What are gallstones and why are they more common in women. How do gallstones form and what symptoms do they cause. When should you seek medical attention for gallstone-related issues. What treatment options are available for gallstones.

Understanding Gallstones: Formation and Composition

Gallstones are solid lumps that develop in the gallbladder when bile crystallizes. These stones can vary in size, ranging from tiny grains of sand to golf ball-sized formations. But what exactly are they made of?

The majority of gallstones, approximately 80%, are composed primarily of cholesterol. These cholesterol stones form when the liquid bile in the gallbladder contains more cholesterol than the bile salts can dissolve. The remaining 20% are known as pigment stones, which consist of calcium salts and bilirubin, a breakdown product of red blood cells.

Interestingly, the formation of gallstones is closely linked to the function of the gallbladder itself. If the gallbladder doesn’t contract and empty properly, it can contribute to the development of cholesterol stones. On the other hand, pigment stones are often associated with certain medical conditions, including liver disease, specific types of anemia, and infections of the bile ducts.

The Role of Bile in Digestion

To fully understand gallstones, it’s crucial to grasp the role of bile in our digestive system. Bile is a substance produced by the liver that aids in the digestion of fats and the absorption of certain vitamins. The gallbladder, a small, pear-shaped organ, stores and concentrates this bile.

When we consume fatty foods, it triggers the release of a hormone that causes the gallbladder to contract. This contraction releases bile into the intestine, where it helps break down fats. However, when this process is disrupted, it can lead to the formation of gallstones.

The Gender Disparity: Why Women Are More Prone to Gallstones

Gallstones are one of the most common digestive problems treated in women, with more than 25 million people in the United States affected. Strikingly, 65% to 75% of those with gallstones are women. But why is there such a significant gender disparity?

The primary reason for this increased risk in women lies in the effect of female hormones. Estrogen increases cholesterol in the bile, while progesterone slows the emptying of the gallbladder. This hormonal influence explains why the risk for women, relative to men, decreases with age.

• Before age 40, women are diagnosed with gallstones almost three times more often than men.
• By age 60, the risk for women is only slightly greater than that for men.

Pregnancy is a significant risk factor for gallstone formation in women. The hormonal changes and increased estrogen levels during pregnancy can lead to a higher likelihood of developing gallstones.

Hormonal Therapies and Gallstone Risk

Hormonal therapies can also impact a woman’s risk of developing gallstones. Estrogen therapy, especially when taken orally rather than through a patch, increases the risk. Oral contraceptive pills also slightly elevate the risk, but this effect is primarily observed in the first decade of use.

Risk Factors Beyond Gender: Who Else is at Risk?

While gender plays a significant role in gallstone formation, several other factors can increase an individual’s risk, regardless of sex. Understanding these risk factors can help in prevention and early detection.

Obesity and Weight Fluctuations

Obesity is a notable risk factor for gallstone formation. Bodies with more fat produce more estrogen, which can contribute to gallstone development. Paradoxically, rapid weight loss can also increase the risk. Very low-calorie diets can interfere with bile production, leading to increased crystallization of cholesterol.

In fact, gallstones are so common after weight-loss surgery that patients may be advised to have their gallbladders removed simultaneously. This highlights the complex relationship between weight and gallstone formation.

Medical Conditions and Gallstone Risk

Certain medical conditions can predispose individuals to gallstone formation. These include:

• Diabetes
• Conditions that decrease gallbladder contractions
• Conditions that reduce intestinal motility (e.g., spinal cord injury)
• Liver disease
• Certain types of anemia

Genetic Factors

There is emerging evidence suggesting a genetic vulnerability to gallstone formation. While the exact genes involved are still being studied, family history can be an important factor in assessing an individual’s risk.

Silent Stones: When Gallstones Go Unnoticed

One of the most intriguing aspects of gallstones is that many people who have them are unaware of their presence. These “silent” gallstones don’t cause major symptoms and are often discovered incidentally during imaging tests performed for other reasons.

Can silent gallstones become problematic over time? While many silent gallstones remain asymptomatic, there’s always a possibility that they may cause issues in the future. Regular check-ups and awareness of potential symptoms can help in early detection if silent stones become symptomatic.

Recognizing Gallstone Symptoms: When to Seek Help

While many gallstones remain silent, they can sometimes cause significant discomfort and health issues. Recognizing the symptoms of gallstone-related problems is crucial for timely medical intervention.

The Gallbladder Attack: Understanding Biliary Colic

The most common symptom of problematic gallstones is biliary colic, often referred to as a gallbladder attack. These attacks occur when gallstones pass through or obstruct a bile duct, typically triggered by the gallbladder’s contraction after a fatty meal.

Key symptoms of a gallbladder attack include:

• Intense pain in the right upper or middle abdomen, just below the rib cage
• Pain that builds to its greatest intensity within an hour and can persist for several hours
• Sharp, knifelike pain or a deep ache
• Pain that may radiate to the back or right shoulder
• Nausea and vomiting

The pain typically subsides as the gallbladder relaxes. If you experience these symptoms, it’s important to seek medical attention promptly.

Serious Complications: Beyond the Typical Attack

In some cases, gallstones can lead to more severe complications that require immediate medical intervention. These include:

1. Acute cholecystitis: Inflammation of the gallbladder
2. Pancreatitis: Inflammation of the pancreas
3. Cholangitis: Inflammation of the bile ducts in the liver

These conditions can cause severe pain and additional symptoms such as high fever, chills, jaundice, and persistent vomiting. If you experience any of these symptoms, seek emergency medical care immediately.

Diagnosing Gallstones: The Path to Confirmation

If gallstones are suspected, healthcare providers have several diagnostic tools at their disposal to confirm the presence of stones and assess their impact on the gallbladder and surrounding organs.

Ultrasound: The Primary Diagnostic Tool

Abdominal ultrasound is the most common and effective method for diagnosing gallstones. This non-invasive imaging technique can detect the presence of stones, as well as any thickening of the gallbladder wall or fluid accumulation that might indicate inflammation.

For optimal results, patients are typically asked to fast for at least eight hours before the ultrasound. This ensures that the gallbladder is full, making stones easier to detect.

Blood Tests and Additional Imaging

In addition to ultrasound, healthcare providers may order several blood tests to assess liver function and check for signs of infection or inflammation. Other diagnostic techniques that might be employed include:

• Cholescintigraphy: A radioactive injection used to view gallbladder function
• CT scans: To provide detailed images of the gallbladder and surrounding tissues
• MRCP (Magnetic Resonance Cholangiopancreatography): A specialized MRI that provides detailed images of the biliary system

These additional tests can help healthcare providers determine the extent of the problem and guide treatment decisions.

Treatment Options: Managing Gallstone-Related Issues

Once gallstones are diagnosed, the treatment approach depends on the severity of symptoms and the overall health of the patient. What are the primary treatment options available for those with symptomatic gallstones?

Watchful Waiting: Monitoring Silent Stones

For individuals with asymptomatic or “silent” gallstones, a watchful waiting approach may be recommended. This involves regular monitoring to ensure the stones don’t become problematic. Lifestyle modifications, such as maintaining a healthy weight and avoiding trigger foods, may be suggested to reduce the risk of complications.

Surgical Intervention: Cholecystectomy

For symptomatic gallstones or in cases of complications, surgical removal of the gallbladder (cholecystectomy) is often the recommended treatment. This procedure is typically performed laparoscopically, involving small incisions and a quicker recovery time compared to traditional open surgery.

After gallbladder removal, most people can digest food normally without experiencing significant issues. The liver continues to produce bile, which flows directly into the small intestine to aid in digestion.

Non-Surgical Alternatives

In some cases, non-surgical treatments may be considered, particularly for patients who are not suitable candidates for surgery. These options include:

• Oral dissolution therapy: Medications that can help dissolve small cholesterol stones over time
• Lithotripsy: A technique using shock waves to break up gallstones, which is typically combined with oral dissolution therapy

However, these non-surgical options are generally less effective than surgery and are not suitable for all types of gallstones.

Living with Gallstones: Prevention and Management Strategies

While not all gallstones can be prevented, certain lifestyle modifications can help reduce the risk of developing symptomatic gallstones or manage existing ones. What strategies can individuals employ to minimize their risk?

Dietary Considerations

A balanced diet plays a crucial role in gallstone prevention and management. Consider the following dietary strategies:

• Maintain a healthy weight through a balanced diet and regular exercise
• Avoid rapid weight loss or extreme dieting
• Include plenty of fiber in your diet
• Limit high-fat and high-cholesterol foods
• Stay hydrated to help maintain proper bile flow

Regular Exercise

Physical activity can help maintain a healthy weight and improve overall digestive health. Aim for at least 150 minutes of moderate-intensity exercise per week, as recommended by health authorities.

Hormone Management

For women taking hormone replacement therapy or oral contraceptives, discussing the potential risks with a healthcare provider is important. Alternative formulations or delivery methods may be considered to minimize gallstone risk.

By understanding the causes, symptoms, and treatment options for gallstones, individuals can take proactive steps to manage their digestive health. Regular check-ups and open communication with healthcare providers are key to early detection and effective management of gallstone-related issues.

What to do about gallstones

Gallstones are one of the most common digestive problems treated in women.

More than 25 million people in the United States have gallstones, and 65% to 75% of them are women. Fortunately, for most people, gallstones are “silent” — they don’t cause major symptoms. When they do act up, there are effective ways to address the problem.

What are gallstones?

Gallstones begin with bile, a substance that helps with the digestion of fats and the absorption of certain vitamins. Bile is made in the liver and carried to the gallbladder, a small, pear-shaped organ that concentrates and stores it. The fat in food triggers the release of a hormone that causes the gallbladder to contract and release bile into the intestine.

Gallstones are solid lumps that develop when the stored bile crystallizes. Most are less than an inch in diameter, but they can be as small as a grain of sand or as large as a golf ball. Most gallstones are composed mainly of cholesterol. The rest — known as pigment stones — are made of calcium salts and bilirubin, a breakdown product of red blood cells.

Cholesterol stones form when liquid bile in the gallbladder contains more cholesterol than the bile salts can dissolve. Cholesterol stones may also develop if the gallbladder doesn’t contract and empty as it should. Pigment stones are associated with certain medical conditions, including liver disease, some types of anemia, and infection of the bile ducts.

Why are women at greater risk?

It’s the effect of female hormones. Estrogen increases cholesterol in the bile, and progesterone slows the emptying of the gallbladder. That may explain why the risk for women, relative to men, decreases with age. Before age 40, women are diagnosed with gallstones almost three times more often than men are (pregnancy, for example, increases the risk), but by age 60, their risk is just slightly greater. Estrogen therapy increases the risk, especially when taken as a pill rather than a patch. Oral contraceptive pills also increase the risk slightly, but only in the first decade of use.

Obesity is another risk factor because bodies with more fat produce more estrogen. Paradoxically, rapid weight loss also increases the risk, because very low-calorie diets interfere with bile production and therefore cause more crystallization of cholesterol. Gallstones are so common after weight-loss surgery that patients may be advised to have their gallbladders removed at the same time. Gallstones are also more likely to occur in people with diabetes or any condition that decreases gallbladder contractions or intestinal motility, such as a spinal cord injury. Finally, there’s some evidence for genetic vulnerability to gallstone formation.

What are the symptoms?

Most people who have gallstones don’t know it. Their gallstones stay silent and may only be discovered incidentally, through an ultrasound or CT scan performed for other reasons. Symptoms arise mainly when stones pass through a bile duct or obstruct it, causing biliary colic — better known as a gallbladder attack. These attacks occur when the gallbladder contracts (usually in response to a fatty meal) and presses the stones so as to block the gallbladder duct. The main symptom is pain, usually in the right upper or middle abdomen (just below the rib cage), which builds to greatest intensity within an hour and can persist up to several hours. It can be either sharp and knifelike or a deep ache; sometimes it radiates to the back or the right shoulder. There may also be nausea and vomiting. The pain subsides as the gallbladder relaxes.

A stone lodged in a duct can also cause more serious problems, including acute cholecystitis (inflammation of the gallbladder), pancreatitis (inflammation of the pancreas), or cholangitis (inflammation of the bile ducts in the liver). Any of these conditions can cause severe pain and other symptoms, including jaundice, high fever, chills, and vomiting. Treatment usually requires hospitalization and often surgical removal of the stone.

If you think you’re having a gallbladder attack, your clinician will probably order several blood tests and an abdominal ultrasound (after you fast for at least eight hours). Ultrasound is particularly helpful in diagnosing acute cholecystitis because it also picks up any thickening of the gallbladder wall and indicates the presence of fluid, which may suggest inflammation. Other diagnostic techniques include cholescintigraphy, a radioactive injection used to view a possible blockage of the cystic duct; magnetic resonance imaging (MRI) of the bile ducts; endoscopic ultrasonography, which introduces an ultrasound device through the mouth, esophagus, and stomach to the duodenum (the first section of the small intestine) to get images of the area; and endoscopic retrograde cholangiopancreatography, which uses a scope inserted through the mouth to the duodenum to view the biliary ducts.

How are gallstones treated?

Typically, gallstones are treated only if they cause symptoms. For recurrent gallbladder attacks, the most effective treatment is surgical removal of the gallbladder, or cholecystectomy. In the past, the standard procedure was surgery requiring a five-inch incision and a hospital stay of up to a week. This approach has largely been replaced by laparoscopic cholecystectomy, in which the gallbladder is removed with instruments inserted through small incisions in the skin. This procedure requires only an overnight hospital stay and a week of recovery at home. However, there’s a slight risk of injuring the bile ducts, and in a small percent of cases, the surgeon may have to switch to an open surgery with a larger incision because of complications.

You can easily live without a gallbladder. The liver produces enough bile for normal digestion. When the gallbladder is removed, bile simply flows directly into the small intestine through the common bile duct. When no food is present, loose stools may result, but you can treat that with a bile acid–binding medication, such as cholestyramine (Questran).

Medical options

If you can’t or don’t want to undergo surgery and your gallstones are small, one option is to take ursodiol (Actigall, Urso), a naturally occurring bile acid that helps dissolve cholesterol stones when taken by mouth two to four times a day. It’s also used to prevent the formation of gallstones in people who are losing weight quickly. Ursodiol dissolves only those gallstones made of cholesterol, and it may take several months before it has an effect.

Drug therapy is occasionally combined with lithotripsy, in which sound waves from outside the body are used to break gallstones into pieces that dissolve more easily or are small enough to safely pass through the bile duct. Unfortunately, stones are likely to recur after medical treatment.

How can I reduce my risk for gallstones?

There’s no proven way to prevent gallstones, but eating a well-balanced diet, maintaining a normal weight, and exercising regularly (at least 30 minutes a day most days of the week). Avoiding fatty foods won’t prevent or get rid of gallstones, but it may reduce the frequency of attacks.

Image: rob_lan/Getty Images

Gallstones: Symptoms, diagnosis and treatment

The gallbladder is a pear-shaped pouch that sits just below the liver. It collects bile, a fluid made to help with digestion, as it flows from the liver to the intestine through the bile ducts. Gallstones are hardened bits of bile that form inside the gallbladder.

Bile makes it easier for you to digest fat. It also contains some waste products, including cholesterol and bilirubin, a substance created when old red blood cells are destroyed.

Gallstones form when cholesterol or bilirubin particles cluster together into a solid lump. The stone grows in size as the bile fluid washes over it, much like a pearl forms inside an oyster.

Most gallstones don’t cause any symptoms or problems. Small ones can leave the gallbladder and its draining ducts, then pass out of the body through the intestines.

Gallstones can cause symptoms if they get caught in the narrow outlet of the gallbladder, or in the ducts that drain the gallbladder. After meals, especially meals high in fat, muscles in the wall of the gallbladder contract to help release bile into the intestines. It can be very painful if the gallbladder squeezes against a gallstone, or if a gallstone blocks bile from being released into the intestines.

More serious problems can develop if a gallstone gets into the drainage-duct system but doesn’t make it all the way through to the intestines. In this case, the stone can cause a blockage, causing a buildup of bile in the gallbladder or liver. Since the digestive tract is teeming with bacteria, blocked fluid can lead to a very serious infection. If a gallstone lodges low down in the draining ducts, it can also block drainage of digestive enzymes from the pancreas. This can lead to inflammation of the pancreas (pancreatitis).

Gallstones are very common. About 1 in 5 women and 1 in 10 men have a gallstone by age 60. They are more likely to happen to older people, those who are overweight, and those who suddenly lose weight. Women who have had multiple pregnancies, taken birth control pills, or took estrogen after menopause are also more likely to develop gallstones.

Symptoms

Eighty percent of people with gallstones do not have any symptoms and do not need treatment. When gallstones do cause symptoms, they include:

• abdominal pain, usually high in the abdomen and often on the right side (where the gallbladder is located). The pain can spread to the back. Pain from gallstones can be steady or come and go. It can last between 15 minutes and several hours each time it occurs.
• sensitivity to high fat meals. Fats trigger the gallbladder to contract and can worsen pain.
• unexplained belching, gas, nausea, or a general decrease in appetite.

Gallstones can sometimes cause more serious problems such as pancreatitis or infections in the gallbladder or bile ducts. These can cause fever, more severe abdominal pain, or jaundice (a yellow color of the skin or whites of the eyes).

Diagnosis

Most gallstones do not show up on regular X-rays, but they are seen easily with an ultrasound. Gallstones often don’t cause symptoms. If you have symptoms that may or may not be due to gallstones, it may be difficult for your doctor to know if the stones are causing your symptoms even if you they show up on an ultrasound or CT scan.

If a stone is blocking the movement of bile, an ultrasound might show widened bile ducts. Your doctor may also order blood tests to evaluate injury to the liver and pancreas.

Prevention

You are less likely to form gallstones if you avoid becoming overweight. If you are a dieter, try to avoid diets that cause you to lose weight very quickly, such as diets restricted to fewer than 500 calories daily.

Birth control pills and estrogen can increase the likelihood of gallstones. Consider avoiding these medications if you already have other risk factors for gallstones. Groups at high risk of gallstones include American Indians, Hispanics, people with sickle cell anemia and women who have had multiple pregnancies.

Treatment

Gallstones require treatment only if they are causing symptoms. Smaller gallstones sometimes float out of the gallbladder on their own and are eliminated from the body in feces. Gallstone attacks can also calm down on their own if the bothersome stones shift position within the gallbladder. Even when gallstone symptoms go away on their own, they return within two years in about two of three people.

Most people whose gallstones cause symptoms will continue to have symptoms until the gallbladder is removed, although medications or procedures to break up the stones may also be used.

Surgery

Surgical treatment for gallstones is highly effective. In most people, symptoms go away completely and stay away. The gallbladder is not a necessary organ and most people do not notice any digestive changes after it is removed. Sometimes abdominal pain or diarrhea develop after the gallbladder is removed, and additional treatment or changes in the diet are needed.

Removing the gallbladder is usually done with a minimally invasive (“keyhole) operation known as laparoscopic cholecystectomy. In this procedure, a surgeon makes one or more small openings in the abdomen. A camera, called a laparoscope, is placed into the abdomen through one of these openings. It lets the surgeon see what he or she is doing during the operation.

Using small instruments inserted into the abdomen through other small openings, the surgeon removes fluid and stones from the gallbladder to deflate it. The gallbladder can then be detached from the digestive system and removed through one of the openings.

People tend to recover very quickly from laparoscopic surgery because the surgical wounds are very small.

Open cholecystectomy can be a better option for gallbladder removal among people who have significant abdominal scarring from prior surgery or those who are very obese.

About 5% of the time, a surgeon starts a laparoscopic procedure but changes to an open cholecystectomy for technical reasons.

For stones caught in the common bile duct, an additional treatment called endoscopic retrograde cholangiopancreatography (ERCP) might be needed. A doctor uses miniature instruments attached to a camera at the end of a flexible tube called an endoscope. The endoscope is passed maneuvered from the mouth down the esophagus and into the intestine. The doctor can tug stones out of the bile duct, or can widen the lower part of the duct so they pass into the intestine on their own.

Medication

When surgery is not a good option, an oral medication known as ursodeoxycholic acid (Actigall) may help. It usually takes about six months to see results, and is effective only about half the time. Once the medication is stopped, gallstones are likely to return.

Other procedures

Two other ways to break up gallstones include:

• shockwaves (lithotripsy) to break apart the gallstones so they can pass out of the body on their own
• dissolving gallstones with chemicals injected directly into the gallbladder

Surgery is strongly preferred over these other treatments because stones are likely to form again if the gallbladder is not removed.

Gallstone disease (stones in the gallbladder)

Gallstone disease (cholelithiasis).

Z disease in which the formation and outflow of bile in the biliary system is disturbed, the exchange of cholesterol and bilirubin in the body changes. As a result of these factors, stones (calculi) form in the bile ducts and gallbladder. Gallstone disease is not dangerous in itself, but the possibility of developing severe complications that are likely to be fatal. Much more often, gallstones form in women.

Causes of stone formation

If the balance of bile components in the bile ducts is disturbed, solid formations (flakes) form, which eventually grow and merge into stones. Most often, stones are formed when cholesterol metabolism is disturbed (its excess content in bile). Cholesterol-rich bile is called lithogenic (leading to the formation of stones). Also, infections, inflammation of the organs of the biliary system, allergic reactions, and autoimmune diseases can lead to the development of gallstone disease.

Diagnosis of cholelithiasis

Ultrasound of the abdominal cavity is the most informative method of examination for cholelithiasis. Ultrasound examination accurately shows the presence of echo-impermeable formations – stones, changes in the walls of the bladder. An ultrasound clearly shows the presence of signs of inflammation of the gallbladder. Magnetic resonance and computed tomography of the liver and biliary tract are also used for diagnosis.

Complications of cholelithiasis

The most common complication of cholelithiasis is not just inflammation of the gallbladder (acute and chronic), called cholecystitis, but inflammation with blockage of the bile ducts by a calculus (stone). Blockage of the bile ducts in the pancreas (part of the tract passes through the pancreas) can cause acute pancreatitis. Another common complication of gallstone disease is cholangitis (inflammation of the bile ducts). When the bile ducts are blocked, the patient develops jaundice due to a violation of the outflow of bile pigments, the level of bilirubin in the blood test increases. With inflammation of the ducts and the gallbladder itself, the temperature rises and symptoms of inflammation appear, and with the addition of pathogenic microorganisms, symptoms of purulent inflammation appear. It is these conditions that greatly worsen the prognosis and can cause the most unfavorable outcome.

Treatment of cholelithiasis

If acute or chronic calculous cholecystitis develops, removal of the gallbladder is indicated as a source of stone formation. Surgical intervention is abdominal or laparoscopic, depending on the state of the body, pathological changes in the walls of the bladder and surrounding tissues, and the size of the stones. It is necessary to determine the feasibility of abdominal or laparoscopic intervention with a surgeon. Of course, laparoscopic surgery has a significant cosmetic advantage when there are no large scars left on the abdomen after surgery. But not always (despite modern equipment) it is possible to perform laparoscopic intervention. Therefore, the decision on the type of intervention for the removal of stones must be made in consultation with the surgeon. The surgical department of the Kirov Railway Hospital has accumulated a large successful experience in the removal of gallbladder stones by laparoscopic cholecystectomy.

Prognosis and prevention of cholelithiasis

Prevention of cholelithiasis consists in avoiding factors that contribute to increased cholesterolemia and bilirubinemia, bile stasis. A balanced diet, normalization of body weight, an active lifestyle with regular physical activity can avoid metabolic disorders, and timely detection and treatment of pathologies of the biliary system (dyskinesia, obstruction, inflammatory diseases) can reduce the likelihood of bile stasis and sedimentation in the gallbladder. Particular attention should be paid to the exchange of cholesterol and the state of the biliary system for persons who have a genetic predisposition to stone formation, those whose relatives already suffer from gallstone disease.

In the presence of stones in the gallbladder, prevention of attacks of biliary colic will be following a strict diet (exclusion from the diet of fatty, fried foods, muffins, confectionery creams, sweets, alcohol, carbonated drinks, etc.), normalization of body weight, consumption of a sufficient amount liquids (water). To reduce the likelihood of movement of calculi from the gallbladder through the ducts, work associated with a long stay in an inclined position is not recommended. Trips (business trips) on rough roads are strictly contraindicated.

The prognosis of the development of cholelithiasis directly depends on the rate of formation of stones, their size and mobility. In the vast majority of cases, the presence of stones in the gallbladder leads to the development of complications. With successful surgical removal of the gallbladder – a cure without pronounced consequences for the quality of life of patients.

Appointment for a consultation with a surgeon and ultrasound examination by phone:

(8332) 25-50-50

Some common misconceptions about gallstone disease

Misconception 1: Gallstones can spontaneously pass from the gallbladder Imagine the structure of bile leg bladder: it has a bottom, a body and a neck. The bubble at the transition to the neck narrows to 7-8 mm. The cervix passes into the cystic duct, which contains a complex valvular apparatus several millimeters in diameter. The neck of the bladder connects with the common bile duct, which then enters the duodenum in the form of a sphincter called the papilla of Vater. The sphincter has the ability to contract, it regulates the flow of bile into the intestines and has a clearance of only 1-1.5 mm! Thus, it is difficult to imagine that stones larger than one millimeter could pass through this powerful valvular apparatus. But they sometimes reach several centimeters in diameter. Most often, stones get stuck in the bile ducts, causing acute cholecystitis, jaundice. Perhaps this misconception is due to the confusion of gallstones and kidney stones. In the urinary system (kidneys), stones can sometimes pass on their own. In the case of the formation of stones in the gallbladder, their independent exit to the outside is unlikely.

Misconception 2: Gallbladder stones can be dissolved with medications and some herbs.

Let’s see what gallstones are. The main chemical compounds that make up their composition are cholesterol, bilirubin, calcium salts, proteins, as well as small amounts of iron, copper, magnesium, sulfur, manganese.

According to the existing classification, stones are divided into cholesterol, complex cholesterol-pigment-salt, pigment. Of all these varieties, only pure cholesterol stones can be dissolved. For this purpose, chenodeoxycholic acid and its preparations are used: chenosan, chenofalk, chenochol, as well as ursodeoxycholic acid and its preparations (ursofalk, ursosan). It should be borne in mind that such treatment is very long, expensive and, unfortunately, does not always lead to the desired results. As for the use of medicinal plants to dissolve stones, they simply do not exist. Phytotherapy (here we also include attempts to be treated with homemade preparations from natural bear bile) aims to improve the chemical composition of bile, accelerate its secretion by the liver, stimulate the emptying of the gallbladder, thereby preventing the formation of stones, but not the removal of stones.

Misconception 3: Stones can be removed from the gallbladder with olive oil

As we have already found out, stones cannot leave the gallbladder. The intake of a significant amount of any vegetable oil sharply stimulates bile secretion, contraction of the muscles of the bladder and ducts, as well as the release of pancreatic juice. As a result, it is possible to provoke an exacerbation of chronic cholecystitis, pancreatitis, cause the movement of calculi and infringement of one of them in the neck of the bladder, which leads to the need for urgent surgical treatment.

Delusion 4: If you use olive oil and lemon or apple juice, you can get the desired result.

This “treatment” has a long history. It is known that for the first time vegetable oil (olive or turpentine) alone or in combination with lemon juice for the expulsion of so-called stones from the gallbladder began to be used by North American healers in the early fifties of the last century. Subsequently, doctors began to use this method. But already in 1891 year, the American doctor Winston in his article showed that the stones found in the feces after taking oil and lemon juice have nothing to do with the gallbladder. Later, scientists found that with the simultaneous ingestion of any of the vegetable oils and acids, in particular lemon juice, special chemical compounds called soaps are formed in the intestines. Passing through the intestines, they acquire a rounded shape. That is why there has been a misconception that softened gallstones come out. Unfortunately, even now you can still find recommendations to use olive oil with lemon juice to remove stones, to lie with your right side on a heating pad. Some so-called folk healers sometimes do it out of ignorance, sometimes deliberately for selfish purposes. Unfortunately, this leads to the opposite goal – the stones do not come out, and the person ends up in the surgical department.

IF STONES ARE ALREADY FORMED, THEN THEY CAN ONLY BE GET RID OF THEM WITH THE HELP OF SURGICAL INTERVENTION. USUALLY IN SUCH CASES, THE GALLBLADER IS REMOVED – CHOLECYSTECTOMY. RECENTLY, LAPAROSCOPIC CHOLECYSTECTOMY IS MORE COMMONLY PERFORMED.

Good to know about laparoscopic cholecystectomy

In order to remove the gallbladder with the formed stones, the surgeon makes 4 punctures of the abdominal wall, each of which requires a miniature skin incision. Unlike the 20 cm incision that is made during open surgery, the 4 abdominal wall punctures do not injure muscle tissue, so patients experience much less pain after surgery and can usually return to normal activities within one week. The abdominal wall is punctured with a thin tube called a trocar. Through a trocar inserted in the navel, the surgeon inserts a laparoscope into the abdominal cavity, to which a small video camera and a light source are connected. The video camera transmits the image from the endoscope to a video monitor, and the surgeon can see the organs from inside the body. Trocar punctures are also made at three other points. Through these trocars, the surgeon introduces the special instruments needed to perform the operation. For example, to hold the gallbladder in a fixed position, a gripping clamp is used – a grasper. Instruments that allow the use of a laser beam or a low voltage electric current are used to separate the gallbladder from the liver while sealing the wound surface and stopping bleeding. Ultimately, the gallbladder is removed from the abdominal cavity through a trocar in the navel. The operation is performed under general anesthesia, takes about an hour and requires the patient to stay in the hospital for another 3-6 days, although, of course, in each individual case, these terms are individual.

In the recovery period, immediately after surgery, nausea and discomfort may sometimes occur. In the first week after surgery, a diet with the exclusion of fatty foods is recommended. During the week, you should also be observed by the surgeon. You can return to a full life activity as soon as you feel comfortable.

Appointment for a consultation with a surgeon and ultrasound examination by phone:

(8332) 25-50-50

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GKB No. 31 im. Academician G.M. Savelyeva – Pills or surgery?

Operative treatment of gallstones has long been recognized as the most effective and safest. However, many still doubt it.

What worries our readers the most?

Doctor of Medical Sciences, Head of the Department of Hospital Surgery of the Russian State Medical University, surgeon of City Clinical Hospital No. 31 of Moscow, Professor Sergey Georgievich Shapovalyants .

1) Why remove the gallbladder if only one small stone has formed in it?

– Small stones in this case do not mean a small problem. On the contrary, they often cause serious complications.

If large formations lead to bedsores and gallbladder ruptures, then small stones are insidious in their own way. They can easily move and penetrate the bile ducts.

Wandering through them, the stones reach the duodenum. There, sooner or later, they get stuck, blocking the outflow of bile. Because of this, mechanical jaundice occurs.

Moreover, an attack of acute pancreatitis may suddenly develop. In this case, an ambulance from a doctor is needed.

Therefore, small stones should not be ignored. Even if at least one is found, you need to act. To date, the only treatment for gallstone disease is surgery – removal of the gallbladder.

2) There is a method of dissolving stones with the help of medicines. Why not try it before going to the surgeon?

– Indeed, there are such drugs. But the difficulty is that they rarely completely dissolve the stones. As a rule, drugs only slightly reduce them. The stone doesn’t go anywhere, it just gets smaller. Whether this is good or bad is a big question. As we said above, small stones cause no less problems than large ones.

Moreover, drugs are only effective against cholesterol stones. If they have a lot of calcium, conservative methods are useless.

One more thing. The size of the stones should not exceed 2 cm. It does not make sense to dissolve larger formations. This will take too long. After all, the stone, on average, decreases by no more than 1 mm per month.

It is not worth spending months or even years on this procedure. After all, no one can give a 100% guarantee of a successful result. And the risk of starting a problem is quite high.

Use with extreme caution in people with other gastrointestinal disorders. It is impossible to dissolve stones with stagnation of bile, acute inflammatory diseases of the gallbladder and bile ducts, liver diseases, stomach and duodenal ulcers, and problems with the intestines.

In addition, this seemingly harmless method of dealing with gallstones has its own side effects. The most common is stool disorder. And given that conservative treatment is designed for a long period, then it is unlikely that it will be possible to “endure” unpleasant reactions.

The situation is not easy. On the one hand, the method of drug dissolution of stones is quite safe – no anesthesia, incisions, postoperative rehabilitation is needed. On the other hand, it has many limitations and is not very effective.

3) How effective is the method of crushing gallstones, because kidney stones are crushed?

– The analogy between kidney stones and gallstones is often used. But these are completely different diseases, each of which manifests itself and is treated in its own way. Bringing them to the same denominator is incorrect.

At one time, the method of crushing gallstones using extracorporeal lithotripsy was widely used. During the session, multiple shock waves were directed at the stone from the outside. As a result, it was broken up into fragments, which then independently exited through the bile ducts and intestines.

In fact, not everything went so smoothly. Large fragments could not pass through the duct, so they remained in the gallbladder. Most of the small ones left “their place of residence”. But some of them got stuck in the bile ducts, clogged them and disrupted the process of bile formation. Therefore, after such a procedure, sometimes it was necessary to urgently do an operation.

There is another important nuance. Usually gallstones are even, smooth, adapted to the shape of the gallbladder. Outside the attack, as a rule, they are not felt in any way. But after crushing, fragments are formed, which can cause colic and other painful sensations.

Due to the impressive number of undesirable consequences, this method is practically not used today. And in some foreign clinics, it is generally prohibited.

4) Is it possible to remove only stones and leave the gallbladder?

– It is possible, but this method is now recognized as ineffective. There is an opinion that some people, especially young people, should not have their gallbladder removed. After all, it performs important functions in the body.

Proponents of this approach perform an operation during which a small incision is made in the gallbladder. Through it, gallstones are taken out. Then the bladder is sutured, and after two or three days, a satisfied patient returns home. Without stones, and with a preserved gallbladder.

But not everything is so simple. Approximately 2-3 months after such an operation, the disease begins to bother again. The percentage of her return of the disease at different intervals reaches almost 100%. The fact is that one of the prerequisites for the formation of stones in the gallbladder is its poor contractility. Bile stagnates in it, from which stones are then formed.

Another reason is the individual characteristics of the bile itself. With any diet, even the lightest, it concentrates and precipitates. In this case, the elimination of stones alone simply does not make sense. Finally, the problem can be solved only by the complete removal of the gallbladder.

5) What are the advantages of laparoscopic stone removal?

– For a long time gallstones were removed by the usual abdominal method. But today, many large hospitals and clinics are switching to a simpler and safer technique – laparoscopy.

The whole operation is carried out through three or four punctures in the abdominal wall. A miniature optical system is inserted through them. With its help, the abdominal cavity is examined, and then the gallbladder is removed with special tools.

As a rule, this is where the patient’s troubles end. After a short period of adaptation, he will be able to forget about gallstone disease forever.

Moreover, the absence of the gallbladder will be almost imperceptible. Indeed, in fact, his “biological loss” occurred much earlier – even at the stage of stone formation. Even then, the gallbladder stopped working normally, and other organs took over its “duties”.

6) Quite often, after gallbladder removal, a person feels even worse than before the operation. Maybe she doesn’t need it at all?

– There is such a thing as postcholecystectomy syndrome. This is a deterioration in well-being after removal of the gallbladder. Most often this happens if the operation is performed at an advanced stage of the disease, when neighboring organs are involved in the process.

In this situation, only one thing can be said – do not take things to extremes. Do the operation as planned, and not when the “thunder strikes.” Then problems can be easily avoided.

There is another reason – insufficiently serious preliminary examination. Today, removal of the gallbladder is considered a technically simple procedure for doctors and easily tolerated by patients. Therefore, the range of preliminary tests is often limited to one ultrasound of the abdominal cavity. And this is extremely small.

To get a complete picture and find out the true cause of poor health, it is necessary to carefully examine not only the gallbladder, but also all nearby organs. It is necessary to carefully assess the condition of the bile ducts, pancreas, duodenum, right kidney, stomach.