What are gallstones. How do gallstones form. What are the main types of gallstones. Who is at risk for developing gallstones. What symptoms do gallstones cause. How are gallstones diagnosed. What treatments are available for gallstones.

Understanding Gallstones: Formation and Types

Gallstones are hard deposits that form in the gallbladder, a small organ located beneath the liver. These stones develop when there is an imbalance in the chemical composition of bile, a fluid produced by the liver to aid in digestion.

There are three main types of gallstones:

• Cholesterol stones: Accounting for about 80% of gallstones, these are typically yellow or green in color and consist of cholesterol monohydrate crystals.
• Pigment stones: These are made mainly from bilirubin and can be either brown or black. Brown stones are often associated with gallbladder infections, while black stones are linked to blood disorders and liver disease.
• Mixed stones: A subtype of cholesterol stones, containing at least 50% cholesterol by weight.

Gallstones can also be classified based on their location:

• Intrahepatic stones: Found within the liver, usually brown pigment stones
• Gallbladder stones: Most commonly cholesterol stones
• Bile duct stones: Typically mixed type stones

Risk Factors for Gallstone Development

Several factors can increase an individual’s risk of developing gallstones. These include:

• Being overweight or obese
• Consuming a high-fat or high-cholesterol diet
• Rapid weight loss
• Diabetes mellitus
• Female gender
• Pregnancy
• Family history of gallstones
• Liver disease, such as cirrhosis
• Age over 60

A helpful mnemonic to remember the primary risk factors is “The Five F’s”: Fair, Fat, Fertile, Female, and in her Forties.

Recognizing Gallstone Symptoms

While many gallstones remain asymptomatic, complications can lead to various symptoms. One common complication is biliary colic, which occurs when stones temporarily obstruct the cystic or common bile duct. Symptoms of biliary colic may include:

• Intermittent pain in the upper right quadrant or epigastric region
• Pain radiating to the back or right shoulder
• Nausea and vomiting
• Sweating
• Restlessness

Other potential symptoms of gallstone complications include:

• Fever and chills (in cases of infection)
• Jaundice (yellowing of the skin and eyes)
• Dark urine and pale stools
• Persistent abdominal pain

Diagnosing Gallstones: Common Investigations

When gallstones are suspected, healthcare providers may employ various diagnostic tools to confirm the presence of stones and assess their impact. Common investigations include:

• Ultrasound: The primary imaging method for detecting gallstones, offering a non-invasive and radiation-free option.
• CT scan: Provides detailed images of the gallbladder and surrounding structures.
• MRCP (Magnetic Resonance Cholangiopancreatography): Offers high-resolution images of the biliary system without the use of radiation.
• ERCP (Endoscopic Retrograde Cholangiopancreatography): Combines endoscopy and X-ray imaging to diagnose and potentially treat gallstone-related issues.
• Blood tests: To check liver function and detect signs of infection or inflammation.

How effective is ultrasound in detecting gallstones? Ultrasound has a sensitivity of about 95% in identifying gallstones larger than 2mm in diameter, making it a highly reliable diagnostic tool for this condition.

Treatment Options for Gallstones

The management of gallstones depends on the severity of symptoms and the presence of complications. Treatment options include:

1. Watchful Waiting

For asymptomatic gallstones, a “watch and wait” approach may be recommended. This involves regular monitoring without active intervention, as many gallstones do not cause problems and may not require treatment.

2. Medication

In some cases, oral medications such as ursodeoxycholic acid may be prescribed to dissolve small cholesterol stones. However, this treatment is typically reserved for patients who cannot undergo surgery and may take months or years to be effective.

3. Surgical Intervention

The most common and effective treatment for symptomatic gallstones is surgical removal of the gallbladder, known as cholecystectomy. This procedure is usually performed laparoscopically, resulting in smaller incisions and faster recovery times compared to open surgery.

4. Non-surgical Stone Removal

For patients with stones in the common bile duct, techniques such as endoscopic retrograde cholangiopancreatography (ERCP) may be used to remove the stones without surgery.

Complications of Untreated Gallstones

If left untreated, gallstones can lead to several serious complications, including:

• Cholecystitis: Inflammation of the gallbladder
• Choledocholithiasis: Stones obstructing the common bile duct
• Cholangitis: Infection of the bile ducts
• Pancreatitis: Inflammation of the pancreas
• Gallbladder cancer: A rare but serious complication associated with long-standing gallstone disease

What is the risk of developing complications from gallstones? While many people with gallstones never experience symptoms, about 20% of those with symptomatic gallstones will develop complications if left untreated.

Preventing Gallstone Formation

While not all risk factors for gallstones are modifiable, there are several steps individuals can take to reduce their risk of developing this condition:

• Maintaining a healthy weight through balanced diet and regular exercise
• Avoiding rapid weight loss or crash diets
• Consuming a diet low in saturated fats and high in fiber
• Staying hydrated by drinking plenty of water
• Managing underlying conditions such as diabetes
• Avoiding prolonged fasting periods

Can dietary changes alone prevent gallstone formation? While dietary modifications can help reduce the risk of gallstones, they are not a guarantee against stone formation. Genetics and other non-modifiable factors also play a significant role in gallstone development.

Living with Gallstones: Long-term Outlook

For individuals diagnosed with gallstones, the long-term outlook can vary depending on the chosen treatment approach and the presence of complications. Those who undergo cholecystectomy often experience complete resolution of symptoms and can lead normal lives without their gallbladder. The body adapts to the absence of the gallbladder, with the liver continuing to produce bile that flows directly into the small intestine.

However, some patients may experience post-cholecystectomy syndrome, which can include symptoms such as:

• Persistent abdominal pain
• Diarrhea
• Flatulence
• Indigestion

These symptoms typically improve over time as the body adjusts to the changes in bile flow. Dietary modifications and medications can help manage these symptoms in most cases.

For those who opt for non-surgical management of their gallstones, regular monitoring and adherence to lifestyle recommendations are crucial to prevent complications and manage symptoms effectively.

The Role of Diet in Post-Gallstone Management

After gallstone treatment, particularly following cholecystectomy, patients may benefit from dietary adjustments to support their digestive health. Recommended dietary practices include:

• Gradually reintroducing fatty foods to allow the body to adapt
• Eating smaller, more frequent meals throughout the day
• Increasing fiber intake to promote regular bowel movements
• Limiting caffeine and alcohol consumption
• Staying well-hydrated to support digestion

How long does it take to fully recover from gallbladder removal surgery? Most patients can return to normal activities within 1-2 weeks after laparoscopic cholecystectomy. However, complete internal healing and adaptation may take several months.

Emerging Research and Future Treatments

The field of gallstone research continues to evolve, with scientists exploring new treatment options and preventive strategies. Some areas of ongoing research include:

• Gene therapy to prevent cholesterol stone formation
• Development of more effective stone-dissolving medications
• Minimally invasive techniques for stone removal without gallbladder removal
• Improved understanding of the gut microbiome’s role in gallstone formation

These advancements may lead to more targeted and less invasive treatments for gallstones in the future, potentially reducing the need for surgical intervention in some cases.

The Impact of Gallstones on Quality of Life

Living with gallstones can significantly impact an individual’s quality of life, particularly when symptoms are present. Patients may experience:

• Anxiety about potential pain attacks
• Dietary restrictions to avoid triggering symptoms
• Limitations in daily activities due to discomfort
• Concerns about potential complications

However, with proper management and treatment, most individuals with gallstones can maintain a good quality of life. Support groups and patient education programs can play a crucial role in helping patients cope with their condition and make informed decisions about their care.

What percentage of people with gallstones require treatment? While up to 20% of adults may have gallstones, only about 20-30% of those with stones will develop symptoms requiring treatment. This means that the majority of people with gallstones may never need intervention.

Special Considerations for High-Risk Groups

Certain populations may require special attention when it comes to gallstone management:

Pregnant Women

Pregnancy increases the risk of gallstone formation due to hormonal changes and increased cholesterol levels. Management of gallstones during pregnancy requires careful consideration of both maternal and fetal health. Non-surgical approaches are often preferred when possible, with surgery reserved for severe cases or postpartum periods.

Elderly Patients

Older adults are at higher risk of developing gallstones and may face increased surgical risks. Treatment decisions for this group often involve weighing the benefits of intervention against potential complications, considering the patient’s overall health status and life expectancy.

Patients with Chronic Diseases

Individuals with conditions such as diabetes, obesity, or liver disease may have a higher risk of gallstone formation and complications. Management strategies for these patients often involve addressing underlying conditions in addition to treating the gallstones themselves.

How does diabetes affect gallstone management? Diabetic patients may have an increased risk of surgical complications and may require more careful perioperative management. Additionally, controlling blood sugar levels is crucial in preventing recurrent gallstone formation.

The Economic Impact of Gallstone Disease

Gallstone disease represents a significant economic burden on healthcare systems worldwide. The costs associated with gallstone management include:

• Diagnostic procedures and imaging studies
• Surgical interventions and hospital stays
• Medication for symptom management
• Lost productivity due to illness and recovery

Understanding the economic impact of gallstones can help inform public health strategies and resource allocation for prevention and treatment programs.

Cost-Effectiveness of Prevention vs. Treatment

Preventive measures, such as lifestyle modifications and early interventions for high-risk individuals, may offer cost-effective alternatives to treating advanced gallstone disease. Public health initiatives focusing on education and risk factor modification could potentially reduce the overall economic burden of this condition.

What is the average cost of gallbladder removal surgery? The cost of laparoscopic cholecystectomy can vary widely depending on the healthcare setting and geographical location, ranging from $5,000 to $20,000 or more in the United States. However, this cost is often offset by the prevention of more severe and costly complications.

Gallstones in Different Cultures and Populations

The prevalence and characteristics of gallstone disease can vary significantly across different ethnic groups and geographical regions. For example:

• Native American populations have a higher prevalence of gallstones compared to other ethnic groups in North America.
• Scandinavian countries report higher rates of gallstone disease compared to Mediterranean countries.
• Asian populations tend to have a higher proportion of pigment stones compared to Western populations.

These variations are likely due to a combination of genetic factors, dietary habits, and lifestyle differences. Understanding these population-specific trends can help tailor prevention and treatment strategies to different communities.

Traditional and Alternative Approaches

In addition to conventional medical treatments, various traditional and alternative approaches to managing gallstones exist in different cultures. These may include:

• Herbal remedies claimed to support gallbladder health
• Dietary practices aimed at preventing stone formation
• Acupuncture for pain management
• Yoga and other mind-body practices to support overall digestive health

While some of these approaches may offer complementary benefits, it’s crucial for patients to discuss any alternative treatments with their healthcare providers to ensure safety and efficacy.

Are there any proven natural remedies for dissolving gallstones? While some natural remedies are promoted for gallstone dissolution, there is limited scientific evidence supporting their effectiveness. The most reliable non-surgical method for stone dissolution remains ursodeoxycholic acid, which is a prescription medication.

Gallstones: Symptoms, clinical signs and management

Author:
Shahab Shahid MBBS
•
Reviewer:
Uruj Zehra MBBS, MPhil, PhD

Last reviewed: May 25, 2023

Reading time: 10 minutes

Gallstones are hard deposits formed in the gallbladder, this is also known as cholelithiasis. If stones are seen in the common bile duct this condition is referred to as Choledocholithiasis. Gallstones can be made up of various constituents such as cholesterol, bilirubin, and mixed. Gallstones can form due to high levels of cholesterol from dietary intake. Another important factor that can contribute to gallstone formation is problems with the contraction of the gallbladder, how often and well the gallbladder empties itself. Other reasons may include, the presence of protein in the liver and bile that increases cholesterol crystallisation leading to stone formation. Gallstones are quite commonly occurring and can lead to a variety of complications.

Contents

1. Gallbladder
2. Types of gallstones
3. Risk factors
4. Signs and symptoms
5. Investigations
6. Management
7. Complications
8. Highlights
9. Sources

+ Show all

Gallbladder

Gallbladder (ventral view)

The gallbladder is a pear-shaped organ that is present beneath the liver. You can locate the gallbladder between the lateral aspect of the rectus abdominis muscle and the right costal margins. Its main function is to store and concentrate bile. The liver produces and releases bile, a green substance that absorbs and breaks down lipids. Bile is made up of mostly bile acid, cholesterol and bilirubin.

The gallbladder opens into the cystic duct and biliary tree. It is made up of a fundus, body and neck. The fundus is along the transpyloric plane, which is halfway between the suprasternal notch and upper border of the pubic symphysis. Other structures that cross the transpyloric plane are the L1 vertebra, neck of the pancreas, first part of the duodenum, right and left colic flexures, hila of the left and right kidneys and hilum of spleen. The neck of the gallbladder leads into the cystic duct that then connects to the common hepatic duct, which then becomes the common bile duct. The gallbladder has a section that is called the Hartmann’s pouch, this is formed from an out pouching from the neck section. The Hartmann’s pouch is a common area for gallstones to become lodged.

To master the anatomy of the gallbladder, take a look at the following resource:

Gallbladder

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Types of gallstones

The most common type of stone is made up of cholesterol, they account for around 80% of gallstones. They occur when there is a problem in the balance of levels of cholesterol, bile acids and lipids. These stones are usually yellow or green in colour and consists of cholesterol monohydrate crystals.

Pigment gallstones are another type of stone; these are made mainly from bilirubin and from the crystallization of calcium bilirubinate. The colours of pigment stones are brown or black. The brown stones are usually associated with gallbladder infection and commonly associated gram-negative bacteria are Escherichia Coli and Klebsiella. Black stones are associated with red blood cell problems for example haemolysis and liver disease.

The third type is mixed gallstone which is a subclassification of the cholesterol stones and contains at least 50% of cholesterol by weight. Gallstones are also classified by their location as intrahepatic, gallbladder and bile duct stones. Intrahepatic are more commonly brown pigment stones, gallbladder stones are predominantly cholesterol and bile duct stones are mixed type.

Common bile duct (caudal view)

Risk factors

Gallstones can occur due to excessive cholesterol and this can be due to diet. Risk factors include being overweight or obese, a high fat or cholesterol diet, rapid weight loss can lead to stone formation, a medical history of diabetes mellitus can put you at risk. Females are more likely to be at risk and pregnancy can contribute. A family history is linked to the condition as well. Other risk factors include liver disease for example, cirrhosis, or being over the age of 60.

A helpful mnemonic to remember the risk factors:

The Five F’s:

1. Fair
2. Fat
3. Fertile
4. Female
5. In her Forties

Signs and symptoms

Gallstones present as asymptomatic majority of the time. If complications from gallstones arise then symptoms can appear.

For example in biliary colic, which occurs if the stones temporarily obstruct the cystic or common bile duct, patients experience the following signs and symptoms:

• Intermittent pain in the upper right quadrant or epigastric region.
• Pain radiates to the back.
• Nausea
• Vomiting
• Bloating
• Belching
• Certain foods evoke symptoms

Acute Cholecystitis is caused due to inflammation of gallbladder wall, signs and symptoms are as follows:

• Right upper quadrant abdominal pain is more severe and constant
• Right shoulder tip pain
• Mild jaundice may occur
• Nausea
• Vomiting
• On examination gall bladder is tender
• Murphy’s sign – patient on deep inspiratory breath with palpation of the upper right quadrant feels pain

Ascending/Acute Cholangitis is an infection of bile duct most commonly due to gallstones, signs and symptoms are as follows: Hallmark of this condition is Charcot’s triad, the common findings are:

• Abdominal pain in the upper right quadrant
• Fever
• Jaundice
• Patients also can have rigors and malaise

Investigations

Initial investigations to order are blood tests to measure bilirubin and liver function tests. The gold standard investigation for gallstones is abdominal ultrasound scan. Other helpful imaging tests are abdominal CT scan and gallbladder radionuclide scan. Endoscopic retrograde cholangiopancreatography (ERCP) is helpful to confirm the diagnosis of choledocholithiasis and also has a role in treatment.

Management

Surgery is usually the first choice after diagnosis, even if the patient does not have symptoms the surgeons advise surgery to avoid complications. Laparoscopic removal of the gallbladder after giving a general anaesthesia is performed. Non-surgical treatment is an option for patients with small, radiolucent cholesterol stones. Extracorporeal shockwave lithotripsy has been used in the management of choledocholithiasis. Bile duct stones can be removed with an (ERCP). The technique used an endoscope which is inserted into the mouth, and passed down the oesophagus, and through the stomach and into the duodenum. The second part of the duodenum is where the sphincter of oddi is located. The ampulla of vater is accessed via the sphincter of oddi, and the scope is passed up the biliary tree. MRCP (magnetic resonance cholangiopancreatography) is less invasive and many clinicians prefer to have this performed before an ERCP. The ERCP procedure can visualise the biliary system and remove any stones if present and insertion of stents to allow for the ducts to remain open is possible too.

Common bile duct (ventral view)

Lifestyle changes are very important to advise patients on. Dietary advice is important; meal plans can be advised to encourage eating several times a day to replace large meals. Reducing fat in diet is crucial and increasing fibre can be helpful too. Avoiding food and drink that has a laxative effect like caffeine and sugary foods, is useful, as after treatment of gall bladder removal patients may experience watery diarrhoea.

Complications

Gallstone ileus is a complication of a gangrenous gallstone. A fistula forms between the gallbladder and duodenum this allows for the stone to enter the intestines. Once the gallstone reaches a diameter of more than 2.5cm, there is a risk of intestinal obstruction.

Gallstone pancreatitis is another potential complication that can occur if the gallstone is passing through the bile duct and becomes lodged in the Sphincter of Oddi.

Choledocholithiasis occurs if the gallstone are formed within the common bile duct that leads to obstruction and infection. This can be life-threatening and emergency medical care is required. Patients may present with abdominal pain, fever, jaundice, anorexia, nausea and vomiting. Transabdominal ultrasound scan is recommended to examine the gallbladder and surrounding structures. To treat stone extraction is needed, lithotripsy is an option where the stone is fragmented or surgery by removing the gallbladder with a cholecystectomy. Stenting can be done to the common bile duct to provide drainage and prevention of future obstruction.

Highlights

• Gallstones can be divided into three main types: Cholesterol stones, pigment stones and mixed.
• Gallstones are usually asymptomatic.
• Risk factors are being female, overweight and a positive family history.
• It can lead to complications such as biliary colic, acute cholecystitis and ascending cholangitis.
• Biliary colic presents with intermittent right upper quadrant pain.
• Acute cholecystitis presents with right upper quadrant pain, radiating to the shoulder tip, mild jaundice, nausea, vomiting. Murphy’s sign is positive.
• Ascending cholangitis presents with Charcot’s triad: right upper quadrant abdominal pain, jaundice and fever.
• The main investigation of diagnosis of gallstones is abdominal ultrasound scan.
• Gallstones can either pass themselves, or medically can be treated with ursodeoxycholic acid and surgically by laparoscopic cholecystectomy.
• Lifestyle changes are advised to patients, for example a healthier diet is important to implement.
• Potential complications of untreated gallstones are gallstone ileus, gallstone pancreatitis and choledocholithisais.

Sources

All content published on Kenhub is reviewed by medical and anatomy experts. The information we provide is grounded on academic literature and peer-reviewed research. Kenhub does not provide medical advice. You can learn more about our content creation and review standards by reading our content quality guidelines.

References:

1. 
   Murray Longmore, Ian Wilkinson, Andrew Baldwin, Elizabeth Wallin: Oxford Handbook of Clinical Medicine, 9th Edition. 
2. 
   Choledocholithiasis Healthline.  (accessed 16/05/2016) 
3. 
   G. Adler, H.E. Blum, M. Fuchs: Gallstones: Pathogenesis and Treatment. Falk Symposium 139.
4. Gallstones: New Insights for the Healthcare Professional: 2011 Edition
5. 
   M. Acalovschi, G. Paumgartner: Hepatobiliary Diseases: Cholestasis and Gallstone. Falk Workshop.
6. 
   Gallstones.  (accessed 16/05/2016) 
7. 
   Gallstones. (accessed 16/05/2016) 
8. 
   Gallstones in Women.  (accessed 16/05/2016) 
9. 
   Gallstones. (accessed 16/05/2016) 
10. 
    Martin C. Carey, ‎J. Mossner, ‎Petr Dite: Future perspectives in Gastroenterology 2008 Falk Symposium 161.

Illustrators:         

• Gallbladder (ventral view) – Esther Gollan
• Common bile duct (caudal view) – Irina Münstermann
• Common bile duct (ventral view) – Samantha Zimmerman

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Gallstones in Children | Causes & Care

The gallbladder is the place where bile (a liquid made of cholesterol, bile pigments, bile salts, and water) is stored between meals. When your child eats, bile is discharged from the gallbladder into the intestines to help with food digestion. Sometimes, parts of the bile harden and form crystals. When a crystal grows larger, it becomes a gallstone. Gallstones can block bile from discharging into the intestine.

The cause of gallstones in children isn’t known, but they seem to happen more frequently in some children who:

• Are born prematurely with a low birth weight
• Have experienced spinal injury
• Have a history of abdominal surgery
• Have cystic fibrosis
• Have hemolytic anemia
• Have sickle-cell anemia
• Have an impaired immune system
• Have used intravenous nutrition
• Have a family history of gallstones

What are the symptoms?

Children with gallstones often experience pain in the right upper or upper middle part of the abdomen. The pain may be more noticeable after meals, especially if the child has eaten fatty or greasy foods. The child also may experience nausea and vomiting. A yellow tint (jaundice) may be noticeable in your child’s skin.

How are gallstones treated?

In most cases where children develop gallstones, the gallbladder must be removed. This operation is called a cholecystectomy. This is because gallstones often redevelop in the gallbladder if it is not removed. In many cases, gallbladder removal can be performed laparoscopically (which uses smaller incisions, thus allowing your child to recover more quickly and comfortably). Without the gallbladder, the liver will discharge bile directly into the intestine.

In some cases, after the gallbladder has been removed, gallstones redevelop in the bile duct. If this occurs, an endoscopy may be performed. During an endoscopy, the gallstone is removed through a flexible tube passed through the mouth, stomach, and intestine, and then into the bile duct.

About surgery for gallstones at Children’s

Surgery for gallstones is commonly performed at Children’s and typically is performed by pediatric general surgeons. Surgery teams at Children’s provide next-generation care to neonatal infants, newborns, children, and adolescents from throughout the Upper Midwest and consistently perform some of the most cutting-edge surgical procedures available, including newborn surgery, laparoscopic and other minimally invasive surgeries, and robotic surgery, when appropriate. Surgery for gallstones is performed at Children’s – Minneapolis, Children’s – St. Paul, and Children’s – Minnetonka.

Contact us

• If you are a family member looking for a Children’s specialist in general surgery or gastrointestinal surgery, please visit Find a Doctor.
• If you are a health professional looking for a consultation or referral information, please call Children’s Physician Access at 1-866-755-2121 (toll-free).

Cholelithiasis: causes, symptoms and recommendations for the treatment of the disease. Dr. Peter

Gallstones are crystallized components of bile ranging in size from a grain of sand to 1-2 cm or more. Bile is produced in the liver and collected in the gallbladder, located under the liver. When needed, bile is sent through the bile ducts to the small intestine, where it aids in the digestion of fats.

The main component of bile is water, which makes up about 80 percent. In addition, bile acids, proteins and bilirubin (a yellowish breakdown product of the red blood pigment hemoglobin) are dissolved in it. Bile also contains cholesterol. Both bilirubin and cholesterol can crystallize, resulting in tiny stones a few millimeters in size (sand) or gallstones up to a few centimeters in size. Doctors in this case speak of gallstone disease.

Gallstones are formed from the crystallization of bile components. If large gallstones from the gallbladder enter the bile duct, they can block it.

Depending on which substance predominates in gallstones, physicians distinguish the following two main groups of calculi:

1. countries.

2. Bilirubin (pigment) stones. They consist of a cholesterol core to which bilirubin is attached. Bilirubin stones cause about 20 percent of gallstones.

Another distinguishing feature is the location of stones in the gallbladder. Distinguish:

• Gallbladder stones (cholecystolithiasis): they develop in the gallbladder, a collecting reservoir for bile.

• Bile duct stones (choledocholithiasis): they are located in the passage between the gallbladder and the small intestine. Sometimes they grow in place. However, often they are actually gallstones that leach into the bile ducts (secondary gallstones).

An estimated 5 to 25 percent of the population has gallstones. Women get sick two to three times more often than men. In addition, the risk of gallstones increases significantly from the age of 40.

Many patients do not even know they have gallstones because the stones do not (yet) cause any symptoms.

Causes of gallstone disease

Gallstones form when bile changes in such a way that less soluble components such as cholesterol or bilirubin begin to crystallize. Then tiny crystals form, which eventually combine and continue to grow – forming sand or stones. In the majority of those affected, several factors contribute to the development of pathology at once (multifactorial genesis). Only in very rare cases is there a single trigger, such as a genetic defect that inevitably leads to the formation of gallstones.

Certain risk factors contribute to the development of gallstones. The most important thing can be reduced to the so-called rule of six:

1. Female.

2. Accumulation of fat (overweight).

3. Pregnancy and childbirth (several children).

4. Age 40 and older.

5. Blonde hair.

6. Family (hereditary predisposition).

The fact that gallstones are more common in some families suggests that genetic factors may play a role: for example, a certain variant of the ABCB4 gene may increase the risk of gallstones. This gene contains the blueprint for a molecular pump that transports cholesterol from liver cells to the bile ducts. In carriers of this gene variant, the composition of bile is changed in such a way that gallstones form more easily.

A very rare genetic defect that always leads to the formation of gallstones. Other risk factors for gallstone formation are:

• Pregnancy, use of female sex hormones, for example as contraceptives (pills) or hormone replacement therapy during menopause.

• certain other medicines such as ceftriaxone (an antibiotic) or somatostatin (used for a hormonal disorder, acromegaly, or upper digestive tract bleeding).

• Stagnation of bile with impaired gallbladder mobility (the gallbladder cannot contract normally, bile accumulates and gallstones form more easily).

• Bile acid wasting syndrome (disease with a corresponding deficiency of bile acids, such as from surgical removal of a large portion of the small intestine—such as Crohn’s disease).

• Diabetes.

• Cirrhosis of the liver (for example, due to excessive alcohol consumption).

• elevated levels of fats in the blood (triglycerides, cholesterol).

• Severe overweight (obesity).

Sudden weight loss over a short period of time, such as through a reduction diet (a diet that consumes less energy than the body actually needs) or surgical reduction of the stomach (in the case of people who are severely overweight)

The fact that women have more gallstones than men probably has to do with female sex hormones. This is also supported by the fact that taking such hormones (for example, as birth control pills) and pregnancy also increase the risk of gallstone disease.

Symptoms

Most people with gallstones do not experience any symptoms. This is called “silent” stones. If they are found at all, it is usually only by chance, for example, during an ultrasound or x-ray examination. Sometimes “silent” stones become “speaking” over time, that is, they begin to cause discomfort. According to studies, two to four out of 100 people with gallstones develop noticeable symptoms within a year.

Symptomatic gallstones are formations that cause discomfort. They can be very different. In mild cases, there is pain and non-specific symptoms in the upper abdomen, such as a feeling of fullness or pressure, belching, and flatulence. These symptoms usually appear after eating and may be aggravated by fatty and/or fried foods.

Sometimes gallstones also cause biliary colic, a severe, cramping pain in the right middle and upper abdomen. It is undulating in nature: the pain increases rapidly, then plateaus, and then subsides spontaneously or after taking medication.

In general, biliary colic usually lasts from 15 minutes to several hours. Sometimes the pain radiates to the back and right shoulder area. Associated symptoms may also include sweating, nausea, nausea, and vomiting. Biliary colic occurs mainly at night and after meals.

Approximately one in two patients who previously had symptoms of gallstone disease, such as colic, reappear within two years.

The size and position of the stones are critical. Most of them are quite small, like a cherry or hazelnut, and often do not cause any discomfort. Others reach the size of a chicken egg. Then the pain is quite likely.

The location of the stones also affects the severity of symptoms. In general, the symptoms of bile duct stones are observed more often than with gallbladder stones. They cause cramping pain when they get stuck in the bile duct and block it, after which bile can no longer flow into the small intestine. Gallbladder stones cause colic when they block the gallbladder’s exit into the bile duct or its entry into the duodenum. Again, the gallbladder is unable to push bile into the small intestine, resulting in more painful contractions.

Possible complications and risks

Gallstones can have several effects.

Inflammation of the gallbladder and possible consequences

When gallstones block the outlet of the gallbladder, bile accumulates in it. This can lead to acute inflammation of the gallbladder (cholecystitis): the accumulated bile stretches the wall of the gallbladder excessively, the mucous membrane lining the organ becomes irritated and inflamed. Signs of a gallbladder infection include severe pain in the upper abdomen, fever, and chills.

If left untreated, acute inflammation of the gallbladder can lead to the formation of pus in the gallbladder (empyema) – possibly even with partial tissue death and thus rupture of the gallbladder wall (perforation). In extreme cases, the peritoneum may also become inflamed (“bilious” peritonitis).

Inflammation can also spread through the blood to the whole body – then doctors talk about “blood poisoning” (sepsis).

Sometimes inflammation of the gallbladder is not acute, but chronic. In very rare cases, the wall of the gallbladder can thicken and calcify as a result—doctors speak of a “porcelain gallbladder.” After that, the organ can no longer contract properly. A certain shape of the “porcelain gallbladder” also increases the risk of cancer.

Inflammation of the bile ducts and jaundice

When a gallstone blocks the bile duct, bile returns to it. A possible consequence is inflammation of the bile ducts (cholangitis) with severe pain in the upper abdomen, fever, and chills. In addition, inflammation can lead to jaundice: since the breakdown product of the red blood pigment – yellow bilirubin – can no longer be excreted from the body due to bile stasis, it is deposited in the tissues. The whites of the eyes and skin may become yellowish. In addition, the urine becomes dark and the stool becomes light.

Like gallbladder inflammation, bile duct inflammation can spread to neighboring organs.

Inflammation of the pancreas

In most people, the bile duct, along with the pancreatic duct, drains into the duodenum, the uppermost part of the small intestine. Thus, if a gallstone blocks the entrance to the intestine, pancreatic secretion may also be affected. Possible consequences are inflammation of the pancreas (acute pancreatitis) with severe pain in the upper abdomen, nausea, vomiting and fever.

Cancer of the gallbladder and bile ducts. Gallstones increase the risk of gallbladder and bile duct cancer, but only slightly. In addition, both types of cancer are rare. However, people with a certain form of the very rare porcelain gallbladder mentioned above are very susceptible to gallbladder cancer. Therefore, it is usually recommended to remove the gallbladder as a precautionary measure.

Diagnosis

If you suspect you have gallstones, your doctor will first discuss your medical history in detail. Among other things, he asks you to describe in detail all your complaints. He also asks about any previous or underlying medical conditions. This is followed by a comprehensive physical examination and imaging procedures.

The most important procedure for suspected gallstones is an ultrasound examination (sonography) of the abdomen. In most cases, it is possible to detect gallbladder stones ranging in size from one to two millimeters. In addition, the doctor can detect any other pathological changes on the ultrasound image. For example, in inflammation of the gallbladder, the wall of the gallbladder is thickened and layered.

However, bile duct stones are not always detectable on conventional ultrasound (through the abdominal wall). Endosonography – ultrasound examination from the inside – gives the best result. The doctor passes a thin flexible tube with an ultrasonic sensor through the mouth, esophagus and stomach into the duodenum to the place where the bile and pancreatic ducts meet. Any bile duct stones are clearly visible through the wall of the duodenum.

A special X-ray examination, endoscopic retrograde cholangiopancreatography (ERCP), also makes it easy to detect gallstones in the gallbladder and bile ducts. In addition, smaller stones may be removed during the examination.

Another imaging modality that can be used to clarify gallstones is magnetic resonance cholangiopancreatography (MRCP). This is an examination of the bile ducts and pancreatic duct using magnetic resonance imaging (MRI).

Blood tests are important in addition to imaging tests. Abnormal values ​​may indicate complications caused by gallstones. If, for example, gamma-HT and/or alkaline phosphatase (AP) are elevated, this may indicate a disease of the biliary tract. Bilirubin usually rises when a gallstone blocks the main bile duct (occlusive jaundice). Elevated levels of white blood cells (leukocytosis) and ESR (blood sedimentation rate) may indicate inflammation of the gallbladder or bile ducts.

How to treat gallstones

The need for treatment of gallstones depends on where they are located and what symptoms (eg, biliary colic) they cause. In principle, both the symptoms (symptomatic therapy) and the gallstones themselves (causal therapy) can be treated.

• Treatment of biliary colic. The doctor treats acute biliary colic with antispasmodic and pain medications (antispasmodics and analgesics). If the gallbladder becomes inflamed, the patient also receives antibiotics. In the first 24 hours after the onset of biliary colic, the patient should also not eat anything (zero diet).

• Treatment of gallstones. Gallbladder stones usually only need treatment if they cause symptoms or complications, such as a gallbladder infection. On the other hand, bile duct stones should always be treated as they often lead to complications.

There are several methods for removing gallstones. The choice of procedure depends, among other things, on the location (gall bladder or bile duct) and the size of the gallstones.

Gallstones are usually removed surgically. This is usually done as part of a so-called laparoscopy. However, other surgical methods are also available. In case of repeated attacks of pain and acute inflammation of the gallbladder, the gallbladder is usually also removed during surgery (cholecystectomy). The body then stores the bile in the bile ducts.

In some cases, medical treatment of gallstones is an alternative to surgery. The patient has to take a drug that can dissolve stones for a long time. In addition, gallstones can also be destroyed using shock waves (shock wave therapy).

Prevention

With proper nutrition, you can prevent the symptoms associated with gallstones and also prevent the formation of (new) gallstones. You should also eat as little fat as possible: dietary fat contributes to biliary colic and stone formation.

In addition, you should eat healthy foods high in fiber. Include whole grains, vegetables, and fruits regularly in your diet. Combined with regular exercise and sports, this diet can help maintain a healthy body weight or reduce excess body fat. Obesity is one of the most important risk factors for gallstones.

Gallstone disease. Full description: causes, symptoms, diagnosis, treatment

Gallstone disease is a disease associated with the formation of stones in the gallbladder and bile ducts.

Gallstone disease is one of the most common diseases of the gastrointestinal tract.

Ultrasound examination of apparently healthy adults in 10-15% of gallbladder stones are detected, the frequency of which increases with age.

Symptoms of cholelithiasis:

• Pain syndrome – there may be pain in the right hypochondrium, passing under the right shoulder blade, shoulder, sometimes in the neck area on the right;
• Dyspension syndrome is manifested by a feeling of bitterness in the mouth, sometimes heaviness in the abdomen;
• Intestinal dispensation: tendency to flatulence, often loose stools, less often – tendency to constipation
• Rarely, nausea or vomiting.

Diagnosis of cholelithiasis

If symptoms of the disease appear, our doctor will definitely refer you for diagnosis.

It is necessary to take a blood test for biochemistry, as well as an ultrasound of the abdominal cavity. If the data is not enough for an accurate diagnosis, you will be offered to undergo a CT scan of the abdominal organs with or without contrast, the results of which will answer all the questions posed by the gastroenterologist. The modern equipment of the Health Clinic will allow you to get the most accurate diagnostic results at affordable prices.

Disease stages:

1st stage. Physico-chemical stage. There are physical and chemical changes in bile. Bile is saturated with cholesterol, thickens, bile acids decrease, bile pigments increase, phospholipids decrease. Such bile is called lithogenic. At this stage, there are no clinical symptoms of the disease. This stage of gallstone disease can last for many years.

2nd stage. Latent asymptomatic lithology.

3rd stage. Topical pains, biliary colic.

Most often it is acute, paroxysmal pain in the right hypochondrium. Clinical manifestations of cholelithiasis depend on the location of gallstones, their size, composition, quantity, severity of inflammation and the functional state of the biliary system.

Treatment of gallstone disease

A gastroenterologist will definitely develop an individual treatment plan for the disease. which includes:

• development of a diet, taking into account the stage of the disease and the patient’s body;
• prescribing a medical course of treatment

Complications of cholelithiasis

One of the most dangerous complications is:

• Obstructive jaundice due to obstruction of the bile duct (obliteration) by a stone. The stone completely blocks the outflow of bile in the neck of the gallbladder or the main bile duct.
• transition of inflammation to surrounding tissues and surrounding organs: cholangitis, acute calculous cholecystitis, gastritis, pancreatitis.