Gallstones: Causes, Symptoms, Diagnosis and Treatment
Gallstones are solid, stone-like materials that develop in the gallbladder. The gallbladder is a small, pear-shaped sac located under the liver in the right side of the abdomen, which stores and secretes bile.
Bile is a liquid made in the liver to help body digests fats. It is mostly composed of bile acids, cholesterol and bilirubin, a byproduct from the breaking down of red blood cells. Gallstones form when bile stored in the gallbladder hardens into pieces of stone-like material.
Types of Gallstones
There are two types of gallstones: cholesterol and pigment gallstones.
- Cholesterol gallstones are usually yellow-green in color and are made primarily of hardened cholesterol. They are the most common type of gallstones, accounting for about 80 percent of all gallstones cases.
- Pigment gallstones are dark brown or black stones that form when your bile contains too much bilirubin. The gallstones can range in size from very small to as large as a ping pong ball. They account for about 20 percent of all gallstones cases.
What Causes Gallstones?
The exact causes of gallstones are still unclear but gallstones can develop when bile contains too much cholesterol, too much bilirubin, or if the gallbladder does not empty completely.
Gallstones also tend to develop in people with cirrhosis, or those who have hereditary blood disorders such as sickle cell anemia.
Who is at Risk for Gallstones?
Risk factors that contribute to the formation of gallstones include:
Being age 40 or older
People who are aged 40 years or older are at higher risk of developing gallstones because their body tend to secrete more cholesterol into bile, which can lead to gallstones.
Being a woman
Excess estrogen in women, particularly during pregnancy or taking birth control pills can increase cholesterol levels in bile, which may cause gallstones to form.
Having a family history of gallstones
If you have family members who have been diagnosed with the gallstones, you are more likely to develop it too.
Obesity is a major risk factor for gallstones, especially in women. It increases the amount of cholesterol in bile, and also make it harder for the gallbladder to empty completely.
People with diabetes tend to have higher levels of triglycerides – a type of blood fat – which may increase the risk of gallstones.
Rapid weight loss
As the body breaks down fat during prolonged fasting and rapid weight loss, the liver secretes extra cholesterol into bile, causing gallstones to form.
Taking cholesterol-lowering drugs
Drugs that lower cholesterol levels could increase the amount of cholesterol secreted into bile, thereby increasing the risk of gallstones.
What are the Symptoms of Gallstones?
Many people suffering from gallstones do not show any symptoms and almost 90 percent have no pain at all, and these conditions are called asymptomatic or silent gallstones. Silent gallstones do not interfere with the function of the gallbladder, liver, or pancreas.
But when gallstones become larger, or when they begin obstructing bile ducts, symptoms begin to occur. When symptoms of gallstones do occur, they are often called an “attack” because they occur suddenly. The following are some common symptoms of gallstones:
- Pain in the upper right part of the abdomen or near the right shoulder.
- Chest pain
- Nausea or vomiting
- Jaundice (yellowing of the skin or the white eyes)
Pain is the main symptom for most individuals with gallstones. This pain is steady and can last for up to several hours. It usually occurs in the evening or during the night.
It is important to seek medical attention if you experience this pain, especially when accompanied with jaundice.
How are Gallstones Diagnosed?
To diagnose gallstones, your health care provider will ask you about your symptoms and perform a physical exam to examine your body and check for pain in your abdomen.
If gallstones are suspected, your doctor may use blood test or imaging tests to detect any gallstones.
The doctor may take a blood sample from you and send the sample to a lab for analysis. The blood test can show signs of infection or inflammation of the bile ducts, gallbladder, pancreas, or liver.
Ultrasound uses sound waves to create images of the gallbladder and bile ducts. It shows signs of inflammation or indications that there is blockage of bile flow. Sometimes, silent gallstones are found when a person does not have any symptoms. Ultrasound is the most common test performed to evaluate gallbladder abnormalities.
- Abdominal computed tomography (CT) scan
This test uses x-rays to produce detailed images of the abdominal organs. The CT can show gallstones and other information such as infection and blockage of the gallbladder or bile ducts. However, CT scans also can miss gallstones that you may have.
- Endoscopic retrograde cholangiopancreatography (ERCP)
ERCP uses an x-ray to look into the bile ducts. It helps the doctor locate the affected bile duct and the gallstone. The stone is captured in a tiny basket attached to the endoscope and removed. This test is more invasive than other tests and is used selectively.
- Magnetic resonance cholangiopancreatography (MRCP)
This test uses magnetic resonance imaging (MRI) to produce detailed pictures of biliary system (gallbladder, liver and bile ducts). It can show gallstones or blockages in the bile duct or the pancreatic duct, and evidence of inflammation. MRCP is a safer alternative to the ERCP so physicians will often opt for MRCP initially.
Also called a HIDA scan, or hepatobiliary scan, cholescintigraphy uses an unharmful radioactive material to produce pictures of the biliary system. It is used to diagnose abnormal contractions of the gallbladder or obstruction of the bile ducts.
This test is useful when the ultrasound result is inconclusive, especially if there is acute inflammation of the gallbladder and the outlet of the gallbladder is blocked. It is also beneficial when the gallbladder is diseased but there are no stones present.
How are Gallstones Treated?
If the gallstones cause no symptoms, treatment is usually not necessary. However, if symptoms are present, especially severe pain, then treatment may be required to relieve or eliminate the symptoms.
Depending on the size and type of gallstones, treatment options may include surgery and non-surgical.
If your gallstones cause you frequent and severe pain, you may be advised to have surgical removal of your gallbladder. But don’t worry, gallbladder isn’t an essential organ so you can still live a normal life without one.
Surgery to remove the gallbladder, called cholecystectomy, is one of the most common operations performed in adults. There are two types of cholecystectomy: laparoscopic cholecystectomy and open cholecystectomy.
- Laparoscopic cholecystectomy
A laparoscopic cholecystectomy is a commonly performed procedure for gallbladder removal. In this procedure, the surgeon makes several small incisions in the abdomen. A laparoscope, a narrow tube with a camera, is inserted through one incision. This allows your doctor to see your gallbladder on a screen. Once gallbladder is found, it will be removed through another small incision.
- Open cholecystectomy
In open cholecystectomy, the surgeon removes the gallbladder through a single, large incision in the upper right side of the abdomen and cuts through the fat and muscle to the gallbladder. The gallbladder is then removed, and any ducts are clamped off.
Open surgery is just as effective as laparoscopic surgery, but it does have a longer recovery time and causes more visible scarring. Most people have to stay in hospital for up to a week. It typically takes about a month to fully recover.
After surgery to remove the gallbladder, bile flows from the liver through the common bile duct and goes directly into the small intestine, instead of being stored in the gallbladder.
Some people may experience more frequent stools after gallbladder removal, but it’s generally resolve over time.
There are non-surgical treatments that can be used to dissolve the stones, but it may take months or possibly even years to get rid of the gallstones, and gallstones will likely form again if treatment is stopped.
By contrast, a surgery resolves this issue quickly. Using these methods to treat gallstones could be an option if you are unable to have surgery because of certain medical condition.
A doctor may use the following types of non-surgical treatments to remove or break up gallstones.
- Endoscopic retrograde cholangiopancreatography (ERCP)
ERCP is a minimally invasive option for removing gallstones from the bile ducts. During ERCP, the opening of the bile duct is widened with a small cut or an electrically heated wire. The stones are then removed or left to pass into your intestine and out of your body.
Sometimes, a small tube called a stent is permanently placed in the bile duct to help the bile and stones pass.
Lithotripsy is a procedure that uses ultrasonic shock waves to break up stones into small pieces. After the treatment, the stone particles will pass out of the body through urination.
The procedure may take about 45 minutes to 1 hour, and usually takes place in a hospital. In most cases, a person can go home the same day.
- Oral dissolution therapy
Oral dissolution therapy is a non-surgical treatment that uses drugs to dissolve gallstones. However, it is rarely used as it can only be used for cholesterol gallstones and symptoms usually recur after treatment with medicine has been stopped. This treatment can take months to years for the stones to dissolve.