Gallstones

Your gallbladder is located just beneath your liver at the upper right side of your abdomen. If you are having sudden pain at the upper or right part of your abdomen, consult a doctor now to check if you’re suffering from gallstones or cholelithiasis.

Gallstones consist of hardened deposits of bile that form in your gallbladder. Bile is digestive fluid synthesized by your liver and is stored in your gallbladder. Bile is released into your small intestines after a meal for the digestion of fats. Your gallbladder is located just beneath your liver at the upper right side of your abdomen.

Gallstones can be as small as a grain of sand or as big as a golf ball. You can have a single stone or multiple stones. Some people with gallstones may not experience any symptoms while others suffer excruciating pain.

How Do Gallstones Form?

It isn’t clear how gallstones form. Scientists think they can be formed through the following:

  1. High cholesterol levels secreted by the liver – Normally, cholesterol secreted by the liver is digested by the bile, but the bile cannot digest large amounts of cholesterol when too much cholesterol is dumped into the gallbladder. The excess cholesterol forms into gallstones.
  2. High levels of bilirubin, which can happen when your red blood cells break down at a faster rate as what happens with blood disorders or biliary tract infections.
  3. Inability of your gallbladder to empty properly and bile becomes concentrated, subsequently hardening into stones.

There are usually three types of stones. The most common stones in Asian population are dark colored pigment stones, which can be brown or black and are made up of bilirubin. Secondly, they can be yellow cholesterol stones made up of the cholesterol, which is more common in Western population. Finally, they can be mixed stones with pigment and cholesterol stones.

What Are The Common Symptoms of Gallstones?

Most people with gallstones are asymptomatic. Others feel a pain that comes so sudden and last several minutes to a few hours.
The symptoms of gallstone disease can be the following:

  • Abdominal bloating, which is typically worse after meals or at night
  • Sudden onset of pain at the right upper part of the abdomen
  • Sudden onset of pain at your epigastric area or the center of your abdomen below your breastbone.
  • Pain from the abdomen going to the back
  • Pain in your right shoulder
  • Nausea and vomiting
  • Severe abdominal pain, fever, or jaundice can signify complications arising from gallstones

How To Diagnose Gallbladder Stones?

The following methods are utilized by your doctor to diagnose gallstones:

  1. Ultrasound- visualizes the gallstones, their location, and number
  2. CT scan or MRI are used to help exclude other causes of abdominal pain, and may be used to diagnose complicated gallstone disease.
  3. Blood tests determine concomitant infections, obstruction, pancreatitis, and jaundice
  4. Endoscopic ultrasound (EUS) – utilizes an endoscope that is inserted into the stomach and the duodenum (first part of the intestine) and can locate the stones in the bile duct.
  5. Endoscopic retrograde cholangiopancreatography (ERCP) can be used to remove stones in the bile duct once they are confirmed

What Are The Treatment Modalities?

The treatment of gallstones depends on what you’re experiencing. If you’re asymptomatic but gallstones were visualized through an ultrasound, you generally wouldn’t need any surgery. However, removal of the gallbladder called cholecystectomy is necessary for people with hemolytic anemia or who are at risk for gallbladder cancer.

If you suffer painful symptoms you’ll be advised to undergo cholecystectomy. You can live without your gallbladder since it only stores bile (which is not a vital function). It is the liver that produces the bile which will flow directly into your small intestines.

People with symptoms can have their surgery scheduled at their convenience. Cholecystectomy is almost always done as a laparoscopic procedure (keyhole surgical technique). This is done as a day procedure or an overnight stay at the hospital. The open technique with a long incision may be used for complicated cases, and this will require longer hospital stay.

Gallstones with complications are usually treated as emergency cases. The following are complications:

  • Bile duct obstruction and cholangitis – your gallstones have blocked your bile duct – the duct that empties bile to the duodenum. This explains the excruciating pain. Apart from the blockage, your bile duct can get inflamed, which is called cholangitis. Your doctor will put you on intravenous antibiotics. The obstruction is usually relieved by endoscopy (ERCP). When your condition has stabilized your gallbladder is then removed.
  • Acute gallstone pancreatitis – Acute pancreatitis can cause sudden severe abdominal pain. It is also potentially life-threatening when it is a severe attack. When symptoms of pancreatitis have abated, early laparoscopic removal of the gallbladder is advised to prevent recurrence of pancreatitis.
  • Acute cholecystitis – Infection within the gallbladder can result in right abdominal pain and fever. In diabetic patients, gangrene of the gallbladder wall can set in quickly if left untreated. Early laparoscopic removal of the gallbladder is advised to treat this condition.

There is no reliable medication that can help dissolve your gallstones. Cholesterol stones may respond to dissolution therapy, but this takes a long time and they can form again once the medications are stopped.

What Are The Preventative Measures?

You can decrease the risk of gallstone formation by eating healthy diets. Crash diets and losing weight quickly increases your risk of gallstones. Obesity is associated with increased gallstone formation, thus maintaining a healthy weight is important.

If you’re experiencing gallbladder problems, seek advice from your doctor immediately before complications set in. It can save you from more suffering.