gold standard treatment
• Minimally invasive
• 4 small incisions
• Same-day or overnight stay
• Recovery: 1-2 weeks
• Success rate: >95%

Open Cholecystectomy

• For complicated cases
• Larger incision
• Hospital stay: 3-5 days
• Recovery: 4-6 weeks

Non-Surgical Options

• Ursodeoxycholic acid (UDCA):
  • Dissolves cholesterol stones
  • Only for small stones
  • Takes months to years
  • High recurrence rate
• ERCP with sphincterotomy:
  • For bile duct stones
  • Endoscopic procedure
  • May avoid surgery
• Shock wave lithotripsy:
  • Rarely used
  • Breaks up stones
  • Limited effectiveness

Pain Management

• NSAIDs for mild pain
• Stronger pain medications for severe attacks
• Antispasmodics
• Anti-nausea medications

Immediate Post-Surgery

• Most people function normally without gallbladder
• Bile flows directly from liver to intestines
• May have temporary digestive changes

Dietary Adjustments

• First few weeks:
  • Low-fat diet
  • Small, frequent meals
  • Avoid greasy foods
  • Gradually increase fiber
• Long-term:
  • Most can return to normal diet
  • Some may need to limit fatty foods
  • Maintain healthy weight

Potential Post-Surgery Issues

• Diarrhea: Usually temporary
• Bloating and gas: May persist in some
• Bile reflux: Rare complication
• Postcholecystectomy syndrome: Persistent symptoms

Dietary Strategies

• Maintain healthy weight
• Avoid crash diets
• Eat high-fiber foods
• Choose healthy fats (olive oil, fish)
• Limit saturated fats
• Regular meal schedule

Lifestyle Modifications

• Regular physical activity
• Gradual weight loss if needed (1-2 lbs/week)
• Stay hydrated
• Limit alcohol consumption
• Manage diabetes if present

Medical Management

• Review medications with doctor
• Consider alternatives to high-risk drugs
• Regular check-ups if high risk
• Preventive UDCA in specific cases

• Acute cholecystitis: Gallbladder inflammation
• Chronic cholecystitis: Long-term inflammation
• Choledocholithiasis: Bile duct stones
• Cholangitis: Bile duct infection
• Gallstone pancreatitis: Pancreas inflammation
• Gallbladder cancer: Rare but serious
• Perforation: Gallbladder rupture
• Fistula formation: Abnormal connections
• Gallstone ileus: Intestinal obstruction

The outlook for gallstones is generally excellent with appropriate treatment:

• Silent gallstones may never cause problems
• Surgery has >95% success rate
• Most people live normally without gallbladder
• Complications are preventable with timely treatment
• Recurrence after surgery is impossible
• Quality of life typically improves after treatment

Early recognition and treatment of symptomatic gallstones prevents serious complications. With modern surgical techniques, most people recover quickly and completely from gallbladder removal.