Gallstones: Symptoms, Diagnosis and Treatment

Gallstones are hard stone-like deposits of bile juice present in the gall bladder, the presence of gallstones medically is known as cholelithiasis. They are usually made of cholesterol or pigment. The size varies greatly from sand grain to that of a golf ball. They can be single (one large stone) or multiple in number (hundreds of stones). The gall bladder is a pouch-like organ just beneath the liver. Generally, gallstones are silent means that they cause no symptoms at all due to their small size but sometimes patients complain of severe pain, and many patients only this time they come to know that they have gallstones. The incidence of gallstones varies greatly from region to region and the prevalence rate ranges from 5 to 25 %.

Types of Gallstones

There are mainly two types of gallstones

• Cholesterol stones: these are the most common type and usually yellow-green in color. The stone is mostly made up of cholesterol.
• Pigment stones: These are less common, darker in color, and made of bilirubin. Bilirubin is a pigment excreted by the liver in the bile juice.

Some people have stones which contain both components in adequate amounts, called mixed stones.

Symptoms of Gallstones

Sign and symptoms occur when the gallstones move from their position and block the neck of the bladder, bile ducts, cystic duct or other biliary ducts. Patients complain of Pain

• Which is severe, sudden, and sharp in the upper right part of the abdomen
• Sometimes it can be in the center of the abdomen
• It can also be felt in the right shoulder or back
• associated with Nausea and vomiting

You should definitely seek for the doctor’s help if your pain is associated with the following features

• Very intense pain such that you can’t find a comfortable position (lasting for several hours)
• Fever with chills
• Yellowing of the skin or the white of the eye – jaundice
• Dark-colored urine or light-colored stool

Risk factors for Gallstones

Not all people develop bile stones but a certain group of people is at higher chances like

• Age: Chances of gallstones increases with age.
• Gender: women are more likely to develop gallstones than men due to the high level of estrogen in the body.
• Genetics: people having a family history of gallstones, American Indians have genes that increase the amount of cholesterol in the bile juice making them more susceptible.
• Pregnancy: due to the high concentration of estrogen hormone
• Rapid weight loss: causes more cholesterol to be released in the bile by the liver
• Overweight or obese
• Physical inactivity
• High fat or cholesterol diet
• Low fiber diet
• Having liver disease
• Diabetes mellitus

Causes of Gallstones

The mechanisms by which gallstones are formed in bile are not understood clearly but physicians know that they may form if your

• bile contains
• Too much of cholesterol: bile contains solubilized cholesterol. An excessive amount can lead to its precipitation in the form of stones
• Too much of bile pigment: chief bile pigment is bilirubin. If the liver produces a high amount of bilirubin in bile. It can eventually lead to stone formation.
• Too less bile salts: they help in dissolving bile pigment and cholesterol in the bile. So, their low quantity disrupts the balance between solubility and precipitation.
• Gall bladder doesn’t empty correctly: gall bladder concentrates bile by absorbing water but prolonged stasis can cause very concentrated bile juice to be formed which contributes to the stone formation.

Complications of Gallstones

Complications arise due to some blockage created by stones

• Gall bladder inflammation or infection: patient complains of fever and pain
• Infection of bile ducts or ever liver
• Pancreatitis if gallstones lodges in the pancreatic duct. It blocks the flow of pancreatic juice and enzymes itself digest the pancreas.

Diagnosis of Gallstones

Your doctor will take your medical history, perform a physical exam and some medical tests to reach a particular diagnosis

• Medical history: your doctor will ask you certain questions about your symptoms, eating habits, past or current illness, medications, and family history
• Physical examination: Basically, your doctor will check your Vitals such as blood pressure, temperature, heart rate, Examine your abdomen for tenderness, swelling, or distension.
• Blood test: to look for the signs of inflammation, infection, or jaundice
• Ultrasound: it is the cheapest and safest imaging technique to find gallstones
• CT scans: it uses x rays to create the images of gallbladder, bile ducts, or pancreas. It has higher sensitivity and can show the missed stones as well
• MRI: It has the same use but it is safe and more expensive
• ERCP: It stands for Endoscopic Retrograde Cholangiopancreatography. It helps your doctor to locate as well as treat the gallstone if it is in the bile duct

Treatment of Gallstones

If your gallstones are causing no symptoms, you don’t need treatment. Treatment is required when they are causing any symptom

• Surgical treatment: Once formed, gallstones can appear again. Since the gallbladder is not an essential organ so, the surgeon removes it. Medically called a cholecystectomy. It is of two types
• Laparoscopic: Most commonly performed and you can go home the same day.
• Open cholecystectomy: It is done when your gallbladder is severely inflamed, infected or scarred. A patient may require at least one week of hospitalization.
• Non-surgical treatment: used only when gallstone is of cholesterol type and the patient cannot undergo surgery due to some preexisting medical condition
• Oral dissolution therapy: medication containing bile salts cab dissolve small cholesterol stones but it may take years to dissolve all
• ERCP: If gallstones are stuck in the common bile duct, it can be removed by ERCP.

Prognosis of Gallstones

Surgical treatment has a good prognosis because complications are rare and gallstones don’t appear again but non-surgical treatment has a bad prognosis due to high chances of recurrence and very slow treatment.

References:

• American Gastroenterological Association