Gallstones

What are gallstones?

Gallstones are deposits of digestive fluid made of hardened substances found in bile, like cholesterol. They are common and may or may not produce symptoms. People with symptoms usually need to have their gallbladders taken out.

How are gallstones created?

Your gallbladder is a small organ in your upper right abdomen, right below your liver. It’s a pouch that stores bile, a green-yellow liquid that helps digestion. Issues with your gallbladder typically occur when something is blocking its bile duct—like a gallstone. Most gallstones are created when substances found in bile, like cholesterol, harden. Gallstones are very common and do not usually cause symptoms. However, about 10 percent of people who are diagnosed with gallstones will develop noticeable symptoms within 5 years.

What are signs and symptoms of gallstones?

Gallstones can lead to pain in the upper right abdomen or the center of your stomach. You may experience gallbladder pain from time to time after you eat foods that are high in fat, such as fried foods, but the pain can occur at almost any time. Pain caused by gallstone issues usually lasts for only a few hours, but it can feel severe. If gallstones are left untreated or unidentified, the symptoms may increase to include:

• A high temperature
• Rapid heartbeat
• Yellowing of the skin and whites of the eyes (jaundice)
• Itchy skin
• Diarrhea
• Chills
• Confusion
• A loss of appetite

These symptoms can be signs of a gallbladder infection, or inflammation of the gallbladder, liver, or pancreas. Because gallstone symptoms may mimic the symptoms of other serious issues like appendicitis and pancreatitis, no matter what, if you’re dealing with one or more of these issues — it’s time to see a doctor or get yourself to the ER.

What are the causes of gallstones?

The actual cause of gallstones is thought to be due to a chemical imbalance of bile inside of the gallbladder. While researchers still aren’t clear about what exactly causes that imbalance to happen, there are a few possible reasons:

• Having too much cholesterol in your bile can lead to yellow cholesterol stones. These hard stones may develop if your liver makes more cholesterol than your bile can dissolve.
• Bilirubin is a chemical produced during the normal breakdown of red blood cells. After it’s created, it passes through the liver and is eventually excreted out of the body.
• Some conditions, such as liver damage and certain blood disorders, cause your liver to produce more bilirubin than it should. Pigment gallstones form when your gallbladder can’t break down the excess bilirubin. These hard stones are often dark brown or black.
• Your gallbladder needs to be able to empty its bile to function properly. If it fails to empty its bile content, the bile becomes overly concentrated, which can cause stones to form.

What are the risk factors for gallstones?

Some risk factors for gallstones are related to diet, while other factors are not as controllable. Uncontrollable risk factors are things like age, race, sex, and family history.

Lifestyle risk factors

• Living with obesity
• A diet high in fat or cholesterol and low in fiber
• Undergoing rapid weight loss
• Living with type 2 diabetes

Genetic risk factors

• Being born female
• Being of Native American or Mexican descent
• Having a family history of gallstones
• Being 60 years or older

Medical risk factors

• Living with cirrhosis
• Being pregnant
• Taking certain medications to lower cholesterol
• Taking medications with a high estrogen content (like certain birth controls)

While some medications may increase your risk of gallstones, don’t stop taking them unless you have discussed it with your doctor and have their approval.

What are some tips to prevent gallstone formation?

While there is no foolproof way to completely prevent gallstones, cholesterol seems to play a major role in their formation. If you have a family history of gallstones, your doctor may advise you to limit foods with a high saturated fat content. Some of these foods include: fatty meat, like sausage and bacon; cakes and cookies and certain cheeses. Because people living with obesity are more predisposed to gallstones, keeping your weight within a moderate range is another way to limit the possibility of their formation.

To help improve your condition and reduce your risk of gallstones, try these tips:

• Eat fewer refined carbs (like cookies and white bread) and less sugar.
• Increase your intake of healthy fats, like fish oil and olive oil, which may help your gallbladder contract and empty on a regular basis.
• Eat the proper amount of fiber per day (women need about 25 grams a day, men need about 38 grams a day).
• Get some sort of physical activity every day.
• Keep yourself properly hydrated.
• If you plan to lose weight, do it slowly. Rapid weight loss may increase your risk of gallstones and other health problems.

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 may be a sign of jaundice, the result of too much bilirubin in your body. The exam may involve using diagnostic tests that help your doctor see inside your body. These tests include:

• Ultrasound. An ultrasound produces images of your abdomen. It can also show abnormalities associated with acute cholecystitis.
• Abdominal CT scan. This imaging test takes pictures of your liver and abdominal region.
• Gallbladder radionuclide scan.
• 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.

What is the treatment for gallstones?

Most of the time, you won’t need treatment for gallstones unless they cause you pain. Sometimes you can pass gallstones without even noticing. If you’re in pain, your doctor will likely recommend surgery. In rare cases, medication may be used.

Surgery

Cholecystectomy, which is surgery to remove the gallbladder, is one of the most common operations performed on adults in the United States. Because the gallbladder isn’t an essential organ, it’s possible to live a healthy life without it. There are two types of cholecystectomy: Laparoscopic cholecystectomy and Open cholecystectomy.  You may experience loose or watery stools after gallbladder removal. Removing a gallbladder involves rerouting the bile from the liver to the small intestine. Bile no longer goes through the gallbladder and it becomes less concentrated. The immediate result is a laxative effect that can cause diarrhea, but this issue should resolve on its own for most people.

Nonsurgical treatments

If surgery can’t be performed, such as if the patient is a much older individual, there are a few other ways doctors can try to get rid of your gallstones.

• Oral dissolution therapy. This involves taking medications that contain bile acid to break up gallstones. This method may take months to years for the stones to break and results vary from person to person.
• Shock wave lithotripsy. Here, a doctor may use some equipment placed on the skin to blast the stone into smaller pieces.
• A non-invasive drainage of the gallbladder involves placing a sterile needle through the skin into the gallbladder to aspirate (draw out) bile.