Picture, Symptoms, Types, Causes, Risks, Treatments

What Are Gallstones?

Gallstones are pieces of solid material that form in your gallbladder, a small organ under your liver. If you have them, you might hear your doctor say you have cholelithiasis.

Your gallbladder stores and releases bile, a fluid made in your liver, to help in digestion. Bile also carries wastes like cholesterol and bilirubin, which your body makes when it breaks down red blood cells. These things can form gallstones.

Gallstones can range from the size of a grain of sand to that of a golf ball. You might not know that you have them until they block a bile duct, causing pain that needs treatment right away.

Gallstone Types

The two main kinds of gallstones are:

• Cholesterol stones. These are usually yellow-green. They’re the most common, making up 80% of gallstones.
• Pigment stones. These are smaller and darker. They’re made of bilirubin. .

Signs and Symptoms of Gallstones

Symptoms may include:

See your doctor or go to the hospital if you have signs of a serious infection or inflammation:

Causes of Gallstones

Doctors aren’t sure exactly what causes gallstones, but they might happen when:

• There’s too much cholesterol in your bile. Your body needs bile for digestion. It usually dissolves cholesterol. But when it can’t do that, the extra cholesterol might form stones.
• There’s too much bilirubin in your bile. Conditions like cirrhosis, infections, and blood disorders can cause your liver to make too much bilirubin.
• Your gallbladder doesn’t empty all the way. This can make your bile very concentrated.

Gallstone Risk Factors

You’re more likely to get gallstones if you:

Gallstone Diagnosis

Your doctor will do a physical exam and might order tests including:

Blood tests. These check for signs of infection or blockage, and rule out other conditions.

Ultrasound. This makes images of the inside of your body.

CT scan. Specialized X-rays let your doctor see inside your body, including your gallbladder.

Magnetic resonance cholangiopancreatography(MRCP). This test uses a magnetic field and pulses of radio wave energy to make pictures of the inside of your body, including your liver and gallbladder.

Cholescintigraphy (HIDA scan). This test can check whether your gallbladder squeezes correctly. Your doctor injects a harmless radioactive material that makes its way to the organ. A technician can then watch its movement.

Endoscopic retrograde cholangiopancreatography (ERCP). Your doctor runs a tube called an endoscope through your mouth down to your small intestine. They inject a dye so they can see your bile ducts on a camera in the endoscope. They can often take out any gallstones that have moved into the ducts.

Endoscopic ultrasound. This test combines ultrasound and endoscopy to look for gallstones.

Gallstone Treatment

You don’t need treatment if you don’t have any symptoms. Some small gallstones can pass through your body on their own.

Most people with gallstones have their gallbladders taken out. You can still digest food without it. Your doctor will use one of two procedures.

Laparoscopic cholecystectomy. This is the most common surgery for gallstones. Your doctor passes a narrow tube called a laparoscope into your belly through a small cut. It holds instruments, a light, and a camera. They take out your gallbladder through another small cut. You’ll usually go home the same day.

Open cholecystectomy. Your doctor makes bigger cuts in your belly to remove your gallbladder. You’ll stay in the hospital for a few days afterward.

If gallstones are in your bile ducts, your doctor may use ERCP to find and remove them before or during surgery.

If you have another medical condition and your doctor thinks you shouldn’t have surgery, they might give you medication instead. Chenodiol (Chenodol) and ursodiol (Actigall, Urso 250, Urso Forte) dissolve cholesterol stones. They can cause mild diarrhea.

You may have to take the medicine for years to totally dissolve the stones, and they may come back after you stop taking it.

Complications of Gallstones

Gallstones can cause serious problems, including:

• Gallbladder inflammation (acute cholecystitis). This happens when a stone blocks your gallbladder so it can’t empty. It causes constant pain and fever. Your gallbladder might burst, or rupture, if you don’t get treatment right away.
• Blocked bile ducts. This can cause fever, chills, and yellowing of your skin and eyes (jaundice). If a stone blocks the duct to your pancreas, that organ may become inflamed (pancreatitis).
• Infected bile ducts (acute cholangitis). A blocked duct is more likely to get infected. If the bacteria spread to your bloodstream, they can cause a dangerous condition called sepsis.
• Gallbladder cancer. It’s rare, but gallstones raise your risk of this kind of cancer.

Preventing Gallstones

Some lifestyle changes might lower your risk of gallstones.

• Eat a healthy diet that’s high in fiber and good fats, like fish oil and olive oil. Avoid refined carbs, sugar, and unhealthy fats.
• Get regular exercise. Aim for at least 30 minutes, 5 days a week.
• Avoid diets that make you lose a lot of weight in a short time.
• If you’re a woman at high risk of gallstones (for example, because of your family history or another health condition), talk to your doctor about whether you should avoid the use of hormonal birth control.

Gallstones: Treatments, symptoms, and causes

Gallstones are stones or lumps that develop in the gallbladder or bile duct when certain substances harden.

The gallbladder is a small sac located on the right-hand side of the body, on the underside of the liver. Some of the chemicals that exist in the gallbladder can solidify into either one large stone or several small ones.

There are approximately 20 million Americans with gallstones. A study revealed that the prevalence of gallstones in adults in industrialized countries is around 10 percent and appears to be rising.

Fast facts on gallstones

Here are some key points about gallstones. More detail and supporting information is in the main article.

• The gallbladder is a small organ located on the underside of the liver.
• Stones can form when there is a chemical imbalance in the gallbladder.
• People with overweight and obesity are more likely to develop gallstones.
• Experts believe a low-fat, high-fiber diet may help prevent gallstones.

Share on PinterestSymptoms of gallstones may include pain on the right-hand side of the body.

The majority of people with gallstones experience no symptoms at all. This is because the stones stay in the gallbladder and cause no problems.

Sometimes, however, gallstones may lead to cholecystitis, or an inflamed gallbladder.

The primary symptom is pain that comes on suddenly and quickly gets worse. This pain can occur on the right side of the body, just below the ribs, between the shoulder blades, or in the right shoulder.

Other symptoms include:

• pain on the right-hand side of the body, just below the ribs
• back pain between the shoulder blades
• pain in the right shoulder
• nausea
• vomiting
• sweating
• restlessness

Gallstones are only treated if they have caused gallbladder inflammation, blockage of the bile ducts, or if they have moved from the bile ducts into the intestines.

Cholecystectomy

Cholecystectomy means the surgical removal of the gallbladder. This is usually performed with keyhole surgery. Keyhole surgery is not possible for about 10 percent of people who need open cholecystectomy. They will have open surgery instead.

With open cholecystectomy, a large cut is made in the abdomen. People who undergo open surgery require a longer hospital stay and recovery time. If a gallbladder is severely inflamed, open surgery will be needed.

For a large proportion of those who undergo a cholecystectomy, gallstones come back within a year. To help prevent this, many people with gallstones are given ursosdeoxycholic acid, which is the acid found in bile.

Ursosdeoxycholic acid lowers the cholesterol content of bile, making it less likely that stones will form.

Ursodeoxycholic acid

If the gallstone is made of cholesterol, it can sometimes be slowly dissolved with ursodeoxycholic acid. This type of treatment, known as dissolution, may take up to 24 months to be effective. It is not as effective as surgery but is sometimes the only choice for people who cannot have a general anesthetic.

Endoscopic retrograde cholangiopancreatolography

When a person with gallstones cannot have surgery or ursodeoxycholic acid, they may undergo endoscopic retrograde cholangiopancreatolography (ERCP), which requires a local anesthetic. A flexible fiber-optic camera, or endoscope, goes into mouth, through the digestive system, and into the gallbladder.

An electrically heated wire widens the opening of the bile duct. The stones are then removed or left to pass into the intestine.

Lithotripsy

Ultrasonic shock waves are aimed at the gallstones, which break them up. If gallstones become small enough, they can then pass safely in the stools. This type of treatment is uncommon and is only used when there are few gallstones present.

In many cases, gallstones are discovered by accident when an individual is being treated for a different condition. A doctor may suspect gallstones after a cholesterol test, an ultrasound scan, a blood test, or even an X-ray.

Blood tests may be used to look for signs of infection, obstruction, pancreatitis, or jaundice.

Cholangiography

A dye is either injected into the blood stream so that it concentrates into the bile ducts or gallbladder, or it is inserted straight into the bile ducts using an ERCP. The dye shows up on X-rays. ERCP is also used to locate and remove stones in the bile duct.

The doctor will then be able to look at the X-rays and identify possible gallbladder or bile duct disorders, such as pancreatitis, cancer of the pancreas, or gallstones. The X-rays will indicate to the doctor whether the dye is reaching the liver, bile ducts, intestines, and gallbladder.

If the dye does not move into one of these areas, it generally means that the gallstone is causing a blockage. An expert will have a better idea of where the gallstone is located.

CT scan

This is a non-invasive X-ray that produces cross-section pictures of the inside of the human body.

Cholescintigraphy (HIDA scan)

A small amount of harmless radioactive material is injected into the patient. This is absorbed by the gallbladder, which is then stimulated to contract. This test may diagnose abnormal contractions of the gallbladder or an obstruction of the bile duct.

It used to be the case that people with gallstones who were not yet ready for surgery would be prescribed an extremely low-fat diet to prevent gallstone growth.

This has recently been shown to be less helpful than previously thought, as rapid weight loss can cause gallstones.

A balanced diet with regular meals is recommended. This will not cure gallstones, but it can have a positive impact on any symptoms and pain experienced.

Avoiding foods high in saturated fats can help to reduce the risk of gallstones developing, such as butter, hard cheese, cakes, and biscuits. Cholesterol is thought to have a role in forming gallstones.

Dietary steps can be taken to help prevent the condition, such as eating more nuts and consuming small amounts of alcohol.

Gallstones may form when the chemicals in the gallbladder are out of balance, such as cholesterol, calcium bilirubinate, and calcium carbonate.

There are two main types of gallstones:

• Cholesterol gallstones: These may form if there is too much cholesterol in the bile. They are the main type of gallstones in the United States.
• Pigment gallstones: These form when the bile has too much bilirubin. They are more common among people with liver disease, infected bile tubes, or blood disorders, such as sickle-cell anemia.

Experts are not completely sure why some people develop the chemical imbalance in their gallbladder that causes gallstones, while others do not.

However, we do know that gallstones are more common among people with obesity, especially women. A study revealed that a bulging midriff almost doubles a woman’s chances of developing gallstones and the need for surgery to remove them.

Other people at risk include:

• women who have been pregnant
• family history
• people who have recently lost lots of weight
• intentionally losing weight rapidly and then regaining it may increase men’s risk for gallstones later in life
• women taking oral contraceptives
• being sedentary
• women undergoing high-dose estrogen therapy
• people with a close relative who has had gallstones
• a study revealed that a gene variant significantly increases the risk of developing gallstones
• people whose intake of dietary fat is high
• twice as many women get gallstones than men
• people over 60 years of age
• native American Indians
• people who take cholesterol-lowering drugs called statins
• people with diabetes

Additionally, hormone replacement therapy (HRT) for women during the menopause is linked to a higher risk of gallbladder problems. A study found that HRT administered by skin patches or gels poses a smaller risk than HRT given orally.

Below is a 3-D model of gallstones, which is fully interactive.

Explore the model using your mouse pad or touchscreen to understand more about gallstones.

If the bile duct or duodenum are blocked by gallstones, the flow of digestive juices to the pancreas may be blocked. This can cause jaundice and acute pancreatitis. Treatment usually involves the surgical removal of the gallbladder.

If is common for people who have had their gallbladder removed to experience feelings of bloating and indigestion, especially when they have a high-fat meal. Some may pass stools more often than before.

Can a person live without the gallbladder?

A person can survive without a gallbladder. The liver produces enough bile to digest a normal diet. If a person’s gallbladder is removed, the bile reaches the small intestine from the liver via the hepatic ducts, rather than being stored in the gallbladder.

A small proportion of people who have had their gallbladder removed will experience softer and more frequent stools for a while because their bile flows into the small intestine more often.

Possible symptoms can occur with complications:

It is important to recognize the potential complications of gallstones.

Biliary colic: When a stone gets stuck in the opening of the gallbladder and will not easily pass through, the contraction of the gallbladder may cause severe pain. When this happens, an individual may experience a painful condition called biliary colic.

The pain is felt in the upper part of the abdomen, but can also exist in the center or to the right of the abdomen. Pain is more common about an hour after eating, especially if an individual has had a high-fat meal. The pain will be constant and last a few hours, and then subside. Some people will experience non-stop pain for 24 hours, while others may experience waves of pain.

Infection: If the gallstones have caused a gallbladder infection, the person with the condition may have a fever and experience shivering. In the majority of gallstone infection cases, people will be hospitalized for the removal of the gallstone.

Jaundice: If the gallstone leaves the gallbladder and gets stuck in the bile duct it may block the passage of bile into the intestine. The bile will then seep into the bloodstream, causing signs of jaundice.

In most cases, this complication will require the surgical removal of the gallstone. For some people, the gallstone eventually passes into the intestine.

Pancreatitis: If a small gallstone passes through the bile duct and blocks the pancreatic duct, or causes a reflux of liquids and bile into the duct, an individiual may develop pancreatitis.

Some factors that increase the risk of developing gallstones, such as age, sex, and ethnic origin, cannot be altered.

However, it is possible that following a vegetarian diet may reduce the risk of developing gallstones. Vegetarians have a significantly lower risk of developing gallstones, compared with people who eat meat.

Many experts say that a diet low in fat and high in fruit and vegetables, including plenty of dietary fiber, may help protect people from developing gallstones.

Controlling bodyweight may also help prevent the formation of gallstones. However, crash dieting and rapid weight loss increase the risk of developing gallstones. Moderation is advised.

Treatment, Definition, Risk Factors & Symptoms

Overview

Do You Have Gallstone Pain?

What are gallstones?

Gallstones are stone-like objects that develop in the gallbladder or bile ducts (the pipe-like system within the liver). Gallstones can range dramatically in size, from tiny grains of sand to golf ball-sized objects. Interestingly, small stones can often cause the most trouble. These are stones that can leave the gallbladder and get stuck. Larger stones tend to remain quietly in the gallbladder. It is important to know that many people who have gallstones are never bothered by them and may not know the stones are even there. In these cases, no treatment is needed.

What are gallstones made of?

Gallstones are made up of hardened materials in your body. Typically, there are two types:

• Cholesterol: Made up of fatty substances in the blood, cholesterol is found throughout the body. These are the most common type of gallstones.
• Pigment Stones (mainly made of bilirubin): This substance is created when red blood cells break down in the liver. Too much bilirubin can actually leak into the bloodstream and cause the skin and eyes to turn yellow (jaundice).

Gallstones that are made up of cholesterol tend to be greenish in color. It is more common to have gallstones made of cholesterol than other types of stone.

Where do gallstones develop?

Gallstones are most commonly found in the gallbladder, as cholesterol stones. Gallstones can also travel from the gallbladder to the common bile duct, which is the largest of the ducts (pipes) in the liver.

Common bile duct stones are much less common than gallstones. Stones that find their way into the common bile duct can create more serious medical situations than just gallstones that remain in the gallbladder. Common bile duct stones can block the common bile duct, resulting in a serious infection called cholangitis. These stones can also cause pancreatitis, a painful condition caused by inflammation of the pancreas. Stones in the common bile duct can be removed without surgery by using a scope. Removal of the gallbladder requires surgery, which is typically done laparoscopically (a minimally invasive surgical procedure).

Illustration showing the gallstones and organs around the gallbladder.

What is the gallbladder?

The gallbladder is a small organ tucked up under the liver, on the right side of your body. It is shaped like a swollen pea pod. The gallbladder’s job is to store and dispense bile—a fluid that helps digest fats in the food you eat. Similarly to a pea pod, the gallbladder is green. This is due to the bile inside the gallbladder. Bile is a mixture of cholesterol, bilirubin, bile salts and lecithin.

The gallbladder is connected to other parts of the digestive system through a series of ducts, or tunnels. These ducts help to carry bile and aid in the entire process of breaking down food. Ultimately, the bile finds its way into the common bile duct, where it passes through a special sphincter (a valve made of muscle), into the small intestine. Once there, the bile can mix directly with food that’s waiting to be digested. The common bile duct then empties bile into the duodenum, the first portion of the very lengthy small intestine.

Not all bile travels directly from the liver into the duodenum. Another portion of bile moves from the liver into the gallbladder through a special duct called the cystic duct. The gallbladder stores bile, which is available to be used for digestion on very short notice. If a fatty meal is eaten, then the gallbladder is signaled to contract and to squeeze some stored bile into the common bile duct where it’s passed into the small intestine to mix with food. All bile ends up in the small intestine, where it helps digest food.

What is bile and what is it used for?

Produced in the liver, bile is a combination of cholesterol, bilirubin, bile salts and lecithin. This solution helps break down fat during the digestion process. Bile is either released directly to the small intestine from the hepatic duct (coming straight from the liver) or from the bile ducts after being stored in the gallbladder. The entire system of ducts is called the biliary system. Bile is an important part of digestion and exits the body with your feces.

Symptoms and Causes

Why do gallstones develop?

Gallstones can develop for several reasons, including:

• Forming when there is a critical concentration of cholesterol or bilirubin in the bile.
• Developing if the gallbladder is lazy and does not completely empty itself of bile.
• Occurring in people with other conditions, like:
• During pregnancy.
• When you rapidly lose weight.

What are the symptoms of gallstones?

The symptoms of gallstones can vary based on the size of the gallstone. Most gallstones do not cause any symptoms at all. These gallstones are known as silent stones and require no treatment.When the gallstones cause symptoms, they may include:

• Pain in the upper mid abdomen or upper right abdomen.
• Associated pain in the right shoulder.
• Chest pain.
• Nausea and vomiting.
• Repeated similar episodes.
• Jaundice (a yellow tint to the skin and eyes).

Pain is the main symptom most people experience with gallstones. This pain is steady and can last from around 15 minutes to several hours. The episodes, which can be severe, generally subside after one to three hours or so. People who have these painful attacks, while uncomfortable, are not in any medical jeopardy. Gallstones can cause acute cholecystitis, which is a more serious condition when the gallbladder is actually inflamed. This happens if a stone blocks off the cystic duct, which increases the pressure within the gallbladder. This condition may require antibiotics, hospitalization and even urgent surgery. Stones that pass out of the gallbladder and into the common bile duct can cause a complete blockage of the duct with jaundice, infection and pancreatitis.You may feel pain in several places, including:

• Upper part of the abdomen, on the right side.
• Between the shoulder blades.
• Under the right shoulder.

When people experience pain with gallstones, it is sometimes referred to as a gallbladder attack or biliary colic.There are two special conditions that could mimic gallstone symptoms. First, some gallbladders contain a thick sludge, which has not formed into actual stones. Sometimes sludge is felt to cause symptoms similar to actual gallstone pain. Secondly, there is an uncommon condition called acalculous cholecystitis, when the gallbladder becomes inflamed, but no stones are present. This is generally treated by surgical removal of the gallbladder.

Who is at risk for gallstones?

You may have an increased risk for developing gallstones if you:

• Are a woman.
• Are over the age of 40.
• Have a family history of gallstones (members of your family have had gallstones).
• Are overweight.
• Have lost a large amount of weight over a short amount of time.
• Have diabetes.
• Have Crohn’s disease.
• Eat a diet that is high in fat and cholesterol.
• Take drugs that lower cholesterol.
• Take various medicines including oral contraceptives.
• Have certain blood disorders.
• Are of Native American or Mexican descent.

Does my diet or weight place me at risk for gallstones?

People who are overweight or planning to lose weight –either through a planned diet program or a surgery—are actually at an increased risk of developing gallstones. The risk is higher for several reasons.

• People who are overweight may have diets that are high in cholesterol. Your bile has cholesterol in it already, but if your diet has excessive amounts of cholesterol, there is a higher chance it will collect in your bile and create a cholesterol gallstone.
• Rapid weight loss is also a concern. The gallbladder is a part of the digestive process. It holds bile to the side like a storage tank. Then the gallbladder releases the bile through the ducts and into the intestine to help break down food. If you go on a diet plan that significantly reduces your calorie intake or you have a weight loss surgery, your liver secretes extra cholesterol into the bile. The gallbladder can sometimes be ‘lazy’ and not able to contract vigorously, which also leads to gallstone formation. Patients who are undergoing a gastric bypass or other surgical procedure that will lead to rapid weight loss are at risk of gallstone formation. For this reason, surgeons may remove the gallbladder prophylactically (a preventive measure) at the time of the weight loss surgery.

If you are considering a weight loss program or surgery, it is important to discuss your risks with a doctor. This could be especially important if you have had stones in the past. It is common for gallstones to happen more than once.

Can children get gallstones?

Gallstones can happen to both children and adults. It is most common to see gallstones in middle-aged adults. However, adults are not the only ones who experience gallstones. One challenge with gallstones in children is identifying symptoms. Young children may have difficulty expressing where the pain is located. If you child has any unusual symptoms or abdominal pain, call your doctor.

Diagnosis and Tests

How are gallstones diagnosed?

The most commonly used test to detect gallstones is an ultrasound. Ultrasound is a painless and accurate procedure that transmits high-frequency sound waves through body tissues. The echoes are recorded and transformed into video or photographic images of the internal structures of the body. While no test is 100%, this is a very accurate test for diagnosing gallstones. There are other radiology tests that are sometimes used, but ultrasound is the main tool for diagnosing gallbladder disease.

In general, ultrasound does not visualize the common bile duct well. Though stones in this duct aren’t as common, they can happen. If they are suspected, the following tests may be done:

• Endoscopic retrograde cholangiopancreatography (ERCP): This is both a test and a possible treatment for common bile duct stones. When used as a test, an endoscope—a flexible tube with a light and a camera attached—is inserted into the patient’s mouth, down the throat, and into the stomach and small intestine. A dye is injected to allow the bile ducts to stand out. If there are gallstones in the bile duct, they can be removed by the endoscope. This scope cannot remove stones contained within the gallbladder.
  
  Illustration showing the flexible tube for the ERCP can diagnose and sometimes treat gallstones.
  
• Magnetic resonance cholangiopancreatography (MRCP): In MRCP, the bile ducts are examined with magnetic resonance imaging (MRI), a test that uses a large magnet, radio waves, and a computer to produce very clear images of parts of the body. Unlike ERCP, MRCP can only diagnose common bile duct stones. It cannot remove them. However, MRCP’s advantage over ERCP is that it is the safer alternative, so often physicians will opt for MRCP initially.
• Endoscopic ultrasound (EUS): This procedure combines endoscopy with ultrasound (there’s a probe at the tip of the scope). Like ERCP, this scope is passed through the mouth and advanced to the common bile duct and gallbladder region. It visualizes the common bile duct well. Similarly to MRCP, allstones are identified but not removed during this procedure. If common bile duct stones are demonstrated by EUS (or MRCP), then an ERCP will generally follow to remove them.

  Illustration showing how the scope of the can go into the body to view the gallstones.

Management and Treatment

Illustration of incision locations for a laproscopic cholecystectomy

How are gallstones treated?

Silent stones are not treated and should be left alone. Most people who have gallstones are in this category.If you have symptoms, such as pain, you will probably need to be treated. The most common treatment for gallstones is to remove the gallbladder surgically. Removal of the gallbladder is called a cholecystectomy. In the majority of cases (90%), this surgery can be performed laparoscopically, a minimally invasive technique that results in less post-operative pain and a faster recovery than conventional cholecystectomy.Gallstones that are found in the bile ducts may need to be removed even if there are no symptoms. This procedure is commonly done with the endoscopic retrograde cholangiopancreatography (ERCP) procedure.

What is a laparoscopic cholecystectomy?

Laparoscopic cholecystectomy is known as a minimally invasive procedure because it uses several small incisions instead of one large one. A laparoscope is a narrow tube with a camera. This surgical tool is inserted through one incision. The camera allows your doctor to see your gallbladder on a TV screen. Your gallbladder is then removed through another small incision.

What happens if a laparoscopic cholecystectomy does not work or if there are complications during surgery?

If the patient has certain complications associated with gallstones, the surgeon may need to remove the gallbladder with an open cholecystectomy. This surgery involves an incision in the abdomen and requires a longer hospital stay (three to five days). Medical issues that could lead to open cholecystectomy include:

• Having severe inflammation of the gallbladder.
• Experiencing difficulties during an attempted laparoscopic surgery.
• Having severe cardiac and respiratory issues.
• Having a late term pregnancy.
• Experiencing major scarring from a previous surgery.
• Having a bleeding disorder or liver disease.
• Having suspected gallbladder cancer, a very rare condition.

What is an endoscopic retrograde cholangiopancreatography (ERCP) procedure?

An endoscopic retrograde cholangiopancreatography (ERCP) procedure is another minimally invasive option for removing gallstones. The endoscope is a tube-like tool. Your doctor will need to move it throughout your digestive system during the treatment. The path the endoscope travels is:

• In the mouth.
• Down the throat.
• Through the stomach.
• Into the duodenum (beginning of the small intestine) where the common bile duct empties its bile.

Once there, the endoscope is used to remove any blockages in the bile duct.

Can I digest food without a gallbladder?

You don’t need a gallbladder in order to digest food properly. If your gallbladder is removed, bile will flow directly from your liver through the hepatic duct and the common bile duct to the small intestine. After the surgery, you may experience some softer stools, which generally resolve over time.

Are there any non-surgical treatments for gallstones?

In most cases where gallstones need treatment, your healthcare provider will use a minimally invasive technique to remove the stone. There are medications that can be used to dissolve the stones. However, as minimally invasive methods have advanced, these drugs haven’t been used as often. Dissolving medications can take months—or possibly even years—to get rid of the gallstones. By contrast, a procedure resolves the issue quickly. Using these medications to treat gallstones could be an option if you are unable to have surgery because of another condition. Talk to your doctor about all treatment options and which one is the best fit for you.

What are the complications of gallstones?

There are several complications of a gallstone attack, including:

Gallstones can also cause the gallbladder or bile ducts to become infected. A blockage in the common bile duct can cause jaundice (yellowing of your skin or eyes) or can irritate the pancreas.

Prevention

Can gallstones be prevented?

Gallstones cannot be prevented. However, you can decrease your risk factors by following healthy lifestyle tips. It is important to maintain a healthy weight through exercise and a balanced diet. Talking to your doctor about weight loss and cholesterol management is also a big part of preventing gallstones.

What foods should I avoid if I have had gallstones in the past?

Many gallstones are formed from cholesterol. Though you cannot prevent gallstones, you can try and limit the amount of fatty foods in your diet. Several tips for limiting cholesterol in your diet include:

• Eating less meat.
• Adding fish.
• Limiting the amount of fried foods.
• Adding more whole grains.
• Choosing low-fat dairy products (cheese, milk).
• Adding fresh vegetables and fruit.

Can I have gallstones more than once?

Yes. If you have experienced a gallstone attack once, it is more likely that you will have them again. The multiple attack nature of gallstones is why your doctor may suggest removing the gallbladder.

Outlook / Prognosis

When can I return to my normal activities after having gallstones?

If you have a gallstone that does not require treatment (silent stone) you can continue on with your normal activities right away. If you have a minimally-invasive procedure, you will need a short amount of time to recover before starting your activities again. Two major advantages of minimally-invasive procedures include a much faster recovery time and less pain. Larger, open surgeries traditionally mean more time in the hospital and a longer recovery at home. Speak with your doctor about a realistic plan for your recovery.

Living With

When should I call my doctor?

If you are experiencing pain in your abdomen, call your doctor, especially if the pain increases over time and is associated with fever, nausea or vomiting. Abdominal pain has many causes and your doctor will evaluate your symptoms carefully in order to make the correct diagnosis. If your symptoms are severe, then you may be directed to an emergency department for immediate evaluation.Are gallstones fatal?Gallstones themselves are not fatal. However, they can cause many complications that could be fatal. Fortunately, this is a rare event. If a large stone blocks your bile ducts after leaving the gallbladder, there could be a build-up of bile in the gallbladder and ducts, causing severe pain and an infection within the ducts. This is an urgent medical situation that needs prompt treatment, such as an emergency endoscopic retrograde cholangiopancreatography (ERCP). Of course, all medical procedures—such as ERCP and cholecystectomy—have risks.

How quickly will I recover from gallstones?

If gallstones cause symptoms, then you may need surgery. If you have a laparoscopic cholecystectomy (minimally invasive procedure to remove the gallbladder) without any complications, you may be home within 24 hours. If there are complicating factors—swelling of the gallbladder, infection, a blocked duct or other medical conditions may need to have an open surgery. If that happens, your hospital stay could be about three to five days.

Department of Surgery – Gallstones

What are gallstones?

Gallstones are hard particles that develop in the gallbladder. The gallbladder is a small, pear-shaped organ located in the upper right abdomen—the area between the chest and hips—below the liver. 

Gallstones can range in size from a grain of sand to a golf ball. The gallbladder can develop a single large gallstone, hundreds of tiny stones, or both small and large stones. Gallstones can cause sudden pain in the upper right abdomen. This pain, called a gallbladder attack or biliary colic, occurs when gallstones block the ducts of the biliary tract.

By BruceBlaus (Own work) [CC BY-SA 4.0 (http://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons

What is the biliary tract?

The biliary tract consists of the gallbladder and the bile ducts. The bile ducts carry bile and other digestive enzymes from the liver and pancreas to the duodenum—the first part of the small intestine. 

The liver produces bile—a fluid that carries toxins and waste products out of the body and helps the body digest fats and the fat-soluble vitamins A, D, E, and K. Bile mostly consists of cholesterol, bile salts, and bilirubin. Bilirubin, a reddish-yellow substance, forms when hemoglobin from red blood cells breaks down. Most bilirubin is excreted through bile. 

The bile ducts of the biliary tract include the hepatic ducts, the common bile duct, the pancreatic duct, and the cystic duct. The gallbladder stores bile. Eating signals the gallbladder to contract and empty bile through the cystic duct and common bile duct into the duodenum to mix with food.

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What causes gallstones?

Imbalances in the substances that make up bile cause gallstones. Gallstones may form if bile contains too much cholesterol, too much bilirubin, or not enough bile salts. Scientists do not fully understand why these imbalances occur. Gallstones also may form if the gallbladder does not empty completely or often enough. 

The two types of gallstones are cholesterol and pigment stones:

• Cholesterol stones, usually yellow-green in color, consist primarily of hardened cholesterol. In the United States, more than 80 percent of gallstones are cholesterol stones.¹
• Pigment stones, dark in color, are made of bilirubin.

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Who is at risk for gallstones?

Certain people have a higher risk of developing gallstones than others:²

• Women are more likely to develop gallstones than men. Extra estrogen can increase cholesterol levels in bile and decrease gallbladder contractions, which may cause gallstones to form. Women may have extra estrogen due to pregnancy, hormone replacement therapy, or birth control pills. 
• People over age 40 are more likely to develop gallstones than younger people. 
• People with a family history of gallstones have a higher risk. 
• American Indians have genetic factors that increase the amount of cholesterol in their bile. In fact, American Indians have the highest rate of gallstones in the United States—almost 65 percent of women and 30 percent of men have gallstones. 
• Mexican Americans are at higher risk of developing gallstones. 

Other factors that affect a person’s risk of gallstones include²

• Obesity. People who are obese, especially women, have increased risk of developing gallstones. Obesity increases the amount of cholesterol in bile, which can cause stone formation. 
• Rapid weight loss. As the body breaks down fat during prolonged fasting and rapid weight loss, the liver secretes extra cholesterol into bile. Rapid weight loss can also prevent the gallbladder from emptying properly. Low-calorie diets and bariatric surgery—surgery that limits the amount of food a person can eat or digest—lead to rapid weight loss and increased risk of gallstones. 
• Diet. Research suggests diets high in calories and refined carbohydrates and low in fiber increase the risk of gallstones. Refined carbohydrates are grains processed to remove bran and germ, which contain nutrients and fiber. Examples of refined carbohydrates include white bread and white rice. 
• Certain intestinal diseases. Diseases that affect normal absorption of nutrients, such as Crohn’s disease, are associated with gallstones. 
• Metabolic syndrome, diabetes, and insulin resistance. These conditions increase the risk of gallstones. Metabolic syndrome also increases the risk of gallstone complications. Metabolic syndrome is a group of traits and medical conditions linked to being overweight or obese that puts people at risk for heart disease and type 2 diabetes.

More information about these conditions is provided in the NIDDK health topic, Insulin Resistance and Prediabetes.

Pigment stones tend to develop in people who have 

• cirrhosis—a condition in which the liver slowly deteriorates and malfunctions due to chronic, or long lasting, injury 
• infections in the bile ducts 
• severe hemolytic anemias—conditions in which red blood cells are continuously broken down, such as sickle cell anemia 

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What are the symptoms and complications of gallstones? 

Many people with gallstones do not have symptoms. Gallstones that do not cause symptoms are called asymptomatic, or silent, gallstones. Silent gallstones do not interfere with the function of the gallbladder, liver, or pancreas. 

If gallstones block the bile ducts, pressure increases in the gallbladder, causing a gallbladder attack. The pain usually lasts from 1 to several hours.¹ Gallbladder attacks often follow heavy meals, and they usually occur in the evening or during the night. 

Gallbladder attacks usually stop when gallstones move and no longer block the bile ducts. However, if any of the bile ducts remain blocked for more than a few hours, complications can occur. Complications include inflammation, or swelling, of the gallbladder and severe damage or infection of the gallbladder, bile ducts, or liver. 

A gallstone that becomes lodged in the common bile duct near the duodenum and blocks the pancreatic duct can cause gallstone pancreatitis—inflammation of the pancreas. 

Left untreated, blockages of the bile ducts or pancreatic duct can be fatal. 

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When should a person talk with a health care provider about gallstones? 

People who think they have had a gallbladder attack should notify their health care provider. Although these attacks usually resolve as gallstones move, complications can develop if the bile ducts remain blocked. 

People with any of the following symptoms during or after a gallbladder attack should see a health care provider immediately: 

• abdominal pain lasting more than 5 hours 
• nausea and vomiting 
• fever—even a low-grade fever—or chills
• yellowish color of the skin or whites of the eyes, called jaundice 
• tea-colored urine and light-colored stools

These symptoms may be signs of serious infection or inflammation of the gallbladder, liver, or pancreas. 

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How are gallstones diagnosed?

A health care provider will usually order an ultrasound exam to diagnose gallstones. Other imaging tests may also be used. 

• Ultrasound exam. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. A specially trained technician performs the procedure in a health care provider’s office, outpatient center, or hospital, and a radiologist—a doctor who specializes in medical imaging—interprets the images. Anesthesia is not needed. If gallstones are present, they will be visible in the image. Ultrasound is the most accurate method to detect gallstones.
• Computerized tomography (CT) scan. A CT scan is an x ray that produces pictures of the body. A CT scan may include the injection of a special dye, called contrast medium. CT scans use a combination of x rays and computer technology to create three-dimensional (3-D) images. CT scans require the person to lie on a table that slides into a tunnel-shaped device where the x rays are taken. An x-ray technician performs the procedure in an outpatient center or hospital, and a radiologist interprets the images. Anesthesia is not needed. CT scans can show gallstones or complications, such as infection and blockage of the gallbladder or bile ducts. However, CT scans can miss gallstones that are present.
• Magnetic resonance imaging (MRI). MRI machines use radio waves and magnets to produce detailed pictures of the body’s internal organs and soft tissues without using x rays. A specially trained technician performs the procedure in an outpatient center or hospital, and a radiologist interprets the images. Anesthesia is not needed, though people with a fear of confined spaces may receive light sedation. An MRI may include the injection of contrast medium. With most MRI machines, the person lies on a table that slides into a tunnel-shaped device that may be open ended or closed at one end; some newer machines allow the person to lie in a more open space. MRIs can show gallstones in the ducts of the biliary system.
• Cholescintigraphy. Cholescintigraphy—also called a hydroxyl iminodiacetic acid scan, HIDA scan, or hepatobiliary scan—uses an unharmful radioactive material to produce pictures of the biliary system. In cholescintigraphy, the person lies on an exam table and a health care provider injects a small amount of unharmful radioactive material into a vein in the person’s arm. The health care provider may also inject a substance that causes the gallbladder to contract. A special camera takes pictures of the radioactive material as it moves through the biliary system. A specially trained technician performs the procedure in an outpatient center or hospital, and a radiologist interprets the images. Anesthesia is not needed. Cholescintigraphy is used to diagnose abnormal contractions of the gallbladder or obstruction of the bile ducts. 
• Endoscopic retrograde cholangiopancreatography (ERCP). ERCP uses an x ray to look into the bile and pancreatic ducts. After lightly sedating the person, the health care provider inserts an endoscope—a small, flexible tube with a light and a camera on the end—through the mouth into the duodenum and bile ducts. The endoscope is connected to a computer and video monitor. The health care provider injects contrast medium through the tube into the bile ducts, which makes the ducts show up on the monitor. The health care provider performs the procedure in an outpatient center or hospital. ERCP helps the health care provider locate the affected bile duct and the gallstone. The stone is captured in a tiny basket attached to the endoscope and removed. This test is more invasive than other tests and is used selectively. 

Health care providers also use blood tests to look for signs of infection or inflammation of the bile ducts, gallbladder, pancreas, or liver. A blood test involves drawing blood at a health care provider’s office or commercial facility and sending the sample to a lab for analysis. 

Gallstone symptoms may be similar to those of other conditions, such as appendicitis, ulcers, pancreatitis, and gastroesophageal reflux disease. 

Sometimes, silent gallstones are found when a person does not have any symptoms. For example, a health care provider may notice gallstones when performing ultrasound for a different reason. 

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How are gallstones treated?

If gallstones are not causing symptoms, treatment is usually not needed. However, if a person has a gallbladder attack or other symptoms, a health care provider will usually recommend treatment. A person may be referred to a gastroenterologist—a doctor who specializes in digestive diseases—for treatment. If a person has had one gallbladder attack, more episodes will likely follow. 

The usual treatment for gallstones is surgery to remove the gallbladder. If a person cannot undergo surgery, nonsurgical treatments may be used to dissolve cholesterol gallstones. A health care provider may use ERCP to remove stones in people who cannot undergo surgery or to remove stones from the common bile duct in people who are about to have gallbladder removal surgery.

Surgery 

Surgery to remove the gallbladder, called cholecystectomy, is one of the most common operations performed on adults in the United States. 

The gallbladder is not an essential organ, which means a person can live normally without a gallbladder. Once the gallbladder is removed, bile flows out of the liver through the hepatic and common bile ducts and directly into the duodenum, instead of being stored in the gallbladder. 

Surgeons perform two types of cholecystectomy: 

• Laparoscopic cholecystectomy. In a laparoscopic cholecystectomy, the surgeon makes several tiny incisions in the abdomen and inserts a laparoscope—a thin tube with a tiny video camera attached. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close-up view of organs and tissues. While watching the monitor, the surgeon uses instruments to carefully separate the gallbladder from the liver, bile ducts, and other structures. Then the surgeon removes the gallbladder through one of the small incisions. Patients usually receive general anesthesia. 

  Most cholecystectomies are performed with laparoscopy. Many laparoscopic cholecystectomies are performed on an outpatient basis, meaning the person is able to go home the same day. Normal physical activity can usually be resumed in about a week.³

• Open cholecystectomy. An open cholecystectomy is performed when the gallbladder is severely inflamed, infected, or scarred from other operations. In most of these cases, open cholecystectomy is planned from the start. However, a surgeon may perform an open cholecystectomy when problems occur during a laparoscopic cholecystectomy. In these cases, the surgeon must switch to open cholecystectomy as a safety measure for the patient. 

  To perform an open cholecystectomy, the surgeon creates an incision about 4 to 6 inches long in the abdomen to remove the gallbladder.⁴ Patients usually receive general anesthesia. Recovery from open cholecystectomy may require some people to stay in the hospital for up to a week. Normal physical activity can usually be resumed after about a month.³

A small number of people have softer and more frequent stools after gallbladder removal because bile flows into the duodenum more often. Changes in bowel habits are usually temporary; however, they should be discussed with a health care provider. 

Though complications from gallbladder surgery are rare, the most common complication is injury to the bile ducts. An injured common bile duct can leak bile and cause a painful and possibly dangerous infection. One or more additional operations may be needed to repair the bile ducts. Bile duct injuries occur in less than 1 percent of cholecystectomies.⁵

Nonsurgical Treatments for Cholesterol Gallstones

Nonsurgical treatments are used only in special situations, such as when a person with cholesterol stones has a serious medical condition that prevents surgery. Gallstones often recur within 5 years after nonsurgical treatment.⁶

Two types of nonsurgical treatments can be used to dissolve cholesterol gallstones:

• Oral dissolution therapy. Ursodiol (Actigall) and chenodiol (Chenix) are medications that contain bile acids that can dissolve gallstones. These medications are most effective in dissolving small cholesterol stones. Months or years of treatment may be needed to dissolve all stones. 
• Shock wave lithotripsy. A machine called a lithotripter is used to crush the gallstone. The lithotripter generates shock waves that pass through the person’s body to break the gallstone into smaller pieces. This procedure is used only rarely and may be used along with ursodiol. 

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Eating, Diet, and Nutrition

Factors related to eating, diet, and nutrition that increase the risk of gallstones include

• obesity 
• rapid weight loss 
• diets high in calories and refined carbohydrates and low in fiber 

People can decrease their risk of gallstones by maintaining a healthy weight through proper diet and nutrition. 

Ursodiol can help prevent gallstones in people who rapidly lose weight through low-calorie diets or bariatric surgery. People should talk with their health care provider or dietitian about what diet is right for them. 

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Points to Remember

• Gallstones are hard particles that develop in the gallbladder.
• Imbalances in the substances that make up bile cause gallstones. Gallstones may form if bile contains too much cholesterol, too much bilirubin, or not enough bile salts. Scientists do not fully understand why these imbalances occur. 
• Women, people over age 40, people with a family history of gallstones, American Indians, and Mexican Americans have a higher risk of developing gallstones. 
• Many people with gallstones do not have symptoms. Gallstones that do not cause symptoms are called asymptomatic, or silent, gallstones.
• If gallstones block the bile ducts, pressure increases in the gallbladder, causing a gallbladder attack.
• Gallbladder attacks often follow heavy meals, and they usually occur in the evening or during the night.
• Gallstone symptoms may be similar to those of other conditions. 
• If gallstones are not causing symptoms, treatment is usually not needed. However, if a person has a gallbladder attack or other symptoms, a health care provider will usually recommend treatment. 
• The usual treatment for gallstones is surgery to remove the gallbladder. If a person cannot undergo surgery, nonsurgical treatments may be used to dissolve cholesterol gallstones. A health care provider may use endoscopic retrograde cholangiopancreatography (ERCP) to remove stones in people who cannot undergo surgery or to remove stones from the common bile duct in people who are about to have gallbladder removal surgery. 
• The gallbladder is not an essential organ, which means a person can live normally without a gallbladder. Once the gallbladder is removed, bile flows out of the liver through the hepatic and common bile ducts and directly into the duodenum, instead of being stored in the gallbladder. 

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References

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Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions. 

What are clinical trials, and are they right for you?
Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for youExternal NIH Link. 

What clinical trials are open?
Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.govExternal Link Disclaimer. 

This information may contain content about medications and, when taken as prescribed, the conditions they treat. When prepared, this content included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1-888-INFO-FDA (1-888-463-6332) or visit www.fda.govExternal Link Disclaimer. Consult your health care provider for more information.

The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory. 

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This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

The NIDDK would like to thank:
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This information is not copyrighted. The NIDDK encourages people to share this content freely.

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November 2013

Cholelithiasis – Symptoms, Causes, Treatments

Cholelithiasis is the medical name for hard deposits (gallstones) that may form in the gallbladder. Cholelithiasis is common in the United States population. Six percent of adult men and 10% of adult women are affected.

The cause of cholelithiasis is not completely understood, but it is thought to have multiple factors. The gallbladder stores bile and releases it into the small intestine when it is needed for digestion. Gallstones can develop if the bile contains too much cholesterol or too much bilirubin (one of the components of bile), or if the gallbladder is dysfunctional and cannot release the bile.

Different types of gallstones form in cholelithiasis. The most common type, called a cholesterol stone, results from the presence of too much cholesterol in the bile. Another type of stone, called a pigment stone, is formed from excess bilirubin, a waste product created by the breakdown of the red blood cells in the liver. The size and number of gallstones varies in cholelithiasis; the gallbladder can form many small stones or one large stone.

The course of cholelithiasis varies among individuals. Most people with cholelithiasis have no symptoms at all. A minority of patients with gallstones develop symptoms: severe abdominal pain, nausea and vomiting, and complete blockage of the bile ducts that may pose the risk of infection.

Cholelithiasis can lead to cholecystitis, inflammation of the gallbladder. Acute gallstone attacks may be managed with intravenous medications. Chronic (long-standing) cholelithiasis is treated by surgical removal of the gallbladder.

Left untreated, cholelithiasis can lead to serious complications such as tissue damage, tears in the gallbladder, and infection that spreads to other parts of your body.
Seek immediate medical care (call 911) for serious symptoms, such as high fever (higher than 101 degrees Fahrenheit), severe abdominal pain, abdominal swelling, and nausea with or without vomiting.

Seek prompt medical care if you are being treated for cholelithiasis, but mild symptoms recur or are persistent.

Symptoms & Causes of Gallstones

What are the symptoms of gallstones?

If gallstones block your bile ducts, bile could build up in your gallbladder, causing a gallbladder attack, sometimes called biliary colic. Gallbladder attacks usually cause pain in your upper right abdomen, sometimes lasting several hours. Gallbladder attacks often follow heavy meals and usually occur in the evening or during the night. If you’ve had one gallbladder attack, more attacks will likely follow.

Gallbladder attacks usually stop when gallstones move and no longer block the bile ducts. However, if any of your bile ducts stay blocked for more than a few hours, you may develop gallstone complications. Gallstones that do not block your bile ducts do not cause symptoms.

When you develop gallstones that block your bile ducts, bile builds up in your gallbladder, causing a gallbladder attack.

Silent gallstones

Most people with gallstones do not have symptoms. Gallstones that do not cause symptoms are called silent gallstones. Silent gallstones don’t stop your gallbladder, liver, or pancreas from working, so they do not need treatment.

Seek care right away for a gallbladder attack

See a doctor right away if you are having these symptoms during or after a gallbladder attack:

• pain in your abdomen lasting several hours
• nausea and vomiting
• fever—even a low-grade fever—or chills
• yellowish color of your skin or whites of your eyes, called jaundice
• tea-colored urine and light-colored stools

These symptoms may be signs of a serious infection or inflammation of the gallbladder, liver, or pancreas. Gallstone symptoms may be similar to symptoms of other conditions, such as appendicitis, ulcers, pancreatitis, and gastroesophageal reflux disease, all of which should be treated by a doctor as soon as possible.

Gallstone complications can occur if your bile ducts stay blocked. Left untreated, blockages of the bile ducts or pancreatic duct can be fatal.

What causes gallstones?

Gallstones may form if bile contains too much cholesterol, too much bilirubin, or not enough bile salts. Researchers do not fully understand why these changes in bile occur. Gallstones also may form if the gallbladder does not empty completely or often enough. Certain people are more likely to have gallstones than others because of their risk factors for gallstones, including obesity and certain kinds of dieting.

Gallstones – causes, symptoms, treatment

Gallstones are crystal-like deposits that form in the gallbladder – a small organ under the liver that stores bile (a fluid used by the digestive system).

The stones may stay in the gallbladder and cause no symptoms, or they may irritate the gallbladder wall or block gallbladder ducts, resulting in infection, inflammation and upper abdominal pain. It is possible for the infection to spread to the liver or pancreas. Treatment can range from pain relief to surgery. 

In New Zealand, the proportion of the population with gallstones may be as high as 20%.

Causes

The gallbladder is part of the digestive system. It is a pear-shaped, sac-like structure approximately 8 cm long and 2.5 cm wide, located alongside the stomach and attached to the lower surface of the liver. The function of the gallbladder is to concentrate, store, and excrete bile ( a fluid that helps in the digestion of fat). 

Bile has several components including cholesterol, bile salts, and bile pigments (eg: bilirubin). Gallstones are thought to develop because of an imbalance in the chemical composition of bile inside the gallbladder, such as when the levels of cholesterol or bilirubin in the bile become too high. The excess cholesterol or bile forms crystals, which eventually form stones. 

The two main types of gallstones are: 

• Cholesterol gallstones: The majority of all gallstones are cholesterol stones. The amount of cholesterol that can dissolve in bile depends on how much bile salt it contains. Too much cholesterol, or too little bile salt, tends to cause cholesterol stones to form in the gallbladder.    
• Pigment gallstones: These stones are formed by calcium and bilirubin when there is an excess of bilirubin in the gallbladder. Pigment stones tend to form in patients with certain blood or liver disorders. 

Risk factors

The risk of developing gallstones tends to increase with age (especially after age 40 years) and they’re more common among people of European ethnicity than Maori, Pacific or Asian New Zealanders.

Women develop gallstones more commonly than men and at a younger age, and there is frequently a family history of the disease.

Other factors that increase the risk of developing gallstones include:

• Being overweight or obese – particularly when the extra weight is carried around the waist
• Eating a high-fat, low-fibre diet
• Having diabetes
• Having high blood cholesterol levels
• Heavy drinking
• Smoking.

As pregnancy and contraceptive pills can slow down gallbladder activity, women who have had multiple pregnancies or long-term contraceptive pill use are at higher risk of developing gallstones.

Signs and symptoms

Gallstones vary greatly in size. Some people may form one large stone, whereas others may have hundreds of tiny stones. Most commonly, gallstones are 5–10 mm in diameter.

Most people with gallstones do not experience any symptoms. If symptoms are present, the most common early sign of gallstones is upper abdominal pain. This pain usually occurs in the upper right side of the abdomen, is often sudden and severe, and may radiate to the chest, back, or the area between the shoulders. Other symptoms that may occur include:

• Indigestion 
• Nausea or vomiting
• Jaundice (the yellow appearance of skin and the whites of eyes caused by bilirubin build-up in the blood) when gallstones block the passage of bile
• Light-coloured stools.

The abdominal pain associated with gallstones is referred to as biliary colic. This type of pain is commonly set off by eating fatty foods and often occurs in the middle of the night. The symptoms experienced may be so severe that people need to seek immediate medical attention.

When infection of the gallbladder is present it is possible to also experience low-grade fever, sweats, and chills.

Diagnosis

If gallstones are suspected, it is important to consult a doctor for an accurate diagnosis and treatment. The doctor will look for signs of jaundice and will assess the abdomen for swelling and pain. Blood tests are usually performed to check the function of the liver and pancreas and to rule out other conditions that may be causing the symptoms. 

The most common test used to definitively diagnose gallstones is an abdominal ultrasound scan to create pictures of the gallbladder, which are then analysed to look for signs of gallstones.

An endoscopic ultrasound (EUS) is a procedure that can help identify smaller stones that may be missed by an abdominal ultrasound. A thin, flexible tube (endoscope) is passed through the mouth and into the digestive tract, to provide a precise image of the gallbladder and nearby tissues.

If it is suspected that gallstones are blocking the ducts, then a test called endoscopic retrograde cholangiopancreatography (ERCP) may be performed. This test involves inserting an endoscope with a light and camera at its tip through the mouth into the digestive tract. A special dye is injected through the endoscope into the bile ducts allowing the outline of the ducts to be highlighted. Gallstones found in the ducts can sometimes be removed during the ERCP procedure.

Other specialised scans or x-rays are sometimes used to confirm the diagnosis and highlight the location of the gallstones.

Treatment

In general, treatment will depend on the frequency and severity of the symptoms experienced. Because it is possible that people who experience biliary colic will not experience a further episode, your doctor may advise a wait and see approach.

If attacks are occasional and mild, they may be able to be managed with pain-relieving medications, applying heat to the affected area, resting and taking sips of water. Reducing the amount of fat in your diet and maintaining a healthy body weight may also be beneficial. If attacks are frequent or severe surgery is usually recommended.

Surgery

Cholecystectomy is the surgical removal of the gallbladder and is a common and routine procedure. It may be recommended when the symptoms of gallstones are problematic. If there is infection or acute inflammation of the gallbladder, this may need to be treated with antibiotics before the gallbladder can be removed.

The gallbladder is not essential to live or to digest food. When the gallbladder is removed, bile is still produced by the liver and flows directly into the small intestine.

The two cholecystectomy techniques are:

Open cholecystectomy

This is the “traditional” but now-a-days less common surgical technique for removing the gallbladder and is performed under a general anaesthetic. A single incision is made below the rib cage. Through the incision, the surgeon can view the area and remove the gallbladder.  

Laparoscopic cholecystectomy

Laparoscopic cholecystectomy is also performed under general anaesthetic but is less invasive and much more commonly used than the open cholecystectomy technique. It has a faster recovery time and a shorter hospital stay (usually just one night). A telescope-like instrument (a laparoscope) is inserted through one incision (allowing the surgeon to view the inside of the abdominal cavity on a television monitor) and surgical instruments are inserted through other incisions. The gallbladder is located and removed through an incision in the belly button.

Surgery risks and complications

As with any surgery, there are possible risks and complications which you should discuss with your doctor before surgery. These include:

• Anaesthetic complications
• Bleeding
• Wound infection
• Injury to or leakage from the bile duct
• Discomfort or numbness around the area of incision
• Jaundice.

Medication

For small gallstones that don’t contain calcium, it may be possible to dissolve them by taking ursodeoxycholic acid tablets. However, ursodeoxycholic acid tablets are not often recommended because they are not always effective, need to be taken for a long time (up to 2 years), and gallstones are likely to form again once treatment is stopped. They are usually used for people who are unable to undergo surgery. Occasionally, they may be used to prevent gallstones in people at high risk of developing them.

References

Chapman, B.A., et al. (2003). Gallstone prevalence in Christchurch: risk factors and clinical significance. N Z Med J. 2000;113(1104):46–8. 
Mayo Clinic (2019). Gallstones (Web Page). Rochester, MN: Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/gallstones/symptoms-causes/syc-20354214 [Accessed: 23/08/19]
NHS (2015). Gallstones (Web Page). Redditch: National Health Service (NHS) 
England. https://www.nhs.uk/conditions/gallstones/ [Accessed: 23/08/19]
O’Toole, M.T. (Ed.) (2017). Cholelithiasis. Mosby’s Dictionary of Medicine, Nursing & Health Professions (10th ed.). St Louis: Elsevier. 
O’Toole, M.T. (Ed.) (2017). Choledocholithiasis. Mosby’s Dictionary of Medicine, Nursing & Health Professions (10th ed.). St Louis: Elsevier. 
Stringer, M.D., et al. (2013). Gallstones in New Zealand: composition, risk factors and ethnic differences. ANZ J Surg. 2013 Jul;83(7-8):575–80.

Last Reviewed – September 2019

Cholelithiasis

Cholelithiasis – in the intra- and extrahepatic bile ducts, brown pigmented stones are primarily found, which in most cases are the result of invasive research methods and surgical intervention on the biliary tract. Stones that migrate from the gallbladder to the common bile duct are usually cholesterol. Concrements formed primarily in the bile ducts are often pigmented, including calcium bilirubinate. In addition, cholesterol and black stones of the gallbladder can migrate into the bile ducts, as a result of which, in a number of patients (15%), the stones simultaneously end up in the gallbladder and in the bile ducts.

Prevalence. In 70-80% of cases, migrated cholesterol stones are found in the bile ducts. In recent years, there has been an increase in the incidence of cholepithiasis by 40%.

Symptoms of Cholelithiasis

The most important clinical symptom of cholelithiasis is jaundice caused by obstruction of the bile ducts. Concrements can spontaneously enter the intestines, being excreted with feces. The diameter of the stone largely determines its migration: for example, calculi with a diameter of 0.7 cm are able to enter the cystic duct, up to 2.5 cm – to reach the iliac spine.The location of the calculus distal to the Wirsung duct provokes the development of biliary pancreatitis. Stones up to 5 cm in diameter can obstruct the lumen of the ileum. Often, the presence of calculi of the bile duct does not give clinical manifestations for many years.The characteristic of pain syndrome in the presence of stones in the bile ducts is similar to that in gallstone disease Charcot’s Triad (intermittent biliary Charcot fever), in which there is pain in the right upper quadrant of the abdomen and epigastrium, the appearance obstructive jaundice after a painful syndrome of hectic fever (often with temperature “candles”, chills, profuse sweating), is a classic syndrome and is observed in 70% of cases.Cholangitis with choledocholithiasis occurs more often than with malignant obstruction of the bile ducts.

Complications of this condition include blockage of the bile duct, cholestasis, secondary biliary cirrhosis, cholangitis, sepsis, liver abscesses, acute pancreatitis, rupture of the bile duct and the formation of fistulas, hemobilia, intestinal obstruction due to gallstone, cholangiocarcinoma. Obstructive jaundice due to choledocholithiasis is usually accompanied by pain.Jaundice caused by a tumor in the bile ducts is often painless. The clinical picture of choledocholithiasis can be manifested by symptoms of infection. In patients with cholangiogenic sepsis, fever, leukocytosis, and chills are observed.

Diagnostics

Diagnosis of choledocholithiasis is quite difficult. In the case of “silent” calculi of the bile ducts, laboratory parameters practically do not change, in contrast to situations characterized by blockage of the bile ducts with the development of ascending cholangitis.At the same time, there is an increase in the activity of serum aminotransferases (ALT, ASAT) and cholestasis enzymes (alkaline phosphatase, γ-glutamyl transpeptidase). If there are signs of inflammation, a blood culture is required. The most common etiopathogenetic factors are enterococci, intestinal gram-negative bacteria. Ultrasound of the bile ducts is informative only in 20-50% of cases, which may be due to the tight fit of calculi to the wall of the gallbladder and their non-displacement. K1 has a higher resolution for visualization of common bile duct stones than ultrasound.When using CT, the initial use of oral contrast agents should be avoided, because they can mask stones in the distal duct Concrements of intrahepatic bile ducts are visualized better than calculi of extrahepatic bile ducts Calcifications of the liver parenchyma can be located in any area: stones of 1-2 mm to 1.5 cm can form clusters of increased echogenicity with indistinct contours, often leaving an acoustic shadow.An echo-negative path and an extended section of the duct are visible next to the stone. Sometimes, due to perifocal inflammation around the stone or their accumulation, an echo-negative halo is located, which may disappear during treatment.

Informative diagnostic methods are oral and intravenous cholegraphy, as well as percutaneous transhepatic cholangiography. Magnetic resonance cholangiopancreaticography (MRCP) is considered one of the most informative methods, since bile duct stones are visualized in 100% of cases, but this study is inferior to endoscopic retrograde cholangiopancreatography (ERCP), which can be performed not only for diagnostic, but also for therapeutic purposes.Endoscopic ultrasound (EUS) in terms of diagnostic significance in choledocholithiasis is comparable to ERCP, ultrasound and CT, as a rule, reveal enlargement of the bile ducts, but the absence of this sign does not exclude the presence of choledocholithiasis. The main limitation of ultrasound is insufficient visualization of the distal common bile duct. These methods provide the necessary visualization with an enlarged common bile duct. Magnetic resonance hepatobiliary scanning in this situation has a higher resolution.

Cholelithiasis (cholelithiasis)

Diagnostics

As already noted, the first symptoms of cholelithiasis, obvious to the patient himself, appear only in the last stages, when the stones are already formed, cause discomfort and are easily diagnosed.

So, the diagnosis of gallstone disease in most cases is based on an analysis of the nature of the patient’s pain, as well as the results of ultrasound of internal organs, allowing you to see even the smallest pebbles.

Radiography, magnetic resonance cholangiopancreatography, retrograde cholangiopancreatography can also be used. Along with this, the patient is offered to pass blood tests, as well as the so-called “liver tests”.

Analyzes for cholelithiasis

So, the main analyzes for cholelithiasis are general and biochemical blood tests.The first allows you to identify the inflammatory process in the body (it is indicated, first of all, by increased ESR, as well as neutrophilic leukocytosis). The second (biochemical blood test for cholelithiasis) indicates an increase in the level of bilirubin, alkaline phosphatase activity, blood cholesterol, etc.

Also, in order to detect bilirubinuria in jaundice, a urinalysis may be prescribed.

Treatment

All patients are primarily interested in the question of how to treat gallstone disease.As already noted, in most cases, this problem can be solved only by surgery, completely removing the gallbladder, and with it the existing stones. But surgical intervention is resorted to only in cases of an acute or chronic form of the disease, when stones pose a real threat to the patient’s health.

It is worth noting that, although the removal of the gallbladder naturally affects the patient’s further lifestyle, this should be treated sensibly. Yes, it’s unpleasant, I don’t want to, but when it’s really necessary, there’s nowhere to go.Thousands of people after such an operation live fully, it is enough to make a few adjustments to their lifestyle and nutrition. So, it is very important that the attending physician is able to correctly assess all the risks and make the right decision with you.

Gallstone disease: treatment without surgery

Of course, the prospect of removing the gallbladder scares the patient, forcing him to look for alternative methods of cure. Immediately, we note: the treatment of gallstone disease with folk remedies, when it comes to the acute or chronic form of the disease, is not able to help in principle.

Modern medicine has a certain arsenal of means of combating gallstone disease, including:

• drug dissolution of calculi;
• non-contact crushing of stones, which are then removed naturally.

Also, always the treatment of gallstone disease involves the rationalization of nutrition (exclusion of fats, etc.)

Note that the use of these modern methods is not always possible.And again, a decision on the choice of the most appropriate method of treatment in a particular case can only be made jointly by the patient and his attending physician, and it depends on the competence of the latter, how successful the treatment will be.

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June
2018

Cholelithiasis

Cholelithiasis – a disease of the gallbladder and bile ducts with the formation of stones.Although, the correct name of the medical term is as “gallstone disease” – ICD-10 code: K80. The disease is complicated by defective liver function, hepatic colic, cholecystitis (inflammation of the gallbladder) and may be obstructive jaundice with the need for a surgical operation to remove the gallbladder.

Today we will consider the causes, symptoms, signs, exacerbation, what to do in case of an attack of pain, when an operation is needed. Let’s especially talk about the nutrition of patients (diet), the menu, what foods can and cannot be eaten during treatment without surgery and after it.

What is it?

Cholelithiasis is a pathological process in which stones (calculi) form in the gallbladder and ducts. Due to the formation of stones in the gallbladder, the patient develops cholecystitis.

How gallstones are formed

The gallbladder is a reservoir for bile produced by the liver. The movement of bile along the biliary tract is provided due to the coordinated activity of the liver, gallbladder, common bile duct, pancreas, duodenum.This ensures the timely flow of bile into the intestines during digestion and its accumulation in the gallbladder on an empty stomach.

The formation of stones in it occurs due to changes in the composition and stagnation of bile (dyscholia), inflammatory processes, motor-tonic disorders of bile secretion (dyskinesia).

There are cholesterol (up to 80-90% of all gallstones), pigmented and mixed stones.

1. The formation of cholesterol stones is facilitated by the oversaturation of bile with cholesterol, its precipitation, the formation of cholesterol crystals.With impaired motility of the gallbladder, crystals are not excreted into the intestine, but remain and begin to grow.
2. Pigment (bilirubin) stones appear as a result of increased breakdown of red blood cells in hemolytic anemia.
3. Mixed stones are a combination of both shapes. Contains calcium, bilirubin, cholesterol.

Occur mainly in inflammatory diseases of the gallbladder and biliary tract.

Risk factors

There are several reasons for the occurrence of gallstone disease:

excessive secretion of cholesterol in bile

Decreased secretion of phospholipids and bile acids into bile

stagnation of bile

biliary tract infection

· hemolytic diseases.

Most gallstones are mixed. They include cholesterol, bilirubin, bile acids, proteins, glycoproteins, various salts, trace elements. Cholesterol stones contain mainly cholesterol, have a round or oval shape, layered structure, a diameter of 4-5 to 12-15 mm, localized in the gallbladder.

1. Cholesterol-pigment-calcareous stones – multiple, have edges, the shape is different. They vary considerably in number – tens, hundreds and even thousands.
2. Pigmented stones – small, multiple, hard, fragile, completely homogeneous, black with a metallic shade, located both in the gallbladder and in the bile ducts.
3. Calcium stones are composed of various calcium salts, bizarre shape, have spike-like processes, light or dark brown in color.

Epidemiology

According to numerous publications during the XX century, especially in the second half of it, there was a rapid increase in the prevalence of cholesterol, mainly in industrialized countries, including Russia.

Thus, according to a number of authors, the incidence of cholelithiasis in the former USSR increased almost twice every 10 years, and stones in the biliary tract were detected at autopsies in every tenth deceased, regardless of the cause of death. At the end of the 20th century, more than 5 million were registered in the Federal Republic of Germany, and in the USA more than 15 million patients with cholelithiasis, and about 10% of the adult population suffered from this disease. According to medical statistics, cholelithiasis occurs in women much more often than in men (ratio from 3: 1 to 8: 1), and with age, the number of patients increases significantly and after 70 years it reaches 30% or more in the population.

Increasing surgical activity for cholelithiasis during the second half of the 20th century led to the fact that in many countries the frequency of operations on the biliary tract surpassed the number of other abdominal operations (including appendectomy). So, in the USA in the 70s, more than 250 thousand cholecystectomies were performed annually, in the 80s – more than 400 thousand, and in the 90s – up to 500 thousand

Classification

Based on the characteristics of the disease adopted today, its following classification is distinguished in accordance with the stages that are relevant for it:

1. Stone formation – a stage that is also defined as latent stone carriage.In this case, there are no symptoms of gallstone disease, however, the use of instrumental diagnostic methods allows us to determine the presence of stones in the gallbladder;
2. Physicochemical (initial) stage – or, as it is also called, the pre-stone stage. It is characterized by changes in the composition of bile. There are no special clinical manifestations at this stage, the detection of the disease at the initial stage is possible, for which a biochemical analysis of bile is used for the peculiarities of its composition;
3. Clinical manifestations – a stage, the symptoms of which indicate the development of an acute or chronic form of calculous cholecystitis.

In some cases, the fourth stage is also distinguished, which consists in the development of complications associated with the disease.

Symptoms of gallstone disease

In principle, gallstone disease can proceed for a very long time without any symptoms or manifestations. This is due to the fact that the stones in the early stages are small, do not clog the bile duct and do not injure the walls. The patient may for a long time be completely unaware of the presence of this problem.In these cases, they usually talk about stone-bearing. When the actual gallstone disease makes itself felt, it can manifest itself in different ways.

Among the first symptoms of the disease should be noted the heaviness in the abdomen after eating, stool disturbances (especially after eating fatty foods), nausea and moderate jaundice. These symptoms may appear even before severe pain in the right hypochondrium – the main symptom of cholelithiasis. They are explained by unexpressed violations of the outflow of bile, which is why the digestion process is worse.

The following symptoms and signs are most common for gallstone disease:

1. Temperature rise. A rise in temperature usually indicates acute cholecystitis, which often accompanies gallstone disease. An intense inflammatory process in the right hypochondrium leads to the release of active substances into the blood that contribute to a rise in temperature. Prolonged pain after colic with the addition of fever almost always speaks of acute cholecystitis or other complications of the disease.A periodic rise in temperature (wave-like) with a rise above 38 degrees may indicate cholangitis. However, in general, fever is not an obligatory symptom in cholelithiasis. The temperature may remain normal even after severe lingering colic.
2. Pain in the right hypochondrium. The most typical manifestation of cholelithiasis is the so-called biliary (biliary, hepatic) colic. This is an attack of acute pain, which in most cases is localized at the intersection of the right costal arch and the right edge of the rectus abdominis muscle.The duration of an attack can vary from 10 to 15 minutes to several hours. At this time, the pain can be very severe, give to the right shoulder, back or other areas of the abdomen. If the attack lasts more than 5-6 hours, then you should think about possible complications. The frequency of seizures varies. It often takes about a year between the first and second seizures. However, in general, they become more frequent over time.
3. Fat intolerance. In the human body, bile is responsible for the emulsification (dissolution) of fats in the intestine, which is necessary for their normal breakdown, absorption and assimilation.In gallstones, stones in the neck or bile duct often block the path of bile to the intestines. As a result, fatty foods do not break down normally and cause intestinal disturbances. These disorders can manifest themselves as diarrhea (diarrhea), flatulence in the intestines (flatulence), and mild abdominal pain. All these symptoms are non-specific and can occur in various diseases of the gastrointestinal tract (gastrointestinal tract). Intolerance to fatty foods can also occur at the stage of stone bearing, when other symptoms of the disease are still absent.At the same time, even a large stone located at the bottom of the gallbladder may not block the outflow of bile, and fatty foods will be digested normally.
4. Jaundice. Jaundice occurs due to stagnation of bile. The pigment bilirubin is responsible for its appearance, which is normally excreted with bile into the intestine, and from there it is excreted from the body with feces. Bilirubin is a natural metabolic product. If it ceases to be secreted with bile, then it accumulates in the blood.So it spreads throughout the body and accumulates in the tissues, giving them a characteristic yellowish tint. Most often, in patients, the sclera of the eyes turn yellow first, and only then the skin. In light people, this symptom is noticeable better, and in dark-skinned people, unexpressed jaundice can be missed even by an experienced doctor. Often, simultaneously with the onset of jaundice, the urine also darkens in patients (dark yellow, but not brown). This is because the pigment begins to be excreted from the body through the kidneys. Jaundice is not an obligatory symptom in calculous cholecystitis.Also, it does not appear only with this disease. Bilirubin can also accumulate in the blood during hepatitis, liver cirrhosis, some hematological diseases or poisoning.

In general, the symptoms of gallstone disease can be quite varied. There are various stool disorders, atypical pains, nausea, periodic bouts of vomiting. Most doctors are aware of this variety of symptoms, and just in case they prescribe an ultrasound of the gallbladder to exclude gallstone disease.

Attack of gallstone disease

An attack of gallstone disease usually means biliary colic, which is the most acute and typical manifestation of the disease. Stone carriage does not cause any symptoms or disorders, and patients usually do not attach importance to unexpressed digestive disorders. Thus, the disease is latent (hidden).

Biliary colic usually appears suddenly. It is caused by a spasm of smooth muscles located in the walls of the gallbladder.Sometimes the mucous membrane is also damaged. This most often occurs when the stone is displaced and gets stuck in the neck of the bladder. Here it blocks the outflow of bile, and bile from the liver does not accumulate in the bladder, but flows directly into the intestines.

Thus, an attack of cholelithiasis is usually manifested by characteristic pains in the right hypochondrium. In parallel, the patient may experience nausea and vomiting. Often, an attack occurs after sudden movements or exertion, or after eating a large amount of fatty foods.Once during an exacerbation, stool discoloration may be observed. This is due to the fact that pigmented (colored) bile from the gallbladder does not enter the intestines. Bile from the liver flows down only in small quantities and does not give an intense color. This symptom is called acholia. In general, the most typical manifestation of an attack of gallstone disease is characteristic pain, which will be described below.

Diagnostics

Identification of symptoms characteristic of hepatic colic requires specialist advice.Under the physical examination, he carried out, it means the identification of symptoms characteristic of the presence of stones in the gallbladder (Murphy, Ortner, Zakharyin). In addition, a certain tension and soreness of the skin in the area of ​​the muscles of the abdominal wall within the projection of the gallbladder is revealed. The presence of xanthomas on the skin (yellow spots on the skin formed against the background of lipid metabolism disturbances in the body) is also noted, yellowness of the skin and sclera is noted.

The results of a general blood test determine the presence of signs indicating nonspecific inflammation at the stage of clinical exacerbation, which in particular consist in a moderate increase in ESR and in leukocytosis.A biochemical blood test determines hypercholesterolemia, as well as hyperbilirubinemia and increased activity characteristic of alkaline phosphatase.

Cholecystography, used as a method for diagnosing gallstone disease, determines the enlargement of the gallbladder, as well as the presence of calcareous inclusions in the walls. In addition, in this case, the stones with lime inside are clearly visible.

The most informative method, which is also the most common in the study of the area of ​​interest to us and for the disease in particular, is an ultrasound of the abdominal cavity.When examining the abdominal cavity, in this case, accuracy is ensured regarding the detection of certain echo-tight formations in the form of stones in combination with pathological deformations that the bladder walls undergo during the disease, as well as with changes that are relevant in its motility. Signs indicating cholecystitis are also clearly visible on ultrasound.

The imaging of the gallbladder and ducts can also be performed using MRI and CT techniques for this purpose in the specified areas.Scintigraphy, as well as endoscopic retrograde cholangiopancreatography, can be used as an informative method indicating disturbances in the processes of bile circulation.

Diet for cholelithiasis

It is necessary to limit or exclude from the diet fatty, high-calorie, cholesterol-rich dishes, especially with a hereditary predisposition to cholelithiasis. Food should be frequent (4-6 times a day), in small portions, which helps to reduce the stagnation of bile in the gallbladder.The food should contain a sufficient amount of dietary fiber, due to vegetables and fruits. You can add food bran (15 g 2-3 times a day). This reduces the lithogenicity (tendency to stone formation) of bile.

The therapeutic diet for cholelithiasis lasts from 1 to 2 years. Compliance with a diet is the best prevention of exacerbations of gallstone pathology, and if you do not adhere to it, then severe complications may develop.

The consequences of non-compliance include: the occurrence of atherosclerosis, the appearance of constipation, dangerous with stones in the bladder, an increase in the load on the gastrointestinal tract and an increase in the density of bile.A therapeutic diet will help to cope with excess weight, improve the intestinal microflora and protect the immune system. As a result, a person’s mood improves, sleep is normalized.

In severe cases, non-compliance with the diet leads to ulcers, gastritis, colitis. If you want to recover from pathology without surgery, then diet is the primary requirement.

Operation

Patients should undergo elective surgery before or immediately after the first biliary colic attack. This is due to the high risk of complications.

After surgical treatment, it is necessary to observe an individual dietary regimen (frequent, fractional meals with restriction or exclusion of individually intolerable foods, fatty, fried foods), adherence to work and rest, physical education. Eliminate alcohol consumption. It is possible to have a spa treatment after the operation, provided that the remission is stable.

Complications

The appearance of stones is fraught not only with dysfunction of organs, but also with the occurrence of inflammatory changes in the gallbladder and organs located nearby.So, due to stones, the walls of the bladder can be injured, which, in turn, provokes the onset of inflammation. Provided that the stones pass through the cystic duct with bile from the gallbladder, the outflow of bile may be difficult. In the most severe cases, stones can block the entry and exit of the gallbladder, becoming stuck in it. With such phenomena, bile stagnation occurs, and this is a prerequisite for the development of inflammation. The inflammatory process can develop over several hours and over several days.

Under such conditions, the patient may develop an acute inflammatory process of the gallbladder. Moreover, both the degree of damage and the rate of development of inflammation can be different. So, both minor edema of the wall and its destruction and, as a result, rupture of the gallbladder are possible. Such complications of gallstone disease are life-threatening. If the inflammation spreads to the abdominal organs and to the peritoneum, then the patient develops peritonitis. As a result, the complication of these phenomena can be infectious-toxic shock and multiple organ failure.In this case, there is a violation of the work of blood vessels, kidneys, heart, brain. With severe inflammation and high toxicity of microbes multiplying in the affected wall of the gallbladder, an infectious-toxic shock can appear immediately.

In this case, even resuscitation measures do not guarantee that the patient will be able to get out of this state and avoid death.

Prevention

For the prevention of the disease, it is useful to carry out the following measures:

· do not practice prolonged therapeutic fasting;

· for the prevention of gallstone disease, it is useful to drink enough liquid, at least 1.5L per day;

· in order not to provoke the movement of stones, avoid work associated with a prolonged stay in an inclined position;

· follow a diet, normalize body weight;

· increase physical activity, give the body more movement;

· eat more often, every 3-4 hours, to cause regular emptying of the bladder from accumulated bile;

· women should limit the intake of estrogen, this hormone promotes the formation of stones or their increase.

For the prevention and treatment of cholelithiasis, it is useful to include in the daily diet a small amount (1-2 tsp.) Of vegetable oil, preferably olive oil. Sunflower is digested only by 80%, while olive oil is completely digestible. In addition, it is more suitable for frying because it produces fewer phenolic compounds.

The intake of vegetable fat stimulates the activity of the bile bladder, as a result of which it is able to empty itself at least once a day, preventing congestion and the formation of stones.

To normalize metabolism and prevent gallstone disease, magnesium should be included in the diet. The trace element stimulates intestinal motility and bile production, removes cholesterol. In addition, an adequate supply of zinc is required for the production of bile enzymes.

In case of cholelithiasis, it is better to stop drinking coffee. The drink stimulates the bladder to contract, which can cause a blockage in the duct and subsequent seizure.

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Laparoscopic cholecystectomy – treatment of gallstone disease

The modern history of the treatment of cholelithiasis (cholelithiasis) reads a little more than 100 years from the moment when in 1882. Langenbuch performed the first cholecystectomy. Progress in the treatment of this disease until the beginning of the 70s of this century was mainly associated with the general development of medicine – the discovery of antibiotics, the development of the principles of general anesthesia, the development of radiation diagnostic methods. However, in recent decades, a new stage in urology has begun – the treatment of cholelithiasis.

For the first time, laparoscopic cholecystectomy in humans was performed Mouret (Lyon, France) in 1987. and then received rapid distribution and recognition in the developed countries of the world.

Laparoscopic cholecystectomy combines:

– radicality (the pathologically altered gallbladder with calculi is removed)

– low invasiveness (the integrity of the soft tissues of the abdominal wall, especially the aponeurosis and muscles, is almost completely preserved), due to which the recovery time of patients is significantly reduced.

– cosmetic effect of the intervention – small skin incisions (5-10 mm) heal with the formation of subtle scars.

INDICATIONS FOR LAPAROSCOPIC CHOLECYSTECTOMY

• Chronic calculous cholecystitis.

• Gallbladder cholesterosis.

• Gallbladder polyposis.

• Acute cholecystitis.

Preoperative examination

General clinical examination methods

• Ultrasound is the main method for diagnosing gallstones, allowing you to determine:

• the presence of stones in the gallbladder and their size;

• the presence of calculi in the CBD or indirect signs of choledocholithiasis;

• the degree of inflammatory-infiltrative changes and the thickness of the gallbladder wall;

• diameter of the CBD, common hepatic and cystic ducts;

• location and size of the gallbladder;

• the presence of an adhesive process in the subhepatic space.

Advantages of endosurgery compared to traditional operations

1. Low trauma, which manifests itself in the form of a decrease in postoperative pain, rapid (1-2 days) restoration of physiological functions.

2. Short hospital stay. Many operations are performed on an outpatient basis, or they require only 2-3 days of stay in a surgical hospital.Reducing the period of disability by 2-5 times.

3. Cosmetic effect. The marks from 5-10 mm punctures are not comparable with the scars left after traditional “open” operations, which is especially important cosmetically.

4. Economic efficiency. Although the cost of the operation is higher, the treatment turns out to be more cost-effective due to savings in medication, a decrease in the length of the hospital period and the patient’s rehabilitation time.

Recovery after surgery

The main advantage of this type of surgery is a quick and painless recovery. After discharge from the hospital, it is extremely important to strictly adhere to some not the most difficult rules that will help the most comfortable rehabilitation. The main recommendations in the postoperative period, doctors – surgeons include:

• Abstinence from intimacy is not required.

• Compliance with a diet.

• Physical activity, exercise and sports are allowed 6-7 days after the operation.

• It is not required to wear a special bandage on an ongoing basis for about 2 weeks.

If you follow these simple recommendations, the rehabilitation period proceeds without complications.Also, do not forget that at first you cannot swim in open reservoirs, as there is a chance to introduce infection into the wound. It must be remembered that many complications after a laparoscopy of the gallbladder arise precisely through the fault of the patient, who neglects the rules of behavior.

Cholelithiasis treatment 🌟 Polyclinic No. 1 RAS

Gallstone disease is a chronic disease of the hepatobiliary system, in which stones form in the gallbladder or ducts as a result of disturbances in the transport of bile or its composition.The actual formation of stones in the gallbladder (cholelithiasis) can lead to complications such as the development of acute and chronic cholecystitis (inflammation of the gallbladder), impaired outflow of bile due to the stone blocking the neck of the gallbladder or the common bile duct (accompanied by biliary colic and jaundice), the transition of inflammation to the peritoneum and the development of peritonitis, the entry of a stone into the intestine with the development of intestinal obstruction, the formation of fistulous passages, cicatricial changes in the ducts, biliary cirrhosis of the liver, malignant processes and many others.

The gallbladder is located at the gate of the liver in the right hypochondrium and is a reservoir for the bile formed in the liver, which then enters the duodenum during digestion. From the liver, bile through the common hepatic duct enters the gallbladder. When bile secretion is stimulated by digestive juices during a meal, bile through the cystic duct enters the common bile and flows into the duodenum. Bile consists of bilirubin (a metabolic product of blood cells), bile acids, cholesterol, phospholipids and other components.The main functions of bile are the secretion of metabolic products and participation in the processes of digestion. Many factors, both external and internal, play a role in the formation of gallstones. Stones can be cholesterol (most often), gallstones, calcareous and mixed. The main mechanisms for the formation of stones are represented by oversaturation of bile with certain components (for example, increased secretion of cholesterol leads to its precipitation), a decrease in the contractile function of the bladder (which leads to stagnation of bile), chronic infection and increased pressure in the biliary tract.Separately, predisposing factors that accelerate the development of the disease are also distinguished: female sex, obesity or rapid weight loss, a “sedentary” lifestyle (physical inactivity), older age, a history of pregnancy, increased gas production, the presence of anatomical anomalies in the structure of the biliary tract, an increased level of fatty acids and cholesterol in the blood (hyperlipidemia), eating habits, smoking and many others.

Symptoms of the disease depend primarily on concomitant disorders in the hepatobiliary system and the gastrointestinal tract and determine the form of the course of the disease.4 main forms can be distinguished: with latent symptoms of the disease are completely absent, and changes in the gallbladder can be detected during a preventive examination – the so-called stage of “stone bearing”, usually sooner or later it turns into clinically expressed. When dyspeptic, there are nonspecific symptoms such as bitterness in the mouth, bloating, diarrhea, a feeling of heaviness after eating, heartburn, nausea, and there are no pronounced pain sensations. With paroxysmal pain, the main manifestation of the disease is the classic “biliary colic”: a sudden painful attack in the right hypochondrium, characterized by acute, severe pain with its spread to the right arm, back and spine, vomiting may occur without relief of the condition.With a prolonged course of colic (more than 6 hours), jaundice and the addition of acute cholecystitis with a rise in temperature may be noted. The torpid painful form is caused by a constant, not sharply expressed pain syndrome in the right hypochondrium without acute attacks.

Diagnostics and treatment of cholelithiasis is carried out by a general practitioner, a gastroenterologist, consultations of a surgeon are also shown to resolve the issue of surgical treatment and an endocrinologist in identifying concomitant endocrinological disorders.

For diagnostics use the collection of complaints, examination of the patient with the use of special methods of palpation of characteristic “pain points”. From laboratory methods, a general clinical blood test and biochemistry are shown. Ultrasound of the abdominal organs (dilatation of the ducts, the presence of stones in them, their localization), as well as the X-ray technique (retrograde cholangiopancreatography), when a contrast agent is injected into the bile ducts with the help of a probe and an X-ray image is taken, is of primary importance in the diagnosis.Sometimes laparoscopy (examination of the abdominal cavity by inserting a laparoscope through a puncture of the abdomen) may be indicated.

Treatment can be both conservative and operative. In the absence of complications in the case of a latent or dyspeptic form, a diet and antispasmodic drugs are prescribed. Litholytic (dissolving stones) drugs may also be prescribed. Shock wave lithotripsy (as in a similar situation with urolithiasis) – a method of remote crushing of stones using energy sources (electromagnetic, piezoelectric, electrohydraulic) is used with preserved contractile function and small stones.

It is believed that cholelithiasis with conservative treatment is prone to frequent relapses, and therefore requires radical surgical treatment in all cases. For the prevention of severe complications, routine surgical treatment is most often carried out – various methods of cholecystectomy (removal of the gallbladder), and in complicated forms – emergency or urgent treatment using various techniques, depending on the complication. After relief of acute manifestations, cholecystectomy can be performed.

Cholelithiasis