Gall Stones

Introduction

The gallbladder is a pear shaped organ located on the right side of the abdomen, just below the liver. It stores bile fluid which is produced in the liver. Bile fluid contains water, proteins, fats, cholesterol, bile salts and bile pigments, which aid in the digestion of food. The gall bladder releases bile fluid into the intestine through the common bile duct following ingestion of food.

An imbalance in the components that form bile can lead to the formation of gallstones. Gallstones are small, hard deposits that form inside the gallbladder. The size of the gallstone can range from a small grain of sand to a large golf ball.

Gallstones are of two types:

Cholesterol stones: These are yellowish-green in color and chiefly made up of hardened cholesterol.

Pigment stones: These are dark and small, usually present in numbers and primarily made of bilirubin, a yellowish bile pigment.

In some cases, a mix of both gallstone types can be seen.

Causes

The exact cause of gallstones is not clear. However, gallstones can form due to increased amounts of cholesterol or bilirubin; or inadequate emptying of the gallbladder.

The risk factors that increase the chance of having gallstones include:

• Pregnant women and women taking birth control pills or hormone replacement therapy
• Elderly people (>60 years)
• Genetic factors & family history of gallstones
• Ethnic background, esp. native Americans and Mexican-Americans
• Diabetes
• Obesity
• Rapid weight loss
• Use of cholesterol-lowering drugs

Signs and Symptoms

Gallstones do not always cause symptoms, and are sometimes called ‘silent stones’. These are often detected by your physician while diagnosing another condition. However, when the gallstone moves and lodges itself in the bile ducts, it causes signs and symptoms such as:

• Pain in the upper abdomen, upper back, and between the shoulder blades; lasting for several hours
• Nausea & Vomiting
• High fever with chills
• Yellowing of skin and eyes
• Other gastrointestinal problems such as bloating, indigestion, and heartburn

Complications

The complications of gallstones include:

• Blockage of the common bile duct leading to jaundice and infection
• Blockage of the pancreatic duct leading to pancreatitis
• Gallbladder inflammation (cholecystitis)
• Increased risk of gallbladder cancer

Diagnosis

Your physician diagnoses gallstones based on your symptoms, medical history, and physical examination. The diagnosis is confirmed based on findings from imaging studies such as ultrasound, CT (Contrast Tomography), MRI (Magnetic Resonance Imaging), and ERCP (Endoscopic Retrograde Cholangio- Pancreatography) which helps to locate gallstones in the gallbladder as well as bile ducts. Your doctor may also request blood tests to any complications of gallstones.

Treatment

Gallstones without symptoms do not require treatment. Treatment for symptomatic gallstones and its complications includes medications to dissolve the gallstones, and surgery to remove the gall bladder (cholecystectomy).

Medications can help dissolve gallstones but may take several months to years, so this option is reserved only for patients contraindicated to surgery.

The surgical removal of the gallbladder does not cause any serious problems as it is not necessary for you to live. Surgery is also recommended as gallstones can reoccur. Once the gall bladder is removed, the bile is directed from the liver into the intestine.

Summary

Gallstones are hard deposits of bile fluid in the gallbladder, primarily composed of either cholesterol or bilirubin. Gallstones may not cause any symptoms (silent gallstones) or may cause severe abdominal pain, vomiting and fever. When symptomatic, medications and surgery to remove the gallbladder are the two mainstay methods of treatment.