Gallstones

Overview

Gallstones can lurk inside your gallbladder. Many people have gallstones and never know it. Gallstones are hard deposits in your gallbladder, a small organ that stores bile, which is a digestive fluid made in the liver. Gallstones may consist of cholesterol, salt, or bilirubin, which is discarded red blood cells. Gallstones range in size. They can be as small as a grain of sand or as large as an apricot.

CAUSES

What Causes Gallstones?

The components in bile can crystallize and harden in your gallbladder, leading to gallstones. According to Harvard Health Publications, 80 percent of gallstones are made of cholesterol. The other 20 percent of gallstones are made of calcium salts and bilirubin. These are known as pigment stones.

Cholesterol Stones

Gallstones may develop when there is too much cholesterol in the bile secreted by your liver. Bile usually dissolves or breaks down cholesterol. However, if your liver makes more cholesterol than your bile can dissolve, hard stones may develop.

Bilirubin

Bilirubin is a chemical produced when your liver destroys old red blood cells. Some conditions, such as cirrhosis of the liver and certain blood disorders, cause your liver to produce more bilirubin than it should. Stones form when your gallbladder cannot break down the excess bilirubin. These hard substances are also called pigmented stones.

Concentrated Bile

Your gallbladder needs to empty bile to be healthy and function properly. If it fails to empty its bile content, the bile becomes overly concentrated, which causes stones to form.

RISK FACTORS

Who Is at Risk for Gallstones?

While your body produces cholesterol naturally, you can also take in excess cholesterol through your diet. Many risk factors for gallstones are related to diet. These include:

being overweight or obese

eating a diet that’s high in fat or cholesterol

rapid weight loss within a short period of time

eating diet that’s low in fiber

having diabetes mellitus

Other risk factors include:

being female

being of American Indian or Mexican-American descent

being pregnant

having a family history of gallstones

being age 60 or older

having cirrhosis of the liver

taking certain medications for lowering cholesterol

taking medications that have a high estrogen content

Don’t stop taking any medicines unless you have discussed it with your doctor.

SYMPTOMS

What Are the Symptoms of Gallstones?

You may not experience any symptoms if you have gallstones. According to the American College of Gastroenterology (ACG), 80 percent of people who have gallstones don’t have any pain at all. These are called “silent” gallstones. Your doctor may find these stones in your gallbladder from X-rays or performing surgery on your abdomen.

Some people do have gallstone symptoms. The most common symptom of gallstones is pain in the right upper quadrant of your abdomen. The pain often radiates to your back or right shoulder or shoulder blade.

Other symptoms include:

fever

a yellowish tint in your skin or eyes, which can indicate jaundice

nausea or vomiting

clay-colored stools

STAGES

What Are the Stages of Gallbladder Disease?

Extreme gallstone pain is known as a “gallbladder attack.” This extreme pain lasts more than one to two hours. Gallstones themselves don’t cause this pain. It occurs when the gallstones block the movement of bile from the gallbladder. This doesn’t usually happen overnight. Instead, there are three stages that lead to the attack.

In stage 1, gallstones form in the gallbladder. Usually, there’s no pain in this stage.

In stage 2, you start to experience gallbladder pain from time to time. You may notice this when you eat foods that are high in fat, such as fried foods. The pain doesn’t usually extend past a few hours. Other symptoms can include stomach pain, burping, diarrhea, nausea, and indigestion.

In stage 3, a gallstone blocks the duct where bile moves from the gallbladder, a gallbladder attack occurs. This stage is a medical emergency. Symptoms can include intense stomach or back pain, fever, chills, or appetite loss.

According to the American College of Gastroenterology (ACG), the risk of silent gallstones causing a gallbladder attack is 1 percent annually. For every 100 people that have silent gallstones, 10 of those people will have an attack within a decade.

DIAGNOSIS

How Are Gallstones Diagnosed?

Your doctor will perform a physical examination that includes checking your eyes and skin for visible changes in color. A yellowish tint in your skin or eyes may be signs of jaundice. Too much bilirubin in your body causes jaundice.

The examination may involve using diagnostic testing to see inside your body. These tests include:

Ultrasound

Ultrasound tests produce images of your abdomen. This is the preferred imaging method to initially confirm that you have gallstone disease.

Abdominal CT Scan

This is an imaging test that takes pictures of your liver and abdominal region.

Gallbladder Radionuclide Scan

This is a very important scan that takes about one hour to complete. A specialist injects a radioactive substance into your veins. The substance travels through your blood to the liver and gallbladder. It highlights any infection or blockages in these organs.

Blood Tests

Your doctor may order blood tests that measure the amount of bilirubin in your blood. The tests also help determine how well your liver is functioning.

How Are Gallstones Treated?

Your doctor may use any of several treatment options to remove stones or improve your condition.

Surgery

Surgery is often the first option if you have significant symptoms.

Your doctor may need to perform a laparoscopic gallbladder removal, which is a common surgery. General anesthesia is usually required for gallbladder removal. The surgeon will usually make three or four incisions on your abdomen. Your surgeon will insert a small, lighted device into one of the incisions and carefully remove your gallbladder.

You usually go home on the day of the procedure if you have no complications.

Medications

Drugs that dissolve gallstones caused by cholesterol are an option if you cannot undergo surgery. These medications may take several years to eliminate the gallstones.

LIFESTYLE CHANGES

Lifestyle Changes After Gallbladder Removal

Much like an appendix, a gallbladder isn’t necessary for a person to live a full and healthy life. However, you may have loose or watery stools after gallbladder removal.

This diarrhea occurs because removing a gallbladder involves rerouting the bile from the liver to the small intestine. Bile no longer goes through the gallbladder after surgery and it becomes less concentrated. The result is a laxative effect that causes diarrhea. If you eat a diet lower in fats, less bile will be released. Examples of dietary steps you can take include:

Reduce your intake of fats. Choose low-fat foods whenever possible. Avoid high-fat, greasy, and fried foods.

Add fiber to your diet. Extra fiber can make your bowel movements less liquid. Try to add only a serving of fiber at a time to prevent gas that can occur from eating excess fiber.

Avoid foods and drinks known to cause diarrhea, such as caffeine, high-fat dairy products, and very sweet foods.

Eat several small meals per day instead of large meals. Smaller meals are easier for the body to digest.

PREVENTION

Can I Prevent Gallstones?

You can’t prevent gallstones, but you can reduce your risk with lifestyle strategies. Eat a balanced diet. Don’t skip meals. Drink sufficient amounts of water each day to keep your body hydrated. If you plan to lose weight, do it slowly. Aim to lose no more than two pounds per week. Rapid weight loss may increase your risk of gallstones and other health problems.

OUTLOOK

What Can I Expect in the Long Term?

Surgery to remove your gallbladder or any stones in your gallbladder is often successful. In most cases, stones don’t return. However, if you don’t have surgery, the gallstones can return. This is true even when you’ve taken medicines to dissolve the gallstones.