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

Can Gallbladder Stones Go Away Without Surgery?

The gallbladder is a small-sized organ located in the right upper quadrant of the abdomen,  below the liver. Its main function is to store bile juice that assists digestion. Gallbladder stones is a medical condition wherein hardened deposits of cholesterol and bilirubin develop and sometimes get lodged in the gallbladder or bile ducts. The size of these stones may vary from the size of a golf ball to a grain of rice. Many stones may develop simultaneously.  These stones can leave the gallbladder and get stuck along the way.

This is when a person may feel the first instance of abdominal pain and discomfort. Interestingly, large-sized gallbladder stones usually stay in the gallbladder and do not cause any discomfort. Depending on the size and discomfort caused, these stones can be removed surgically or via symptomatic care.

What are the types of gallbladder stones?

Depending on its composition, there are mainly two variants of gallbladder stones.

1. Cholesterol gallstones

These are the most common types. They account for almost 80% of all gallbladder stones. These stones are generally greenish-yellow in colour, constitute cholesterol and lipid-protein, and contain other components.

2. Pigmented gallstones

These are generally smaller in size and black or brown. These stones are formed due to the excess amount of bilirubin in the bile. Bilirubin is the byproduct of destroyed and fragmented red blood cells. This yellow coloured substance passes through the liver into the gallbladder and is then excreted.

What are the symptoms of gallbladder stones?

Usually, gallbladder stones do not exhibit any symptoms. However, if these stones lodge in the bile duct, it might lead to :

• Sudden and rapidly growing pain in the upper right part of your abdomen
• Sudden and rapidly increasing pain in the centre of your abdomen, just below your breastbone
• Back pain between your shoulder blades
• Pain in your right shoulder
• Nausea or vomiting

When do you need to visit the doctor?

Gallbladder stones may not show any signs or symptoms always. However, immediate medical help is required if constant, searing abdominal pain, nausea, and fever develop. Make a note of the symptoms and medical history. Gallbladder stones pain may last for several hours to a few minutes. If severe symptoms and inflammation like these mentioned below occur, it is advisable to seek professional help immediately.

1. Abdominal pain that lasts for several hours
2. Fever or body chills
3. Yellowish skin and eyes. This symptom may indicate jaundice.
4. Dark-coloured urine and light-colored stool

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What are the causes of gallbladder stones?

Researchers have not yet found the exact reason why gallbladder stones occur. These stones might be caused by:

1. Excess cholesterol in the bile: The body requires bile for digestion. It also dissolves cholesterol excreted by the liver. If the liver excretes more cholesterol than required,  the excess cholesterol may crystallize and eventually form gallbladder stones.
2. Excess bilirubin in the blood: Conditions like liver cirrhosis, biliary tract infections, and certain blood disorders can cause your liver to produce bilirubin in excess. This excess bilirubin can lead to the formation of gallbladder stones.
3. Incomplete emptying of the gallbladder: If it does not empty itself, there might be an accumulation of bile, causing gallbladder stones.

Several factors might put a person at risk of developing gallbladder stones. A few of them are:

1. Hereditary: If an immediate member of the patient’s family has a history of gallbladder stones, the chances of occurrence are higher.
2. Lifestyle: Some common reasons for developing gallbladder stones are obesity, rapid weight loss within a short period, and diabetes mellitus.
3. Medical: Suffering from liver cirrhosis, estrogen, blood disorders like sickle cell anaemia or leukaemia, and pregnancy are all risk factors associated with gallbladder stones.

What are the complications of gallbladder stones?

Several complications may occur due to the formation of gallbladder stones. The most common ones are:

1. Acute cholangitis: This condition refers to the infection of bile ducts due to blockage. Infected bile ducts may spread bacteria in the bloodstream, developing a severe health condition called sepsis.
2. Acute cholecystitis: When a gallbladder stone gets logged in the gallbladder’s neck causing intense pain and discomfort, it may lead to Acute Cholecystitis. In extreme cases, the gallbladder might get ruptured or burst.
3. Blockage of the pancreatic duct: The pancreatic duct facilitates the movement of pancreatic juices that aids digestion. With gallbladder stones blockage, inflammation in the pancreas may occur which causes intense excruciating abdominal pain
4. Cancer in the gallbladder: Gallbladder stones might cause gallbladder cancer in an extremely rare cases. History of gallbladder stones might increase the risk of cancer, though it is very rare.

What are the diagnostic procedures for gallbladder stones?

The doctor might perform the following diagnostic tests:

1. A blood test to check for infections
2. Abdominal ultrasound to check for gallbladder stones
3. CT scan is a specialized scan that enables the doctors to check for gallbladder stones.
4. Magnetic Resonance Cholangiopancreatography (MRCP) uses radio waves and magnetic pulses to check the liver and gallbladder functioning.
5. Cholescintigraphy (HIDA scan) involves the use of radioactive material. This scan allows the doctors to check whether the gallbladder contracts properly or not.
6. Endoscopic Retrograde Cholangiopancreatography (ERCP) involves the insertion of a  small tube, which will be passed through the endoscope to the biliary tree. A contrast dye would be injected through a small tube into the ducts, after which X-rays will be taken.
7. Endoscopic ultrasound is the combination of ultrasound and endoscopy conducted to check for gallbladder stones.

What are the treatment procedures for gallbladder stones?

Today, there are numerous treatments for gallbladder stones. The doctor might likely remove the gallbladder through surgical processes.. The removal of the gallbladder does not hinder the digestion process. The following are some of the surgical procedures used.

1. Laparoscopic cholecystectomy is the most common surgical process. It takes around 24 hours for the patient to get discharged after completing the procedure and about 2 to 3 days to recover fully.
2. Open cholecystectomy is a slightly longer procedure that involves removing the gallbladder through larger incisions in the belly. Undergoing this procedure might take a few days for the patient to get discharged and about 7 to 10 days for a full recovery.

Medications to dissolve gallstones: Medicines may help dissolve gallstones without surgery. However, in this way, it may take months or years of treatment to dissolve the gallstones. In addition, there are chances of the formation of gallstones again if treatment is stopped.

Medications for gallstones are not used commonly and are reserved for those who cannot undergo a surgery. Ursodiol  and chenodiol may be used to  dissolve cholesterol stones. They can cause mild diarrhea.

Shock wave therapy is another non-surgical technique, that uses high-frequency sound waves to break/fragment the stones. Afterwards, bile salt is administered to dissolve small ston pieces. This therapy is used rarely.

Doctors may also try to remove gallstones during an ERCP test. During this procedure, the physician inserts an instrument through the endoscope to attempt removing the stone.

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Can gallstones be prevented?

Since lifestyle is a significant contributor to gallbladder stones, a few preventive measures can be practised to lower the  risk.

1. Consumption of fiber-rich food. Fiber acts as a prebiotic that helps maintain the gut microbiota. It also helps facilitate proper digestion and overall health.
2. Maintaining a healthy weight decreases the chances of excess cholesterol in the bloodstream. Also, it also reduces the chances of being obese. 
3. A balanced diet helps facilitate better digestion, thus, reducing the chances of gallstones.
4. Slow and controlled weight loss reduces the risk of gallstones.
5. Women with high risk of gallstones should check with the doctor whether they should avoid the use of hormonal birth control.

Gallbladder stones are usually harmless and dissolve on their own. But, they may pose to be life-threatening if these stones block any duct or cause an infection. Hence, it is worthwhile to take preventive measures. Avoid processed food; instead, consume more fresh fruits, vegetables, legumes, grains, and nuts. Maintaining a healthy lifestyle reduces the chance of acquiring many diseases.

Frequently Asked Questions (FAQs)

1. Is it normal to have stones in the gallbladder?

Although a vast majority have gallbladder stones , symptoms or signs may not always occur. If, however, symptoms occur, seek medical help immediately.

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2. How much time is required to recover from passing a gallstone?

However, if one has undergone surgery, it might take up to a week of hospitalization, depending on the severity. Further, to resume daily work, it might take up to four to six weeks.

3. Does drinking water help with gallstones?

Yes, it does. Drinking adequate amounts of water helps the gallbladder and prevents the build-up of bile. This, in turn, prevents the formation of gallbladder stones.

4. Will the removal of the gallbladder hinder my digestion?

It is possible to live normally without the gallbladder. When your gallbladder is removed, bile flows directly from your liver into the small intestine, and this may sometimes cause diarrhoea. As bile does not accumulate in the gallbladder, the quantities of digestive fluid can’t be stored up and used to break down a meal, especially a fatty meal. But, this condition is not considered serious and can be corrected by simply limiting fat in the diet.

5. Will my gallbladder stones come back after they have been non-surgically regmoved?

There is a high probability that the gallbladder stones might recur. It is advisable to consume a healthy diet, exercise regularly, and increase water intake if one has suffered from gallbladder stones. Surgical intervention, however, makes sure that it does not recur in the future.

City Clinical Hospital No. 31 im. Academician G.M. Savelyeva – Pills or surgery?

The surgical 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 the 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 preparations. 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 one more 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 a 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 removal of the gallbladder, 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.

Not all medical institutions are equipped for this. Therefore, it is better to contact large clinics and centers.

When stones are suspected, endoscopic bile duct ultrasonography is now used successfully. It is performed using a miniature ultrasound probe or endoscope, at the end of which is an ultrasound probe. If there are stones in the bile ducts, you first need to eliminate them, and only then take on the gallbladder.

Computed tomography can help examine the liver and pancreas. Many of the necessary details will tell a biochemical blood test. Of course, not everyone needs these studies. But if there are at least some doubts, they cannot be ignored.

It is a thorough examination before surgery that allows you to choose the right tactics for treatment, preparation and recovery period. After all, the goal of surgical manipulations is not just to remove the problem, but to make it the most comfortable way for the patient.

Treatment and removal of stones in the gallbladder (treatment of gallstone disease, surgery), stones in the gallbladder laparoscopy in Nizhny Novgorod in the clinic

Gallstone disease is a problem that worries a large part of the population. The main contingent of patients are people with overweight, impaired metabolic processes in the body, diseases of the biliary tract, associated with stagnation of bile in the gallbladder.

The occurrence of stones in the gallbladder is a process associated with the stagnation of bile, the precipitation of cholesterol crystals contained in it. Gradually, small crystals combine and form stones, which sometimes reach impressive sizes. Under the action of the contraction of the bladder, it is possible for the stone to pass through the ducts.

Not always the size of the stone allows it to pass freely, which often leads to obstruction of the duct, accompanied by the so-called hepatic colic – acute paroxysmal pain in the right hypochondrium, and jaundice may also occur.

A large, heavy stone that lies in the gallbladder can form a decubitus due to constant pressure, and subsequently perforate the wall of the gallbladder with the development of peritonitis. All these complications can be prevented if timely treatment of gallstone disease , namely, to remove stones from the gallbladder.

To make a diagnosis, various measures are required (blood tests, ultrasound, x-rays with and without contrast). In particularly difficult cases, it is possible to perform a diagnostic laparoscopy.

Gallbladder stones may not cause any symptoms at all, so it is important to consider this disease in the differential diagnosis.

Gallbladder stones – treatment, modern approach to the problem

Treatment of gallstones can be conservative (without surgery) or surgical. Many people are afraid to go for surgery, as it is associated, in their opinion, with a great risk to health. But they expose themselves to even greater risk by refusing surgery for gallstone disease. Conservative treatment of cholelithiasis is possible in the presence of stones, ideally 5 mm (size up to 15-20 mm is allowed).

We must not forget that getting rid of stones, but not curing the main cause of their occurrence, you can get a relapse of the disease. Therefore, a radical treatment for gallstones is removal of stones from the gallbladder along with it. The operation is called a cholecystectomy.

The classic option for the surgical treatment of gallstone disease is cholecystectomy with laparotomic access (that is, an incision on the anterior abdominal wall).

However, medicine does not stand still and because of its trauma, long recovery period and possible complications, the method fades into the background. The current alternative (and the “gold standard for gallstone surgery”) is laparoscopic cholecystectomy.

The advantage of such an operation for cholelithiasis is that not one large incision is made, but several small ones (5-10 mm in size), which significantly reduces tissue trauma. Trocars and an optical device are inserted into the abdominal cavity through the holes, which transmits the image to the screen.

In this way, the surgeon can examine the gallbladder as well as adjacent organs. Removal of stones from the gallbladder is not performed separately.

During the operation, the entire gallbladder is removed along with its contents using a special electric knife, which ensures a minimum of bleeding. The gallbladder is placed in a special plastic bag in order to remove it from the abdominal cavity without tearing it. This is the prevention of the development of bile peritonitis. Also, the use of such a bag allows at laparoscopy, gallbladder stones should be removed one by one if they are large and cannot pass through a small hole in the abdominal wall at the same time.

Surgery for cholelithiasis is a guarantee of successful recovery and adequate prevention of relapses.

Advantages of laparoscopic surgery for cholelithiasis:

• Early activation period of the patient
• Minimize trauma and reduce the risk of complications
• Fast and accurate operation

Treatment of stones in the gallbladder in Nizhny Novgorod

Removal of stones from the gallbladder is possible during a laparoscopic operation – cholecystectomy.