How do i get gallstones: Symptoms & Causes of Gallstones

01.12.202124.07.2023 by alexxlab

Gallstones | Johns Hopkins Medicine

What are gallstones?

Gallstones form when bile stored in the gallbladder hardens into stone-like
material. Too much cholesterol, bile salts, or bilirubin (bile pigment) can
cause gallstones.

When gallstones are present in the gallbladder itself, it is called
cholelithiasis. When gallstones are present in the bile ducts, it is called
choledocholithiasis. Gallstones that obstruct bile ducts can lead to a
severe or life-threatening infection of the bile ducts, pancreas, or liver.
Bile ducts can also be obstructed by cancer or trauma, but this is not
related to gallstones.

What causes gallstones?

Cholesterol stones are believed to form when bile contains too much
cholesterol, too much bilirubin, not enough bile salts, or when the
gallbladder does not empty as it should for some other reason.

Pigment stones tend to develop in people who have cirrhosis, biliary tract
infections, and hereditary blood disorders such as sickle cell anemia. The
causes of these stones are uncertain.

What are the symptoms of gallstones?

At first, most gallstones do not cause symptoms. However, when gallstones
become larger, or when they begin obstructing bile ducts, symptoms or
“attacks” begin to occur. Attacks of gallstones usually occur after a fatty
meal and at night. The following are the most common symptoms of
gallstones. However, each individual may experience symptoms differently.
Symptoms may include:

Steady, severe pain in the upper abdomen that increases rapidly and
may last from 30 minutes to several hours
Pain in the back between the shoulder blades
Pain in the right shoulder
Nausea
Vomiting
Fever
Chills
Jaundice. A yellowing of the skin or eyes.
Abdominal bloating
Intolerance of fatty foods
Belching or gas
Indigestion

People who experience the following symptoms should consult their doctor
immediately:

Some people with gallstones do not have any symptoms. These stones are
called “silent stones,” because they do not interfere with the function of
the gallbladder, liver, or pancreas, and do not require treatment in most
cases.

The symptoms of gallstones may resemble other conditions or medical
problems, such as heart attack, appendicitis, ulcers, irritable bowel
syndrome, hiatal hernia, pancreatitis, or hepatitis. Always consult your
health care provider for a diagnosis.

Who is affected by gallstones?

The following are suggested risk factors for gallstones:

Obesity.
Obesity is a major risk factor for gallstones, especially in women.
Estrogen.
Excess estrogen from pregnancy, hormone replacement therapy, or
birth control pills appears to increase cholesterol levels in bile
and decrease gallbladder movement, both of which can lead to
gallstones.
Ethnicity.
Native Americans have the highest rates of gallstones in this
country and seem to have a genetic predisposition to secrete high
levels of cholesterol in bile.
Gender.
Women are twice as likely to develop gallstones than men.
Age.
People over 60 are more likely to develop gallstones than younger
people.
Cholesterol-lowering drugs.
Drugs that lower cholesterol in blood can actually increase the
amount of cholesterol secreted in bile, which, in turn, increases
the risk of gallstones.
Diabetes.
People with diabetes generally have high levels of fatty acids,
called triglycerides, which increase the risk for gallstones.
Rapid weight loss.
As the body metabolizes fat during rapid weight loss, it causes the
liver to secrete extra cholesterol into bile, which can cause
gallstones.
Fasting.
Fasting decreases gallbladder movement, which causes the bile to
become overconcentrated with cholesterol.

How are gallstones diagnosed?

In some cases, asymptomatic gallstones are discovered by
accident–during testing for another diagnosis. However, when pain
persists or happens again and again, your health care provider may want
to conduct a complete medical history and physical examination, in
addition to the following diagnostic procedures for gallstones:

Ultrasound.
A diagnostic technique that uses high-frequency sound waves to
create an image of the internal organs.
Cholecystography.
X-ray that shows the flow of contrast fluid through the
intestines into the gallbladder.
Blood tests.
These look for signs of infection, obstruction, jaundice,
and/or pancreatitis.
Computed tomography scan (also called a CT or CAT scan).

A diagnostic imaging procedure that uses a combination of
X-rays and computer technology to produce horizontal, or axial,
images (often called slices) of the body. A CT scan shows
detailed images of any part of the body, including the bones,
muscles, fat, and organs. CT scans are more detailed than
general X-rays.
Endoscopic retrograde cholangiopancreatography (ERCP).

A procedure that involves inserting an endoscope (viewing tube)
through the stomach and into the small intestine. A special dye
injected during this procedure shows the ducts in the biliary
system.
Sphincterotomy.
Opening the muscle sphincter, a ring of muscle around a natural
opening that acts like a valve, wide enough so stones can pass
into the intestine.

Treatment for gallstones

Specific treatment for gallstones will be determined by your health
care provider based on:

Your age, overall health, and medical history
Extent of the condition
Your tolerance of specific medicines, procedures, or therapies
Expectations for the course of the condition
Your opinion or preference

If the gallstones cause no symptoms, treatment is usually not
necessary. However, if pain persists, treatment may include:

Gallbladder removal (cholecystectomy).
Once removed, the bile flows directly from the liver to the
small intestine. Side effects of this may include diarrhea
because the bile is no longer stored in the gallbladder.
Oral dissolution therapy.
Drugs made from bile acid are used to dissolve the stones.
Methyl-tert-butyl ether.
A solution injected into the gallbladder to dissolve stones.
Extracorporeal shockwave lithotripsy (ESWL).
A procedure that uses shock waves to break stones up into tiny
pieces that can pass through the bile ducts without causing
blockages.
Contact dissolution therapy.
An experimental procedure that involves injecting a drug
directly into the gallbladder to dissolve the stones.

Picture, Symptoms, Types, Causes, Risks, Treatments

Written by WebMD Editorial Contributors

What Are Gallstones?
Gallstone Types
Symptoms of Gallstones
Causes of Gallstones
Gallstone Risk Factors
Gallstone Diagnosis
Can Gallstones Go Away on Their Own?
Gallstone Treatment
Complications of Gallstones
Preventing Gallstones
More

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

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

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

The two main kinds of gallstones are:

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

Gallstones don’t normally cause symptoms. Symptoms occur only when a gallstone gets stuck and blocks the flow of bile through your system.

If you have symptoms, they may include:

Pain in your upper belly, often on the right, just under your ribs
Pain in your right shoulder or back
An upset stomach
Vomiting
Other digestive problems, including indigestion, heartburn, and gas

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

Belly pain that lasts several hours or is severe
Fever and chills
Yellow skin or eyes

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

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

You’re more likely to get gallstones if you:

Have a family history of them
Are a woman
Are over age 40
Are of Native American or Mexican descent
Are obese
Have a diet high in fat and cholesterol but low in fiber
Don’t get much exercise
Use birth control pills or hormone replacement therapy
Are pregnant
Have diabetes
Have an intestinal disease like Crohn’s
Have hemolytic anemia or cirrhosis of the liver
Take medicine to lower your cholesterol
Lose a lot of weight in a short time
Are fasting

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

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

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

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

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

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

Endoscopic retrograde cholangiopancreatography (ERCP). Your doctor runs a tube called an endoscope through your mouth down to your small intestine. They inject a dye so they can see your bile ducts on a camera in the endoscope. They can often take out any gallstones that have moved into the ducts, but that’s only done if treatment is planned as part of the procedure since it’s invasive.

Endoscopic ultrasound. This test combines ultrasound and endoscopy to look for gallstones that may be in places that are hard to see with other imaging, such as in the common bile duct as it passes through the pancreas.

If your gallstones aren’t causing symptoms, there’s usually no need for you to have surgery. You’ll only need it if a stone goes into, or blocks, one of your bile ducts. This causes what doctors call a “gallbladder attack.” It’s an intense, knife-like pain in your belly that can last several hours.

If you have sickle cell or another blood disorder, your doctor may consider doing a cholecystectomy as a precaution, even if you don’t have symptoms.

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

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

Laparoscopic cholecystectomy. This is the most common surgery for gallstones. The surgeon works through tiny cuts (incisions). They pass a narrow tube called a laparoscope into your belly through a small cut. The tube contains a tiny light and a camera. The doctor will take out your gallbladder through another small cut using special devices. You’ll usually go home the same day.

Open cholecystectomy. Your doctor makes bigger cuts in your belly to remove your gallbladder. You’ll stay in the hospital for a few days afterward. You’ll need open surgery if you have a bleeding disorder. You may also need it if you have severe gallbladder disease, are very overweight, or are in your last trimester of pregnancy.

For both types of surgery, you’ll get general anesthesia. This means you won’t be awake during the procedure.

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

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

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

Gallstones can cause serious problems, including:

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

Some lifestyle changes might lower your risk of gallstones.

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

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Gallstone disease – causes, symptoms, diagnosis, complications, treatment of stones in the gallbladder

Gallstone disease is a chronic disease of the organs of the hepatobiliary system, characterized by a violation of the synthesis and circulation of bile, the formation of stones in the gallbladder or bile ducts. Most often, the pathology is manifested by paroxysmal pain in the right hypochondrium – biliary colic, jaundice. A complete cure is possible only by surgery. Without removal of calculi, the development of severe, including life-threatening, complications is possible – cholecystitis, peritonitis and others.

According to the clinical recommendations of the Russian Federation, the prevalence of gallstone disease in developed countries reaches 10-15%, which is explained by the nature of the diet of their inhabitants. In Africa and Asia, this figure is much lower and is about 3.5-5%. Mostly people aged 40 to 69 are ill. In women, the risk of developing gallstone disease is 2-3 times higher than in men.

Causes

The main cause of stone formation in the gallbladder and ducts is an increased concentration of bile. When it is oversaturated with cholesterol, large calculi of a yellowish-white color are formed. If there is an inflammatory process in the bile ducts, as well as with hemolysis and cirrhosis of the liver, pigmented brown or black stones are formed.

The following factors contribute to the development of gallstone disease:

genetic predisposition;
high-calorie diet with excessive intake of fatty foods and simple carbohydrates;
sedentary lifestyle;
obesity;
taking hormonal contraceptives;
pregnancy;
rapid weight loss, low-calorie diet;
helminthiasis;
alcohol abuse;
chronic liver pathology, diabetes mellitus, Crohn’s disease, anemia, cystic fibrosis, infectious process in the biliary tract;
certain medications, eg octreotide, clofibrate.

Symptoms

Pathology for a long time may not have clinical manifestations. Symptoms of gallstone disease appear with inflammation or obstruction in the biliary tract, when stones from the cavity of the gallbladder move into its neck or ducts and clog them. This process may be accompanied by an attack of biliary colic, symptoms of acute calculous cholecystitis, as well as chronic cholecystitis, cholangitis, biliary pancreatitis.

Biliary colic has the following symptoms:

Severe pain in the projection of the gallbladder. It starts in the right hypochondrium, suddenly and can give in the back, under the right shoulder blade, in the neck, in the right shoulder. In rare cases, its migration to the region of the heart causes angina pectoris. The duration of such an attack in cholelithiasis is from a couple of minutes to several days. The nature of pain is first acute, then constant, aching.
Taste of bitterness in the mouth, loss of appetite.
Dyspeptic manifestations. Nausea, vomiting with an admixture of bile, not leading to relief, frequent and loud belching of air or food eaten.
Increased body temperature. With purulent cholecystitis, fever can reach 39 ° C and above.
Digestive disorder. Often the patient has bloating, constipation of the atonic type.

An exacerbation of gallstone disease can be triggered by a violation of the diet. The movement of calculi can also be caused by shaking riding, torso tilts. With the development of choledocholithiasis – the entry of stones into the bile ducts and their blockage – mechanical jaundice develops. With it, the skin, sclera of the eyes and mucous membranes become icteric, there is itching of the skin, darkening of the urine and discoloration of the feces.

Often cholelithiasis appears together with hiatal hernia, peptic ulcer of the stomach or duodenum, diverticulosis of the colon. This is due to the common innervation of the affected organs and similar predisposing factors for these pathologies. In such a situation, the clinical picture of the disease may not be entirely characteristic.

Diagnosis

The diagnosis of gallstone disease is handled by a gastroenterologist, a surgeon, a general practitioner and a general practitioner. In a conversation with the patient, he finds out the duration and nature of the symptoms, the presence of predisposing factors. An important place in the examination is occupied by palpation of the right upper quadrant of the abdomen, during which pain and other characteristic signs of acute cholecystitis are determined: a symptom of Zakharyin, Ortner, Murphy.

Further examination includes the use of laboratory and instrumental methods:
1. Complete blood count. Neutrophilic leukocytosis and accelerated ESR indicate inflammation in the gallbladder – acute cholecystitis.
2. Biochemical blood test. Allows you to identify a typical for cholelithiasis increase in cholesterol and bilirubin, alkaline phosphatase activity. Blockage of the bile ducts and bile stasis often lead to liver damage, so indicators such as alanine aminotransferase, aspartate aminotransferase, gamma-glutamyltranspeptidase, total and C-reactive protein are also important in cholelithiasis.
3. Tumor markers in serum. Their determination is aimed at identifying signs of cancer of the hepatobiliary system.
4. General analysis of urine. Particular attention is paid to the level of bilirubin metabolic products.
5. Ultrasound of the liver and biliary tract. Method of choice in the diagnosis of gallstone disease. During the examination, the so-called “non-functioning” gallbladder can be determined, containing a small amount of bile or, on the contrary, an organ stretched and not contracting in response to choleretic food. There is also severe pain in the right hypochondrium when pressed by the probe (“Murphy’s ultrasound symptom”), the presence of fluid around the gallbladder, thickening of its wall more than 4 mm. Despite the high sensitivity of ultrasound, with choledocholithiasis, it is not sufficiently informative.
6. Plain radiography of the abdominal cavity. The method allows to detect gallstones with a sufficient content of calcium in them and complications of cholelithiasis. The method is also used to recognize emphysematous cholecystitis, porcelain gallbladder, lime bile.
7. X-ray studies with contrast. During execution, a “disabled”, non-staining gallbladder can be determined. Endoscopic retrograde cholangiography is an invasive method that includes cannulation of the major papilla with the introduction of contrast through the choledochus. Percutaneous transhepatic cholangiography is performed if other contrast methods cannot be performed. Oral contrast-enhanced cholecystography and intravenous dye cholangiography are rarely performed.
8. Esophagastroduodenoscopy. A method of visualization of the duodenum with a mandatory examination of the major duodenal papilla.
9. Magnetic resonance cholangiopancreatography. It has high accuracy in detecting small calculi with a size of 2 mm, including those in the area of the bile ducts (situations where the capabilities of ultrasound are insufficient).
10. Endoscopic ultrasound examination of the pancreato-biliary zone. This study allows you to recognize even very small stones, sludge, strictures of the terminal part of the common bile duct. However, the invasiveness of the procedure and the ability to assess the ductal system only in the area where it enters the duodenum impose restrictions on its implementation.
11. Bilioscintigraphy. This is a radioisotope study with 99mTc labeled iminodiacetic acids. Gallstone disease is indicated by the absence of visualization of the gallbladder, accompanying not only the obstruction of the cystic duct, but also acute or chronic cholecystitis or previous cholecystectomy.

Complications

In cholelithiasis, the walls of organs are traumatized by a stone with the development of inflammation in them, so the pathology can be complicated by cholangitis, cicatricial fusion of the major duodenal papilla, the formation of fistulous tracts between the biliary tract and neighboring organs or the abdominal cavity.

Untimely detection and treatment of acute cholecystitis is dangerous for the development of such fatal complications of cholelithiasis as empyema, gangrene and perforation of the gallbladder, peritonitis.

Treatment

When cholelithiasis is established, the patient is prescribed a diet, he is also recommended lifestyle correction and weight loss. Meals should be frequent and in small portions, with the exception of fried and fatty foods, every 3-4 hours, balanced, contain proteins, carbohydrates, and dietary fiber.

Drug therapy is effective only at the initial stage of gallstone disease, before the formation of calculi. In this case, the treatment is aimed at normalizing the composition of bile and preventing its stagnation. Ursodeoxycholic acid preparations are used, which reduces the saturation of bile with cholesterol and partially extracts it from stones. To alleviate the symptoms of acute calculous cholecystitis, patients are prescribed antispasmodics. Manifestations of chronic cholecystitis, dyspeptic disorders and indigestion are eliminated with the help of defoamers, prokinetics, probiotics, choleretic, enzyme preparations. Antibacterial agents are also prescribed according to indications.

If stones are found in the gallbladder, as well as signs of obstructive jaundice, surgical treatment of gallstone disease is indicated. The most commonly performed removal of the gallbladder along with stones is cholecystectomy. Such an operation not only prevents complications of acute cholecystitis, but also malignant degeneration of the inflamed organ in the long term.

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Gallbladder stones: causes, symptoms and treatment at the FSCC FMBA

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Contents

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Stones in the gallbladder (cholelithiasis) – a disease of the gallbladder, which is accompanied by the formation of stones. Stones in the bladder disrupt the process of digestion, interfere with the normal outflow of bile, and cause acute conditions such as colic.

Gallstones are solid masses of various sizes, shaped like rounded stones. They are formed during the hardening of bile, caused by an excess of cholesterol, bile salts, bilirubin.

The gallbladder is a small sac-like organ located under the liver. The main functions are the accumulation and concentration of bile.

In turn, bile is a fluid that is synthesized in the liver. Bile consists of acids, pigments, enzymes. Bile is involved in the breakdown of fats. The liver, gallbladder, duodenum and pancreas are connected by a duct system.

Types of gallstones

Cholesterol stones. Yellow-green in color. Predominantly formed in women and obese people. The share of cholesterol stones accounts for up to 80%.
Pigment stones. Black-brown in color. Formed with concomitant diseases of the liver, cirrhosis, inflammation of the bile ducts.