What are gallstones?
When bile stored in the gallbladder hardens into stone-like material, it is known as gallstones.
At first, most gallstones do not cause symptoms. However, when gallstones become larger, or when they begin obstructing bile ducts, symptoms or "attacks" begin to occur. Attacks of gallstones usually occur after a fatty meal and at night. The following are the most common symptoms of gallstones:
- Steady, severe pain in the upper abdomen that increases rapidly and may last from 30 minutes to several hours
- Pain in the back between the shoulder blades
- Pain in the right shoulder
- Jaundice, yellowing of the skin or eyes.
- Abdominal bloating
- Intolerance of fatty food
- Belching or gas
Some people with gallstones do not have any symptoms. These stones are called "silent stones," because they do not interfere with the function of the gallbladder, liver or pancreas, and do not require treatment in most cases.
When to see a doctor
People who experience the following symptoms should consult their doctor immediately:
- Low-grade fever
- Yellowish color of the skin or whites of the eyes
- Clay-colored stools
Too much cholesterol, bile salts or bilirubin (bile pigment) can cause gallstones.
The following are considered risk factors for gallstones:
- Obesity: Obesity is a major risk factor for gallstones, especially in women.
- Estrogen: Excess estrogen from pregnancy, hormone replacement therapy, or birth control pills appears to increase cholesterol levels in bile and decrease gallbladder movement, both of which can lead to gallstones.
- Ethnicity: Native Americans have the highest rates of gallstones in this country and seem to have a genetic predisposition to secrete high levels of cholesterol in bile.
- Gender: Women are twice as likely to develop gallstones than men.
- Age: People over 60 are more likely to develop gallstones than younger people.
- Cholesterol-lowering drugs: Drugs that lower cholesterol in blood can actually increase the amount of cholesterol secreted in bile, which, in turn, increases the risk of gallstones.
- Diabetes: People with diabetes generally have high levels of fatty acids, called triglycerides, which increase the risk for gallstones.
- Rapid weight loss: As the body metabolizes fat during rapid weight loss, it causes the liver to secrete extra cholesterol into bile, which can cause gallstones.
- Fasting: Fasting decreases gallbladder movement, which causes the bile to become overconcentrated with cholesterol.
How is it diagnosed?
In some cases, asymptomatic gallstones are discovered by accident, during testing for another diagnosis. However, when pain persists, your health care provider may want to conduct a complete medical history and physical examination, in addition to the following diagnostic procedures for gallstones:
- Ultrasound: A diagnostic technique that uses high-frequency sound waves to create an image of the internal organs.
- Cholecystography: X-ray that shows the flow of contrast fluid through the intestines into the gallbladder.
- Blood tests: These look for signs of infection, obstruction, jaundice and/or pancreatitis.
- Computed tomography scan (also called a CT or CAT scan): A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body.
- Endoscopic retrograde cholangiopancreatography (ERCP): A procedure that involves inserting an endoscope (viewing tube) through the stomach and into the small intestine. A special dye injected during this procedure shows the ducts in the biliary system.
- Sphincterotomy: Opening the muscle sphincter, a ring of muscle around a natural opening that acts like a valve, wide enough so stones can pass into the intestine.
When gallstones are present in the gallbladder itself, it is called cholelithiasis. When gallstones are present in the bile ducts, it is called choledocholithiasis. Gallstones that obstruct bile ducts can lead to a severe or life-threatening infection of the bile ducts, pancreas or liver. (Bile ducts can also be obstructed by cancer or trauma, but this is not related to gallstones).
Types of treatment
If the gallstones cause no symptoms, treatment is usually not necessary. However, if pain persists, treatment may include:
- Gallbladder removal (cholecystectomy): Once removed, the bile flows directly from the liver to the small intestine. Side effects of this may include diarrhea because the bile is no longer stored in the gallbladder.
- Oral dissolution therapy: Drugs made from bile acid are used to dissolve the stones.
- Methyl-tert-butyl ether: A solution injected into the gallbladder to dissolve stones.
- Extracorporeal shockwave lithotripsy (ESWL): A procedure that uses shock waves to break stones up into tiny pieces that can pass through the bile ducts without causing blockages.
- Contact dissolution therapy: An experimental procedure that involves injecting a drug directly into the gallbladder to dissolve the stones.