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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90,000 symptoms, treatment. What causes stones in the gallbladder?

The disease ranks third in prevalence after cardiovascular and endocrine pathologies. The disease is more often diagnosed in women.

Gallbladder stones: causes and mechanism of disease development

Stones in the gallbladder and bile ducts are formed due to a violation of the process of metabolism of bile components. Pathology develops with the simultaneous presence of the following factors: the production of lithogenic bile (oversaturated with cholesterol), an imbalance between the activity of pronucleating and antinucleating components, and a decrease in the contractile function of the gallbladder.

Among the main causes of gallstone disease are:

• hereditary factor;
• overweight;
• dramatic weight loss;
• eating foods high in cholesterol and low in fiber;
• inflammatory processes and biliary dyskinesia;
• taking oral contraceptives;
• malabsorption syndrome;
• disorders in the work of the endocrine system;
• Crohn’s disease;
• liver disease.

Also, the disease can develop during pregnancy.

There are 2 main mechanisms for the development of the process of formation of stones in the gallbladder: vesicoinflammatory and hepatometabolic. The first variant develops against the background of an inflammatory process, leading to a violation of the acid-base balance of bile and a decrease in the protection of protein fractions, which causes crystallization of bilirubin. Further, the epithelium and mucus join it, which causes the formation of a calculus. In the second case, the disease develops against the background of a violation of the metabolic processes of the liver, which is often the result of existing liver diseases, unbalanced nutrition, endocrine disorders, hypothyroidism.

Symptoms of cholelithiasis

The disease develops gradually and may not manifest itself in the early stages. The average growth rate of stones is 3-5 mm per year, so the first symptoms often appear only after a few years.

Symptoms of gallstone disease are varied and depend on the location of the stones, their size, etc. You can suspect stones in the gallbladder by the following signs:

• pain and heaviness in the right hypochondrium;
• taste of bitterness in the mouth;
• nausea;
• flatulence and other bowel disorders;
• belching of air;
• yellowing of the skin and mucous membranes.

Many of these symptoms may indicate other diseases, so for an accurate diagnosis, you need to see a doctor. You can contact a general practitioner or go directly to a gastroenterologist. The main method for diagnosing cholelithiasis is ultrasound, it allows not only to confirm the diagnosis, but also to determine the exact localization of stones and their size.

Treatment of cholelithiasis

If stones are found in the gallbladder, treatment should be started immediately. Otherwise, the disease will progress and lead to complications, including: acute cholecystitis, pancreatitis, perforation of the gallbladder, stones in the intestines and the formation of intestinal obstruction. Also, over time, the disease can provoke the development of an oncological process in the gallbladder.

The possibilities of modern medicine make it possible to successfully treat gallstone disease. The main thing is to choose the right tactics. There are 2 main options here:

• conservative treatment;
• surgery.

Conservative treatment is aimed at dissolving stones with the help of special preparations and crushing them with the help of a laser or ultrasound. There are a number of contraindications to these methods of treatment, besides, it does not always completely solve the problem, therefore, an operation is often prescribed for stones in the gallbladder – cholecystectomy, which involves the removal of the gallbladder.

To date, most often the removal of the gallbladder is carried out by the modern laparoscopic method, since the strip operation requires a longer rehabilitation. Laparoscopy is performed under general anesthesia: the surgeon makes 2-4 punctures of the abdominal wall. A video endoscope with a light source is inserted into one puncture, and manipulators into the others. The whole process usually takes 1-2 hours. After that, the patient is sent to the hospital. In the absence of complications, in most cases, the patient is discharged after one or two days.

Laparoscopic cholecystectomy can be done at the DIALINE Surgery Center. The operation is carried out using advanced high-precision equipment, which, combined with the extensive experience of our specialists, allows us to solve the problem quickly and without consequences.

You can make an appointment with a gastroenterologist either on your own in your DIALINE personal account or by ordering a call back.

Do not delay treatment, see a doctor right now:

causes, symptoms and treatment at the FSCC FMBA

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

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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.

Symptoms

Many people with gallstones do not experience symptoms. Complaints arise during the formation of large stones, an increase in their number, as a result, the development of complications. Complications include inflammation, infection, impaired bile flow after duct closure.

Gallstone colic is a key sign of gallstones. The pain occurs suddenly, quickly reaches a maximum. Colic is characterized by increasing pain in the right hypochondrium. The duration is several hours. Colic is provoked by the intake of fatty foods. Characterized by the following features:

• Sudden, increasing pain in the upper right abdomen
• Severe pain in the center below the sternum
• Right shoulder pain
• Increased pain when eating fatty foods
• Nausea or vomiting
• Fever
• Jaundice
• Discolored chair (clay color)

Causes of cholelithiasis

Responsible for the development of gallstones:

• Increased content of cholesterol in bile. High cholesterol levels in the blood lead to high levels of cholesterol in the bile. Excess cholesterol occurs with diabetes, obesity. Lecithin and acids, aimed at dissolving cholesterol, cannot cope with the splitting process. Cholesterol turns into crystals.
• Excess bilirubin. Bilirubin is a breakdown product of red blood cells. An increase in the synthesis of bilirubin is associated with cirrhosis, infection, and blood pathology. Bilirubin as well as cholesterol provokes the formation of stones.
• Impaired contractility of the gallbladder. With incomplete emptying, part of the bile remains in the bladder, concentrates in the form of a precipitate, then crystallizes with the formation of stones

Risk factors:

• Female
• History of cholelithiasis
• Age over 40
• Overweight, obesity
• Metabolic disorders (diabetes mellitus)
• Reduced physical activity
• Unbalanced nutrition
• Pregnancy
• Diseases of the liver

Diagnostics

Diagnosis requires a comprehensive examination. The attending physician conducts a survey, determines the main complaints, the history of the development of symptoms, finds out what provokes the appearance of complaints. Then the doctor conducts an examination, palpates the abdomen in different departments. The survey includes:

• Laboratory tests
• Instrumental diagnostics
• Endoscopic methods

Laboratory tests

If gallstone disease is suspected, a general and biochemical blood test is performed. Assess the performance of the liver and biliary tract.

Instrumental diagnostics

• Ultrasound is a highly effective non-invasive imaging modality. The method is based on the reflection of ultrasonic waves from internal organs and image formation.
• Computed tomography. Allows you to visualize gallstones, as well as complications caused by gallstone disease. The method is based on X-ray radiation.
• Magnetic resonance imaging. Highly informative method in relation to the detailed image of the structures of the liver, gallbladder, biliary tract, as well as inflammation. MRI is based on electromagnetic waves interacting with radio frequency radiation.
• Cholecystography. The patient is injected intravenously with a contrast agent, then an x-ray is taken. The image accurately determines the condition of the biliary tract, the site of obstruction, the presence of inflammation.

Endoscopic methods

• Retrograde cholangiopancreatography is the preferred endoscopic procedure for stone detection. This procedure allows you to remove intraductal stones using a duodenoscope, as well as inject a contrast agent for subsequent x-rays.

Complications

• Cholecystitis is the most common complication. Occurs when a stone enters the cystic duct. Bile, which stagnates in the bladder, causes it to become inflamed. Cholecystitis is accompanied by intense pain, fever.
• Choledocholithiasis is characterized by the movement of a stone into the common bile duct, with an increased risk of damage to both the gallbladder and the liver. Closure of the common bile duct is accompanied by pain, development of obstructive jaundice, infection

Treatment of the gallbladder in the Federal Scientific and Practical Center

Treatment depends on the clinical picture, the intensity of symptoms, concomitant diseases. The goal of treatment is to relieve symptoms, prevent complications and prevent recurrence of the pathology.

Treatment of the gallbladder includes:

• Prescribing drugs
• Surgery
• Extracorporeal lithotripsy
• Endoscopic Stenting
• Lifestyle correction (elimination of excess body weight, proper nutrition)

Medical therapy

Prescribing drugs has two goals: preventing the formation of new and dissolving existing stones. Medicines are effective for small, non-calcified cholesterol stones in a normally functioning gallbladder. The duration of the course is 12 months and longer if necessary.

Laparoscopic surgery

In cholelithiasis, which is accompanied by symptoms, frequent colic, removal of the gallbladder (laparoscopic cholecystectomy) is indicated.

Surgeons of the FSCC FMBA of Russia perform the operation through one access – an advanced type of surgical removal of the gallbladder. The technique consists in creating one incision near the navel, while classical laparoscopy involves four incisions-ports.

Minimally invasive ICG fluorescent navigational laparoscopy is the method of choice for surgical treatment at the Federal Research and Clinical Center. It is based on the use of a fluorescent contrast agent, which is administered intravenously to the patient before surgery. Thanks to the contrast agent, the visualization of anatomical structures, blood vessels, and bile ducts improves. The use of ICG technology has been proven to reduce the risk of intraoperative complications, reduce the patient’s stay in the hospital and the recovery period.

Endoscopic retrocholangiopankeratography (ERCP)

ERCP under the control of the SPY GLASS DC imaging system is a modern method for the diagnosis and treatment of cholelithiasis. The SpyGlass DC device is an ultra-thin endoscope with a miniature camera fixed on it, which is passed through the channel of the main endoscope. An advanced device determines the cause of the disease with high accuracy, allows visually controlled crushing of large stones.

ERCP, along with lithotripsy, is the method of choice in the presence of contraindications to surgical treatment.

Extracorporeal shock wave lithotripsy

Extracorporeal lithotripsy is an alternative to surgery. Under the influence of high-frequency shock waves, stones in the gallbladder can be crushed and destroyed.

Prophylaxis

Following simple recommendations reduces the risk of developing gallstones:

• Regular physical activity
• Maintenance of optimal weight, if overweight, gradual reduction
• Complete, balanced diet, eating at the same time
• Eating high fiber foods

Information verified by an expert

This article is informational and is not intended for self-diagnosis and self-treatment. If signs of discomfort appear, you should contact your doctor.

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