How do you get stones in your gallbladder: Gallstones Types, Treatment, Causes, Diet, Symptoms, Pain & Surgery
Gallstones Picture, Causes, Age, & Symptoms
Gallstones are crystal-like deposits that develop in the gallbladder — a small, pear-shaped organ that stores bile, a digestive fluid produced by the liver.
These deposits may be as small as a grain of sand or as large as a golf ball; they may be hard or soft, smooth or jagged. You may have several gallstones or just one.
Some 30 million American adults suffer from gallstones. Yet most of those who have the condition do not realize it. In this case, what you don’t know probably won’t hurt you; gallstones that are simply floating around inside the gallbladder generally cause no symptoms and no harm.
These “silent” stones usually go unnoticed unless they show up in an ultrasound exam conducted for some other reason. However, the longer a stone exists in the gallbladder, the more likely it is to become problematic. People who have gallstones without symptoms have 20% chance of having an episode of pain during their lifetime.
When symptoms do occur, it’s usually because the gallstone has moved and become lodged within a duct that carries bile, such as the cystic duct, a small conduit that connects the gallbladder to another tube called the common bile duct. The typical symptom is abdominal pain, perhaps accompanied by nausea, indigestion, or fever. The pain, caused by the gallbladder’s contraction against the lodged stone, generally occurs within an hour of eating a large meal or in the middle of the night. Stones can also clog the common bile duct, which carries bile into the small intestine, and the hepatic ducts, which take bile out of the liver.
Obstructions in the bile pathway may cause a duct to become inflamed and possibly infected. Blockage of the common bile duct, which merges with the pancreatic duct at the small intestine, can also lead to inflammation of the pancreas (gallstone pancreatitis).
In a rare but dangerous condition that occurs most often in older women, gallstones migrate into the small intestine and block the passageway into the large intestine; symptoms include severe and frequent vomiting. Although gallstones are present in about 80% of people with gallbladder cancer, it is uncertain whether gallstones play a role, except when really large stones (greater than 3 centimeters in diameter) are present.
About a million new cases of gallstones are diagnosed in the U.S. each year. For reasons that are still unclear, women are two times more likely than men to be afflicted. Native Americans have the highest rates of gallstones in the U.S. because they have a genetic disposition to secrete high levels of cholesterol in bile (a contributing factor to gallstones.) Mexican-Americans also have high rates of gallstones.
Gallstones are also more common in people over age 60, in those who are obese or have lost a lot of weight in a short amount of time, in those who have diabetes or sickle cell disease, and in women who have had multiple pregnancies and who take hormone replacement therapy or birth control pills.
What Causes Gallstones?
The primary function of the gallbladder is to store bile, a brown or yellowish fluid that helps the body break down fatty food. When you eat a meal, the gallbladder releases its stored bile into the cystic duct. From there the fluid passes through the common bile duct and into the small intestine to mix with food.
Chief among the ingredients of bile are cholesterol and bile acids. Normally, the concentration of bile acids is high enough to break down the cholesterol in the mixture and keep it in liquid form. However, a diet high in fat can tip this delicate balance, causing the liver to produce more cholesterol than the bile acids are able to handle. As a result, some of this excess cholesterol begins to solidify into crystals, which we call gallstones. About 80% of all gallstones are called cholesterol stones and are created this way. The remaining 20% consist of calcium mixed with the bile pigment bilirubin and are called pigment stones.
Gallstones can form even in people who eat properly. And as researchers have found, a diet extremely low in fat can also contribute to gallstone formation: With little fatty food to digest, the gallbladder is called into play less frequently than usual, so the cholesterol has more time to solidify. Other factors that can reduce activity in the gallbladder, possibly leading to gallstone formation, include cirrhosis, the use of birth control pills or hormone replacement therapy, and pregnancy.
Family history, diabetes, sudden weight loss, and cholesterol drugs, and older age can also increase risk for gallstones.
Gallbladder Surgery & Removal for Gallstones: What to Expect
Your gallbladder is a pear-shaped organ that stores bile, the fluid that helps digest food. If it’s not working the way it should (or your bile gets out of balance), hard fragments start to form. These can be as small as a grain of rice or as big as a golf ball.
Gallstones don’t go away on their own. If they start to hurt or cause other symptoms, your doctor may decide to remove your gallbladder. This type of surgery is called a cholecystectomy. It’s one of the most common surgeries doctors perform.
About 80% of people who have gallstones will need surgery.
Types of Gallbladder Surgery
Doctors can remove your gallbladder in one of two ways:
Open surgery: During this procedure, your surgeon will make a 5- to 7-inch incision (cut) on your belly to take out your gallbladder. 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.
Laparoscopic cholecystectomy: Doctors also call this “keyhole surgery.” Your surgeon doesn’t make a big opening in your belly. Instead, they make four small cuts. They insert a very thin, flexible tube that contains a light and a tiny video camera into your belly. These help your surgeon see your gallbladder better. Next, they’ll insert special tools to remove the diseased organ.
For both types of surgery, you’ll be given general anesthesia. This means you’ll sleep through the procedure and won’t feel any pain while it’s being done.
Do I Need Surgery?
If your gallstones aren’t causing symptoms, there’s 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 left untreated, gallstones can also lead to more serious problems, like:
- Cholecystitis — an inflamed gallbladder
- Pancreatitis — an inflamed pancreas
- Cholangitis — inflamed bile ducts
Before your doctor opts for surgery, they’ll run several tests to see the effect your gallstones are having on your health. Tests might include:
- Blood test
- MRI HIDA (hepatobiliary iminodiacetic acid) scan — a radioactive chemical is put into your body to create images of any blocked ducts
- Endoscopic ultrasonography — an imaging device is put into your mouth and down through your digestive tract so sound waves can create a detailed picture of your small intestine
Can I Try Other Treatments First?
You may be able to manage your symptoms for a short time by making changes to your diet. This includes cutting back on fatty foods. But dietary changes don’t always help prevent gallbladder attacks.
If surgery isn’t an option for you, your doctor can prescribe a medication to dissolve your gallstones. But this can take months or even years to work. And even if your gallstones do go away, there’s a chance they’ll return.
Gallbladder Surgery Risks
You can live without your gallbladder. Your liver can make enough bile on its own. This will naturally find its way into your small intestine even if your gallbladder is removed.
Doctors believe gallbladder surgery is safe, but some problems can still arise. These may include:
- Problems with anesthesia
- Bile leakage
- Damage to a bile duct
- Damage to your intestine, bowel, or blood vessels
- Deep vein thrombosis (blood clots)
- Heart problems
You also run the risk of a problem doctors call “post-cholecystectomy syndrome” (PCS). It can happen if any gallstones are left in your bile ducts or bile happens to leak into your stomach. The symptoms of PCS are similar to those of gallstones. They include belly pain, heartburn, and diarrhea.
The length of time it takes you to heal depends on the type of surgery you have.
If you have your gallbladder removed during open surgery, you’ll need to stay in the hospital for a few days afterward. It may take between 6 to 8 weeks for your body to heal fully.
Laparoscopy is less involved, so you’ll have less pain and heal faster than if you have open surgery. Most people who have it are able to go home from the hospital the same day. You’ll likely be back to your normal routine within 2 weeks.
Gallstones Diagnosis, Tests, & Treatments
How Do I Know if I Have Gallstones?
If your symptoms suggest a gallstone problem, your doctor might first examine your skin for jaundice, and then feel your abdomen to check for tenderness. A blood test may reveal evidence of an obstruction.
Because other digestive problems, such as an infection of the duct, can produce symptoms similar to those of a gallstone attack, the doctor may also run other tests to determine if gallstones are in fact the culprit.
The most common technique is an ultrasound exam. This quick, painless procedure uses high-frequency sound waves to create pictures of the gallbladder, bile duct, and their contents. CT scans are also sometimes done to look at the anatomy of your internal organs.
A more complicated test may be used if the doctor suspects that a gallstone is lodged in a bile duct. Commonly known by the acronym ERCP, this test allows the doctor to look at the bile duct through a small flexible tube called an endoscope. The doctor sprays the back of the patient’s throat with an anesthetic drug to prevent gagging, sedates the patient, and passes the endoscope into the mouth, through the stomach, and into the area of the small intestine where the bile duct enters. Dye is injected through the tube and into the bile duct, and then the doctor takes X-rays. Stone removal can be done during this procedure as well. The procedure takes about an hour.
What Are the Treatments for Gallstones?
In most cases, treatment of gallstones is considered necessary only if you are having symptoms. Of the various conventional treatments that are available, surgical removal of the gallbladder is the most widely used. Some alternative treatments have also been found to be effective in alleviating the symptoms of troublesome gallstones.
Conventional Medicine for Gallstones
When deciding what course of action to take for symptomatic gallstones, doctors usually choose from among three main treatment options: Watchful waiting, nonsurgical therapy, and surgical removal of the gallbladder.
Gallstones and Watchful Waiting
Though a gallstone episode can be extremely painful or frightening, almost a third to half of all people who experience an attack never have a recurrence. In some cases, the stone dissolves or becomes dislodged and thereby resumes its “silence. ” Because the problem may solve itself without intervention, many doctors take a wait-and-see approach following the initial episode.
Even when the patient has had repeated gallstone episodes, the doctor may postpone treatment or surgery because of other health concerns. If your surgery has been delayed, you should remain under a doctor’s care and report any recurrences of gallstone symptoms immediately.
Nonsurgical Therapy for Gallstones
If you are unable or unwilling to go through surgery for a gallstone problem that requires treatment, your doctor may recommend one of several noninvasive techniques. Note that though these methods may destroy symptom-causing gallstones, they can do nothing to prevent others from forming, and recurrence is common.
Some gallstones can be dissolved through the use of a bile salt, although the procedure can be used only with stones formed from cholesterol and not from bile pigments. The drug Actigall (ursodiol) is taken as a tablet; depending on its size, the gallstone may take months or even years to go away. Because some stones are calcified, this treatment often doesn’t work.
Another nonsurgical technique, shock wave therapy, uses high-frequency sound waves to fragment the stones. Bile salt is administered afterward to dissolve small pieces. This therapy is rarely used.
Doctors can also attempt to remove gallstones during an ERCP. During the procedure an instrument is inserted through the endoscope to attempt removal of the stone.
While these therapies may work for some, all of the above nonsurgical therapies are usually unsuccessful long term (since recurrence is common) and are rarely advised in clinical practice.
Surgery to Remove the Gallbladder
While the gallbladder serves an important function, it is not essential for a normal, healthy life. When gallstones are persistently troublesome, doctors often recommend removing the organ entirely. This operation is considered among the safest of all surgical procedures. Each year approximately 750,000 Americans have their gallbladder removed. It is also the only treatment method that eliminates the possibility that other gallstones will develop in the future.
When the gallbladder has been removed, bile flows directly from the liver into the small intestine, and this sometimes leads to diarrhea. Because bile no longer accumulates in the gallbladder, quantities of the digestive fluid cannot be stored up and used to break down an especially fatty meal. This condition is not considered serious, however, and can be corrected by simply limiting fat in the diet.
In the past, removal of the gallbladder was done through traditional “open” surgery, which requires surgeons to make a large incision in the abdomen. Patients faced a two- or three-day hospital stay plus several weeks of recovery at home.
Today, however, the most commonly used surgical technique is a much simpler approach known as laparoscopic cholecystectomy. The doctor makes several small incisions in the abdomen, then uses special pencil-thin instruments to remove the gallbladder. A tiny microscope and video camera, snaked through the incision to the site, allow the surgeon to view the operation.
Laparoscopic surgery is highly effective and very safe. It has reduced the hospital stay to a day or two. Patients report less pain and are generally able to resume a normal lifestyle in a short period of time. However, people who are obese or who have a severe infection or inflammation in the gallbladder may still be considered candidates for traditional open surgery.
What Causes Gallstones and How Can You Get Rid of Them?
Contrary to the name, gallstones aren’t exactly stones. Instead, they’re solid pieces of material that can start forming in the gallbladder, which is a small organ right under your liver. Many of us have gallstones but just don’t know it. Then, once they block one of your bile ducts, that’s when you feel the pain, and thus treatment is necessary.
Blockages can cause digestive enzymes to get trapped in the pancreas. This can lead to a very painful inflammation called gallstone pancreatitis. If those ducts stay blocked for a long time, the outcome can be fatal. At the very least, infections can occur to the gallbladder, liver or pancreas.
There are two main types of gallstones:
- Cholesterol stones, which are yellow-green in color, and the most common, representing 80% of all gallstones.
- Pigment stones, which are smaller and darker, comprised of bilirubin, a fluid made by your liver and stored in the gallbladder.
Essentially, gallstones are hardened-deposits of digestive fluid that form in the gallbladder, a pear-shaped organ that houses a digestive fluid referred to as bile. That bile is routinely released into your small intestine. Gallstones can be as small as a grain of sand to as large as a golf ball. Some people get one, some get several. Medications and gallbladder removal surgery are usually the remedies. If you don’t exhibit symptoms, no surgery or treatment is required.
There can be many causes of gallstones; the exact cause of yours will be determined by a doctor at your visit. Gallstones can have many originations, including:
- Family history
- History of gallbladder problems
- High cholesterol
- Failure of the gallbladder to empty properly
You may be at a higher risk for gallstones if you’re obese, take birth control pills, or hormone replacement therapy for menopause symptoms, are pregnant (due to the extra estrogen), have diabetes, or have pigment stones (common in those suffering from cirrhosis or sickle cell anemia).
Other risk factors you should be on the lookout for include:
- Being female
- Being over the age of 40
- Being sedentary
- Eating a high-fat or high-cholesterol diet
- Having diabetes
- Experiencing rapid weight loss
- Having liver disease
As we said above, you may not be aware you even have gallstones until you experience pain or your doctor finds it through a physical exam or testing. Other symptoms can include:
- Pain in the stomach or upper back that lasts for hours on end
- Sudden and rapidly intensifying pain in the upper right part of the abdomen or just below the breastbone
- Pain between the shoulder blades or right shoulder
- Digestive issues, such as bloating, gas, indigestion and heartburn
Wondering when you should see a doctor? You should call your doctor immediately if you feel stomach pain that’s so intense you can’t sit or lie down comfortably, have yellow skin or whites of the eyes, or have a high fever with the chills.
Those who don’t feel pain or otherwise have symptoms don’t need to take action. However, if you experience any of the above symptoms, get to a gastroenterologist right away.
The first thing your doctor will do if he or she suspects you have gallstones is to give you a thorough exam, then order some blood tests. These will check to see if you have an infection or obstruction. Depending on those results, you will then get an ultrasound, CT scan, MRI or endoscopic ultrasound.
Your doctor may prescribe medications such as chenodiol, ursodiol, or a combination of the two, as they are designed to dissolve gallstones. This is a very conservative approach, as sometimes it can take months or years to dissolve your gallstones in this way. Plus, if you stop taking the meds, your gallstones can come back.
Another option is to have gallbladder removal surgery, called cholecystectomy. This is the optimal treatment, as gallstones frequently recur. After removal of the gallbladder, bile will flow right from your liver into your small intestine. Much like your appendix, you can live without your gallbladder, and having it removed doesn’t affect how you digest food. One immediate effect can be an increase in diarrhea, but this is normal and temporary.
Please note, the information provided throughout this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and video, on or available through this website is for general information purposes only. If you are experiencing related symptoms, please visit your doctor or call 9-1-1 in an emergency.
Gallstones – NHS
Gallstones are small stones, usually made of cholesterol, that form in the gallbladder. In most cases, they do not cause any symptoms and do not need to be treated.
Get advice about coronavirus and liver disease from the British Liver Trust
Symptoms of gallstones
Gallstones often have no symptoms.
But if a gallstone becomes trapped in an opening (duct) inside the gallbladder, it can trigger a sudden, intense pain in your tummy that usually lasts between 1 and 5 hours.
This type of abdominal pain is known as biliary colic.
Some people with gallstones can also develop complications, such as inflammation of the gallbladder (cholecystitis).
This can cause:
- persistent pain
- yellowing of the skin and eyes (jaundice)
- a high temperature
When gallstones cause symptoms or complications, it’s known as gallstone disease or cholelithiasis.
The gallbladder is a small pouch-like organ found underneath the liver. Its main purpose is to store and concentrate bile.
Bile is a liquid produced by the liver to help digest fats. It’s passed from the liver into the gallbladder through a series of channels known as bile ducts.
The bile is stored in the gallbladder and, over time, becomes more concentrated, which makes it better at digesting fats.
The gallbladder releases bile into the digestive system when it’s needed.
What causes gallstones?
Gallstones are thought to develop because of an imbalance in the chemical make-up of bile inside the gallbladder.
In most cases the levels of cholesterol in bile become too high and the excess cholesterol forms into stones.
Gallstones are very common. It’s estimated more than 1 in every 10 adults in the UK has gallstones, although only a minority of people develop symptoms.
You’re more at risk of developing gallstones if you’re:
- overweight or obese
- female (particularly if you have had children)
- 40 or over (the risk increases as you get older)
Treatment is usually only necessary if gallstones are causing:
In these cases, keyhole surgery to remove the gallbladder may be recommended.
This procedure, known as a laparoscopic cholecystectomy, is relatively simple to perform and has a low risk of complications.
It’s possible to lead a normal life without a gallbladder.
Your liver will still produce bile to digest food, but the bile will drip continuously into the small intestine, rather than build up in the gallbladder.
Gallstone disease is usually easily treated with surgery.
Very severe cases can be life threatening, particularly in people who are already in poor health.
But deaths from gallstone disease are rare in the UK.
In this video, a doctor explains what gallstones are, the symptoms and the treatment options.
Media last reviewed: 14 May 2018
Media review due: 9 May 2021
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Page last reviewed: 10 October 2018
Next review due: 10 October 2021
Gallstones | Cedars-Sinai
Not what you’re looking for?
What are gallstones?
Gallstones are lumps of solid material that form in your gallbladder. They are also called cholelithiasis. They are made when the digestive juice called bile turns hard and stone-like.
The gallbladder is a small organ under your liver. It stores bile made by the liver. Bile is made of several things such as cholesterol, bile salts, and a yellowish pigment (bilirubin).
Gallstones can be as small as a grain of sand or as big as a golf ball. Your gallbladder may form a single large stone, hundreds of tiny stones, or both sizes at the same time. In some cases, gallstones block the tubes that carry bile (bile ducts). This can lead to a life-threatening infections of the bile ducts, pancreas, or liver. Once you have had gallstones, you are at risk of having more.
There are 2 types of gallstones: cholesterol and pigment.
These stones are:
- Most common type of stone
- Often a yellow-green color
- Made mainly of hardened cholesterol
These stones are:
- Less common
- Dark color
- Made of a yellowish pigment called bilirubin
What causes gallstones?
Cholesterol stones form when your gallbladder doesn’t empty the way it should. They also form when bile has:
- Too much cholesterol
- Too much of a yellowish pigment called bilirubin
- Not enough bile salts
Health experts don’t know what causes pigment stones to form. But pigment stones are more common in people who have:
- A liver disease (cirrhosis) where scar tissue replaces healthy liver tissue
- An infection in the vessels that transport bile (biliary tract infection)
disorders that are passed from parent to child (hereditary) such as sickle cell
Who is at risk for gallstones?
Some people have a higher risk for gallstones. These include:
Americans. They have the highest rates of gallstones in the U.S. This may be
genetic as they have very high levels of cholesterol in their bile.
Americans. They have higher than average rates of gallstones.
- Women.They are twice as likely to have gallstones as men.
age 60. Risk for gallstones increases with age.
People with a
family history of gallstones. Gallstones seem to run in some families
(inherited). There may be a genetic link.
Health issues that may raise your risk for gallstones include:
This is a major risk factor, mainly for women.
Estrogen. Women may have extra estrogen from pregnancy, hormone replacement
therapy, or birth control pills. This seems to raise cholesterol levels in bile and
slow down gallbladder movement. Both can lead to gallstones.
Eating a high-fat, high-cholesterol, or low-fiber diet raises your risk. They lead to
more cholesterol in the bile and reduced gallbladder emptying.
Cholesterol-lowering medicines. These medicines can increase the amount of
cholesterol in bile.
Diabetes. People with diabetes often have high levels of fatty acids
(triglycerides). This raises the risk for gallstones.
weight loss. As the body processes fat during very fast weight loss, the
liver sends out extra cholesterol into bile.
for a few days (prolonged fasting). Fasting slows down gallbladder movement.
Over time, your bile has too much cholesterol.
What are the symptoms of gallstones?
Some people with gallstones don’t have any symptoms. These stones are called silent stones. They don’t stop the gallbladder, liver, or pancreas from working properly. In most cases they don’t need to be treated. Most gallstones don’t cause symptoms right away.
Gallstone symptoms (also called a gallbladder attack) may happen very suddenly. They often:
- Begin when gallstones get bigger
- Happen when the stones start to block bile ducts
- Occur after a fatty meal or at night
Each person’s symptoms may vary. Symptoms may include:
- Steady, severe pain in your upper belly (abdomen) that quickly gets worse
- Pain in your back between the shoulder blades
- Pain in your right shoulder
- Yellowing of the skin or eyes (jaundice)
See your healthcare provider right away if you have any of these symptoms during or after a gallbladder attack:
- Pain that lasts more than 5 hours
- Low-grade fever
- Yellowish color of the skin or whites of the eyes
- Clay-colored stools
The symptoms of gallstones may look like other health problems. Always see your healthcare provider to be sure.
How are gallstones diagnosed?
people have gallstones but don’t know it because they don’t have symptoms. In some
cases, gallstones are found by accident. This may happen if you are being tested for a
different health problem.
But if you have pain that doesn’t go away, your healthcare provider will look at your past health and give you a physical exam.
You may also have some tests to check for gallstones such as:
Ultrasound. This imaging test uses high-frequency sound waves to create
images of your internal organs on a computer screen. It is used to see the
gallbladder and gallstones.
(hepatobiliary scintigraphy or cholescintigraphy). This scan checks for any
abnormal contractions of the gallbladder and blockages in your bile ducts. A
radioactive chemical or tracer is shot (injected) into your vein. The amount of
radiation is very small. It is not harmful. It collects in your liver and flows into
your gallbladder. A special scanner is used to watch the tracer move through your
organs. You will take a medicine to make your gallbladder contract.
tests. These look for signs of infection, blockage, liver problems, jaundice,
A CT scan shows detailed images of any part of the body. It can show gallstones. It
can also show infection or bursting of the gallbladder or bile ducts.
MRCP (magnetic resonance cholangiopancreatography).
This is a special MRI test that creates images using magnetic fields and pulsed
EUS (endoscopic ultrasound). This internal
ultrasound is done with a flexible lighted scope. You are given medicine to help you
relax and then a scope is passed through your mouth. It creates internal images using
(endoscopic retrograde cholangiopancreatography). ERCP uses both X-ray and a
long flexible lighted tube. The tube is put in your mouth and throat. It goes down
your food pipe (esophagus), through your stomach, and into the first part of your
small intestine (duodenum). Your healthcare provider can see the inside of these
organs on a video screen and check for any problems. A dye is put into your bile
ducts through the tube. The dye lets the bile ducts be seen clearly on the
How are gallstones treated?
If your gallstones don’t cause any symptoms, you often don’t need treatment.
Gallstones that do cause symptoms should be treated right away. They may lead to damage or infection if your bile ducts are blocked for a long time.
If your symptoms don’t go away, your treatment may include:
(endoscopic retrograde cholangiopancreatography). ERCP uses both X-ray and a
long flexible lighted tube (endoscope). The tube is put into your mouth and throat.
It goes down your food pipe (esophagus), through your stomach, and into the first
part of your small intestine (duodenum). A dye is put into your bile ducts through
the tube. The dye lets the bile ducts be seen clearly on X-rays. Small stones can be
taken out through the scope.
Sphincterotomy. This can also be done through the tube during an ERCP. Tight
rings of muscle (called sphincters) are around the openings of the bile ducts. They
can block gallstones. Cutting these rings lets the ducts open wider so that stones
can pass into your intestine.
removal (cholecystectomy). If stones are in your gallbladder, your
gallbladder must be removed. These stones cannot be taken out with ERCP. Gallbladder
removal is a common surgery. Your body will work well without your gallbladder. It is
not essential for a healthy life.
drainage/cholecystostomy. If stones in your gallbladder cause a blockage of
bile acid and subsequent infection, your gallbladder will have to be removed.
However, if you are too sick to undergo surgery or there are other complications, a
drainage tube may be inserted into your gallbladder through the skin of your abdomen.
This will temporarily remove the blockage and drain any infection.
dissolution therapy. The stones are dissolved using medicines made from bile
acid. But gallstones tend to come back when the medicine is stopped.
Methyl-tert-butyl ether. This solution can be shot (injected) into your
gallbladder to dissolve stones. This is an experimental procedure.
Most people respond very well once their stones are dissolved or taken out.
Key points about
- Gallstones are lumps of solid material that form in your gallbladder.
- They are made when the digestive juice called bile gets hard and stone-like.
- If your gallstones cause no symptoms, treatment is often not needed.
symptoms don’t go away, you will need treatment to remove the gallstones.
- If stones are in your gallbladder, the gallbladder must be removed. This is a common surgery.
Tips to help you get the most from a visit to your health care
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember
what your provider tells you.
- At the visit, write down the name of a new diagnosis, and any
new medicines, treatments, or tests. Also write down any new instructions your
provider gives you.
- Know why a new medicine or treatment is prescribed, and how it
will help you. Also know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results
- Know what to expect if you do not take the medicine or have the
test or procedure.
- If you have a follow-up appointment, write down the date, time,
and purpose for that visit.
- Know how you can contact your provider if you have questions.
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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
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
Jaundice. A yellowing of the skin or eyes.
Intolerance of fatty foods
Belching or gas
People who experience the following symptoms should consult their doctor
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
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.
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:
A diagnostic technique that uses high-frequency sound waves to
create an image of the internal organs.
X-ray that shows the flow of contrast fluid through the
intestines into the gallbladder.
These look for signs of infection, obstruction, jaundice,
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
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
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.
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
Contact dissolution therapy.
An experimental procedure that involves injecting a drug
directly into the gallbladder to dissolve the stones.
90,000 Gallstones – Should I Operate?
The formation of stones in the gallbladder is the main symptom of gallstone disease (GSD). In Russia and Europe, this disease is recorded in 10-15% of the population. The source of development of stones is cholesterol, salts and other components of bile, which is formed in the liver and then accumulates in the gallbladder. The formation of gallstones is facilitated by stagnation of bile, inflammation in the wall of the gallbladder and ducts, hormonal and metabolic disorders.Sometimes gallstones may not manifest themselves, but more often they cause pain and other concerns. The greatest danger is posed by complications of gallstone disease.
Why is cholelithiasis dangerous?
– The presence of stones in the gallbladder constantly maintains inflammation in its wall. In the presence of provoking factors – the intake of fatty foods, alcohol, physical activity – the inflammation is exacerbated, and an attack of acute cholecystitis develops, which may require emergency surgery.It is impossible to completely cure chronic cholecystitis in the presence of gallstones.
– The contraction of the gallbladder after a meal can lead to the wedging of a stone into the excretory duct of the bladder, as a result of which the gallbladder becomes clogged and creates a “disabled gallbladder” effect.
– Small stones can slip from the gallbladder into the bile ducts, causing jaundice and acute pancreatitis. These diseases require urgent surgical treatment and to this day often lead to death.
– Large stones can cause a pressure ulcer in the wall of the gallbladder. In this case, a fistula usually develops between the gallbladder and the intestine. The constant reflux of intestinal contents into the gallbladder and bile ducts leads to the development of severe inflammation in them.
– With a prolonged course of calculous cholecystitis, chronic pancreatitis inevitably develops. In this case, even the elimination of cholecystitis (removal of the gallbladder) does not give a complete recovery, since pancreatitis continues to cause pain and other complaints.
– Prolonged trauma to the wall of the gallbladder by stones in it can lead to the development of gallbladder cancer.
Methods for the treatment of gallstone disease?
The main method of treatment of gallstone disease is surgical. The methods of dissolving and crushing gallstones did not justify themselves due to low efficiency, a large number of complications, and high cost of treatment.
For over 100 years, the main operation used for cholecystectomy has been the removal of the gallbladder.It makes no sense to remove stones alone, as the cause of the disease is that the diseased gallbladder forms stones, and not stones cause gallbladder disease.
Previously, the gallbladder was removed through a large incision in the abdominal wall. Now the “gold standard” in the treatment of gallstone disease is laparoscopic cholecystectomy, performed through small punctures. The operation takes about an hour. Postoperative hospital stay – 1-2 days. After surgery, it is recommended to limit excessive physical activity and follow a diet for 1 to 2 months.
Today, laparoscopic cholecystectomy is a fairly safe operation. The complication rate does not exceed 0.1-0.3%, which is lower than with open surgery.
What to do in case of detection of ZhKD?
Don’t expect complications! The first step on the road to recovery is to call us and come for a consultation with a surgeon. A specialist in our multidisciplinary clinic will determine the need for surgical treatment and answer all your questions.
Today, only one list of life-threatening complications of cholelithiasis dictates the need for urgent treatment of this disease. The recommendation “do not remove stones if they do not bother” should be recognized as hopelessly outdated.
Find out more about the possibilities of the Center for Minimally Invasive Surgery at the Reaviz multidisciplinary clinic.
90,000 symptoms and when to see a doctor
For diagnostics and treatment of gallstones, read the link.
Get immediate help if you develop signs and symptoms of a serious complication of gallstones, for example:
- Abdominal pain is so severe that you cannot sit still or find a comfortable position
- Yellowing of the skin and whites of the eyes (jaundice)
- High temperature with chills
The number for calling an ambulance in Moscow is 103
Causes of ZhKB
It is not clear what causes the formation of gallstones.Doctors believe that gallstones can occur in the following cases:
Your bile contains too much cholesterol . Usually, your bile contains enough chemicals to dissolve the cholesterol secreted by your liver. But if your liver secretes more cholesterol than bile can dissolve, the excess cholesterol can turn into crystals and eventually stones.
Your bile contains too much bilirubin . Bilirubin is a chemical that is produced when red blood cells are broken down in the body.Under certain conditions, the liver produces too much bilirubin, including cirrhosis of the liver, biliary tract infections, and some blood disorders. Excess bilirubin contributes to the formation of gallstones.
Your gallbladder is not emptying properly. If the gallbladder is not emptied completely or frequently enough, bile can become very concentrated, which contributes to the formation of gallstones.
Types of gallstones
Types of gallstones that can form in the gallbladder include:
Cholesterol stones in the gallbladder.The most common type of gallstones, called cholesterol gallstones, are often yellow in color. These gallstones are composed primarily of undissolved cholesterol, but may contain other components as well.
Pigmented stones in the gallbladder. These dark brown or black stones form when your bile contains too much bilirubin.
Factors that can increase your risk of gallstones include:
- Age 40 and over
- Overweight or obese
- High Fat Diet
- High Cholesterol Diet
- Low Fiber Diet
- Family history of gallstones
- Presence of certain blood disorders such as sickle cell disease or leukemia
- Very fast weight loss
- Taking medications containing estrogen, such as oral contraceptives or hormone therapy.
- Liver disease
Complications of gallstones may include:
Inflammation of the gallbladder . A gallstone lodged in the neck of the gallbladder can cause inflammation of the gallbladder (cholecystitis). Cholecystitis can cause severe pain, peritonitis.
Blockage of the common bile duct . Gallstones can block the channels (ducts) that carry bile from the gallbladder or liver into the small intestine.This can lead to severe pain, jaundice, and bile duct infection.
Blockage of the pancreatic duct . The pancreatic duct is a tube that runs from the pancreas and connects to the common bile duct just before entering the duodenum. The pancreatic juices, which aid digestion, pass through the pancreatic duct.
A stone in the gallbladder can cause blockage of the pancreatic duct, which can lead to inflammation of the pancreas (pancreatitis).Pancreatitis causes severe, persistent abdominal pain and usually requires hospitalization. Severe forms of pancreatitis often end in the death of the patient.
Gallbladder cancer . People with gallstones have an increased risk of developing gallbladder cancer.
Prevention of ZhKB
You can reduce your risk of gallstones:
Don’t skip meals . Try to stick to your normal meal times every day.Skipping meals or fasting can increase your risk of gallstones.
Lose weight slowly . If you need to lose weight, take your time. Rapid weight loss can increase your risk of gallstones.
Eat more high-fiber foods . Include more fiber-rich foods in your diet, such as fruits, vegetables, and whole grains.
Maintain a healthy weight . Obesity and being overweight increase the risk of gallstone formation.Work towards a healthy weight by reducing your calorie intake and increasing your physical activity. Once you reach a healthy weight, work to maintain it by continuing to eat a healthy diet and exercise.
City Clinical Hospital No. 31 – Gallstones
Many women carry gallstones. Is it always necessary to remove the gallbladder in this case? Is there an alternative to surgery?
Says the head of the Department of Hospital Surgery of the Russian State Medical University, surgeon of the 31st City Clinical Hospital.Moscow Doctor of Medical Sciences, Professor Sergei Georgievich Shapovalyants .
– Is it necessary to remove the gallbladder if only one small stone has formed in it? Is it worth sacrificing an entire organ?
– This question is asked by many patients, because few people want to immediately take drastic measures. They believe that small gallstones are not dangerous and can be simply watched. And sometimes this tactic is actually used.However, we must admit it is very, very dangerous. Even small stones can cause serious complications. If large formations can lead to bedsores, breakthroughs of the gallbladder, then small stones are insidious in their own way. They can migrate and enter the bile ducts. Wandering along them, the stones reach the level of the confluence in the duodenum and get stuck there. Due to a violation of the outflow of bile, the pigment bilirubin begins to accumulate in the blood, and obstructive jaundice occurs. In addition, severe acute pancreatitis can develop rapidly.In this case, there is no time for reflection – an ambulance is needed.
All patients should also know that if a stone appears in the gallbladder, it will never completely dissolve. The presence of even the smallest stones indicates that the work of the gallbladder is impaired, bile begins to precipitate. And if this trend has appeared, it will develop.
– But there is a method of dissolving stones with the help of medicines. Why not try it before you go to the surgeon?
– Indeed, there are drugs with which one can try to influence some gallstones.But not completely dissolve them – this does not happen, but only slightly reduce their size. This can be done only with a strict combination of the size of the stone, its chemical composition, contractile function of the gallbladder and drug tolerance.
Bile acids are used to dissolve stones. Two of them are used as drugs – chenodeoxycholic acid and ursodeoxycholic acid. These drugs are marketed by many companies under different names. Some of the most famous are Henofalk and Ursofalk.With the help of these funds, you can act exclusively on cholesterol stones. If the stones contain a lot of calcium or bilirubin, then the use of bile acids is useless. They never dissolve these substances.
Gallstones should be no more than 2 cm in diameter. Larger formations, of course, can be tried to be reduced. However, this will take a very long time, up to several years, because on average stones are reduced by 1 mm per month.
In addition, stones can be dissolved only if the function of the gallbladder is preserved, when it continues to contract normally and excrete bile.And in acute inflammatory diseases of the gallbladder and bile ducts, in liver diseases, gastric and intestinal ulcers, this is contraindicated and pointless.
It should be said that the intake of bile acids is very often accompanied by undesirable reactions, in particular, upset stools. But despite this, the patient must take these drugs regularly and for a long time, at least several months. One has only to stop the treatment – and the stones grow again.So the drug method has very limited effectiveness.
-What can you say about the method of crushing gallstones? Crushed kidney stones?
– Analogies between the cleavage of kidney and gallstones are in fact drawn often. At one time, gallstones were crushed by extracorporeal lithotripsy. Moreover, this method was very popular. During the lithotripsy session, multiple shock waves were sent to the stone outside the body. As a result of this impact, the stone was crushed into fragments.Then small fragments left the body on their own through the bile ducts and intestines. At the same time, large fragments that could not pass through the duct remained in the gallbladder.
But that’s half the trouble. The fragments formed as a result of crushing often got stuck in the bile ducts, clogged them and disrupted the entire process of bile secretion.
There is one more important point. Before lithotripsy, stones are usually even, smooth, adapted to the shape of the gallbladder.And a person often does not feel them. As soon as you crush it, turn it into a mass of small, but sharp fragments, biliary colic, jaundice appear, and the pancreas becomes inflamed. The patient’s position can be severely deteriorated. So this method can be considered simply dangerous, and many foreign and domestic clinics refuse it.
– Clearly, all conservative methods do not bring much success. But if one decides to have an operation, why is it necessary to remove an entire organ? Is it possible to remove only stones and leave the gallbladder?
– Alas, this method is today recognized as ineffective, although in some places it is still practiced.It is believed that some patients, especially young ones, should not have their gallbladder removed. Still, it performs certain 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 the satisfied patient returns home. No stones, and the gallbladder was in place.
However, not everything is so simple. Approximately 2-3 months after such an operation, gallstone disease raises its head again.The same symptoms and complications return as the person had before the intervention. The relapse rate at different intervals reaches almost 100%. This is due to the fact that one of the prerequisites for the formation of stones in the gallbladder is its poor contractility. Such a bubble is called stagnant. Another reason is the innate features of the bile structure. When bile, in any diet, even a purely vegetarian one, is concentrated and precipitated. In this case, removing only stones is simply meaningless.The problem can be finally solved only by completely eliminating the gallbladder.
– Does this always require abdominal surgery?
– Of course not. In large clinics and hospitals, removal of the gallbladder is performed by laparoscopy. The operation is performed through three or four punctures in the abdominal wall. An optical system is introduced inside. The abdominal cavity is examined and the gallbladder is removed with special instruments.
As a rule, this is where all the patient’s troubles end.After a short period of adaptation, he can forget about gallstone disease forever. Moreover, the absence of a gallbladder will remain almost invisible for him. Indeed, in fact, his “biological loss” occurred much earlier – even at the stage of formation of stones. Even then, the gallbladder ceased to function normally, and other parts of the biliary system began to perform its work.
– Honestly, I know of cases when after such an operation people felt no better, but even worse … What can you say about this?
– You are right, there is such a thing as postcholecystectomy syndrome.It implies just the deterioration in well-being that you are talking about. Most often this happens if the operation is performed at an already advanced stage of the disease. When neighboring organs are involved in the inflammatory process. In this situation, only one thing can be said – do not take it to extremes. Do the surgery as planned, not when the thunder breaks out.
But there is another reason for the poor condition. And this is a rather serious problem with deep roots. The fact is that the operation to remove the gallbladder began to be considered technically simple for doctors and quite easily tolerated for patients.For these reasons, many people go to it without much hesitation. Although in reality it is not always worth doing this.
The circle of passed examinations of the patient is often limited to one ultrasound of the abdominal cavity. Moreover, according to its results, a person may not have stones as such, but “clots” or “suspensions” are found. True, the patient presents some complaints similar to the symptoms of gallstone disease. It is they who are taken as the basis for the decision.
The patient is operated quickly, and the operation does not bring relief.The question arises: was the gallbladder really the cause of poor health? After all, the same symptoms can occur due to other problems, in particular, due to duodenal dyskinesia. And if in such a situation the gallbladder is removed – a kind of buffer that softens unpleasant manifestations – then the existing problems will immediately worsen. Pain syndrome will appear, the whole complex of symptoms will emerge.
– What to do in such a situation?
– Sadly – to open a new case history.In general, in order to avoid such a development of events, before the operation, it is necessary to undergo a thorough examination not only of the gallbladder, but also of all organs located nearby. It is necessary to carefully assess the condition of the bile ducts, pancreas, duodenum, right kidney, stomach. Not all medical institutions are equipped with the necessary equipment for this. Therefore, it is better to go to large clinics and centers.
Endoscopic ultrasonography of the bile ducts is now successfully used in cases of suspected stones.After all, if there are also pebbles there, then first you need to eliminate them, and only then take up the gallbladder. In order to avoid those very complications.
Computed tomography will help to examine the liver and pancreas. A biochemical blood test will tell you many necessary details. Of course, not everyone needs this research. But if there are any doubts, they cannot be ignored.
So take a closer look at yourself. Take drastic measures deliberately and trusting your doctor.
Please note! The prerequisites for the occurrence of gallstone disease are:
2. Sedentary lifestyle;
Make an appointment with our specialists
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90,000 Stones in the gallbladder: causes, treatment
The disease ranks third in prevalence after cardiovascular and endocrine pathologies. The disease is more commonly diagnosed in women.
Stones in the gallbladder: causes and mechanism of development of the disease
Stones in the gallbladder and bile ducts are formed as a result of a violation of the exchange 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 the pronucleating and antinucleating components, and a decrease in the contractile function of the gallbladder.
Among the main reasons for the development of gallstone disease are:
- hereditary factor;
- dramatic weight loss;
- eating foods high in cholesterol and low in plant fiber;
- inflammation and dyskinesia of the biliary tract;
- taking oral contraceptives;
- malabsorption syndrome;
- disorders in the endocrine system;
- Crohn’s disease;
- liver disease.
Also, the disease can develop during pregnancy.
There are 2 main mechanisms of development of the process of formation of stones in the gallbladder: gallbladder-inflammatory and hepatic-metabolic. The first option 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 are attached to it, which causes the formation of calculus.In the second case, the disease develops against the background of a violation of the metabolic processes of the liver, which is often a consequence of already existing liver diseases, unbalanced nutrition, endocrine disorders, and hypofunction of the thyroid gland.
Symptoms of gallstone disease
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 stones, their size, etc. You can suspect stones in the gallbladder by the following signs:
- pain and heaviness in the right hypochondrium;
- flatulence and other bowel disorders;
- belching with air;
- yellowing of the skin and mucous membranes.
90,058 taste of bitterness in the mouth;
Many of these symptoms may be indicative of other medical conditions, so you need to see your doctor for an accurate diagnosis.You can contact a therapist or directly to a gastroenterologist. The main method for diagnosing gallstone disease is ultrasound, it allows not only to confirm the diagnosis, but also to determine the exact location of stones and their size.
Treatment of gallstone disease
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 intestine and the formation of intestinal obstruction.Also, over time, the disease can provoke the development of an oncological process in the gallbladder.
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;
- surgical intervention.
Conservative treatment is aimed at dissolving stones using special preparations and crushing them using a laser or ultrasound.There are a number of contraindications to these methods of treatment, besides, it does not always allow to completely solve the problem, therefore, often with stones in the gallbladder, an operation is prescribed – cholecystectomy, which involves the removal of the gallbladder.
Today, most often the removal of the gallbladder is carried out by the modern laparoscopic method, since the lane 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 you to solve the problem quickly and without consequences.
You can make an appointment with a gastroenterologist either on your own in your DIALINE account, or by ordering a call back.
Make an appointment
90,000 Cholelithiasis – what to do? – Medical center “Lotos”
Pirogova Irina Yurievna
Deputy chief physician for organizational and methodological work, head of the center of gastroenterology and hepatology, gastroenterologist
What should a person do if such a concept as gallbladder stones suddenly and insidiously burst into his life?
Cholelithiasis is a chronic inflammatory disease of the biliary tract, accompanied by the formation of stones most often in the gallbladder (cholecystolithiasis) or bile ducts (choledocholithiasis).
The disease is based on a change in the viscosity of bile (dyscholia) associated with a violation of the physicochemical properties of bile. Stones are formed as a result of the deposition of bile pigments, cholesterol, certain types of proteins, calcium salts, infection of bile, its stagnation, and lipid metabolism disorders.
According to the World Health Organization, gallstones can be found in 10-12% of the world’s population. In advanced economies – even more often.This disease affects every fifth woman and every tenth man. Over the past decade, the incidence of this disease has doubled.
Gallstones are cholesterol (the vast majority, about 90% of the variants of gallstones), as well as pigmented and mixed stones. So, due to the oversaturation of cholesterol in bile, cholesterol stones are formed, precipitated, and crystals are formed. A disturbance in the gallbladder of the motor boat leads to the fact that these crystals are not excreted into the intestines, which ultimately leads to their gradual growth.Pigmented stones (they are also called bilirubin stones) are formed with increased breakdown of erythrocytes, which occurs with actual hemolytic anemia. As for the mixed stones, they are a kind of combination based on the processes of both forms. Contained in such stones cholesterol, bilirubin and calcium, the very process of their formation occurs as a result of inflammatory diseases affecting the biliary tract and, in fact, the gallbladder.
Causes contributing to the formation of gallstones
- unbalanced diet – predominance of animal fats
- hormonal disorders
- sedentary lifestyle
- disorders associated with fat metabolism, weight gain 90 059
- inflammation and other abnormalities in the gallbladder
- various types of liver damage
- diabetes mellitus, etc.
Based on the features of the disease adopted today, the following classification is distinguished in accordance with the stages that are relevant for it:
- Physicochemical (initial) stage – or, as it is also called, the pre-stone stage. It is characterized by changes in the composition of bile. There may be no special clinical manifestations at this stage, or they may be minimal. It is detected mainly by ultrasound diagnostics, biliary sludge or drying of bile in the gallbladder is determined.This stage is most favorable for drug (non-surgical) treatment.
- The formation of stones is a stage that is also defined as latent stone carriage. In this case, there are no symptoms of gallstone disease, however, the use of instrumental diagnostic methods allows us to determine the presence of stones in the gallbladder (ultrasound diagnostics, computed tomography). Depending on the size, density of calculi, indications for drug or surgical treatment are determined.
- Clinical manifestations are a stage, the symptoms of which indicate the development of an acute or chronic form of calculous cholecystitis. Mostly the treatment of this stage is the surgical removal of the gallbladder with stones.
Operate or not
Only a surgeon or gastroenterologist can answer this question after an individual consultation.
Non-surgical treatment of cholesterol stones is currently possible, but it must be timely, at the stage of formation of a soft and small stone (that is, in the first or second stage of cholelithiasis).
To determine the possibility of therapeutic treatment of cholecystitis with stones, it is necessary to study the gallbladder using computed tomography to determine the density of the stone and bile.
At the “Lotos” Medical Center, MSCT of the gallbladder is performed with determination of the density of calculi. This test has many advantages over abdominal ultrasound, because determines the density of the stone, which means its ability to dissolve. Dense, calcareous stones in Hounsfield CT units are more than 100 units and cannot be dissolved by drugs.Soft, cholesterol from 30 to 90 units can be dissolved with medication. The size of the stone also matters – stones up to 10-15 mm dissolve, when the gallbladder is filled less than 1/3.
In order to dissolve small stones, preparations of special bile acids, similar to those found in human bile, can be used. Bile acid preparations are effective not only for dissolving calculi, but also for preventing their formation. They are appointed by a specialist gastroenterologist.The course of treatment is at least six months, and only under the supervision of a doctor.
Is it necessary to remove the gallbladder if the stone does not bother
Currently, the overwhelming majority of surgeons agree that patients with asymptomatic cholelithiasis should not immediately undergo prophylactic cholecystectomy (removal of the gallbladder) with a newly discovered small stone. The risk of developing severe complications with small single stones is assessed as low, therefore, such patients should regularly undergo ultrasound examinations of the abdominal cavity and follow the recommendations on lifestyle and nutrition.
In the case of calculous cholecystitis, when the patient periodically suffers from bouts of biliary colic, doctors recommend cholecystectomy, which should be performed routinely. Each subsequent attack can cause the development of acute cholecystitis, which can be accompanied by severe complications from the liver and pancreas.
If a picture of acute cholecystitis develops – biliary colic lasts more than 3 hours, the pain is localized in the right upper quadrant of the abdomen, is not relieved by antispasmodic drugs, the temperature rises, nausea and vomiting occur – an ambulance should be called.
Radical treatment of the disease
Surgery for gallstone disease is the gold standard for the treatment of this pathology. Its purpose is to remove a receptacle for calculi, avoiding recurrence of biliary colic, as well as preventing the appearance of obstructive jaundice, cholangiogenic sepsis, and biliary peritonitis. Performed in a planned manner, that is, even before the development of complications, the operation is safe. The chance of complete recovery after surgery is about 95%.
“Off”, that is, the gallbladder clogged with stones, cannot be cured without surgery.
The operation can be performed in two ways – abdominal and laparoscopic.
This is a “major” operation in which an incision is made on the anterior abdominal wall under general anesthesia. As a result of this access, surgeons can thoroughly examine and feel all biliary tract, conduct a local ultrasound or X-ray with contrast to remove all existing stones. The method is indispensable for inflammatory and cicatricial processes of the area under the liver.The disadvantages of this intervention are: a longer recovery period after surgery; a greater chance of developing incisional hernias; cosmetic defect; more often complications develop after surgery.
The most commonly used method of surgical treatment. Surgery laparoscopy, performed for gallstone disease, is an intervention under visual control using a fiber optic device connected to a monitor through several small incisions in the abdominal wall.
The laparoscopic method has many advantages over abdominal surgery:
- the wound does not hurt so much and not so long
- it does not restrict breathing
- intestinal paresis is not pronounced
- less severe cosmetic defect
There are also negative sides to laparoscopic cholecystectomy – there are more contraindications for surgery. In particular, the laparoscopic method cannot be used not only for severe disorders of the heart, blood vessels and lungs, but also in the following cases: obesity, peritonitis, late pregnancy, acute pancreatitis, obstructive jaundice, fistulas between internal organs and bile ducts, gallbladder cancer , adhesions in the upper abdominal cavity, acute cholecystitis (if more than 2 days have passed since the disease), cicatricial changes in the hepatobiliary zone.
Regardless of how many stones are found in the gallbladder – one large or many small ones – the gallbladder is removed completely.
This is how the removal of the gallbladder looks on the monitor of the laparoscopic unit:
In our medical center, highly qualified surgeons in a high-tech surgical hospital will be able to perform cholecystectomy with the method that is necessary in your specific case.
Is it possible to live without a gallbladder
The pathologically altered gallbladder cannot fully perform its functions, and is the cause of constant pain and a source of chronic infection. Therefore, cholecystectomy, performed in accordance with the indications of a qualified doctor, improves the patient’s condition and does not affect the digestive function.
If you or your loved ones have gallstone disease, you need to act quickly and correctly, without starting the disease.A properly selected examination and treatment in our center will help to cope with the problem of gallstones.
– Pirogova Irina Yurievna
90,000 Cholelithiasis – prices for treatment, symptoms and diagnosis of cholelithiasis in the “CM-Clinic”
Gallstone disease may not manifest itself clinically for a long time.Symptoms appear when the biliary tract is blocked by calculus (biliary colic) or when inflammation develops (acute cholecystitis).
Biliary colic is one of the most common manifestations of gallstone disease. It develops when the stone moves, when it clogs the exit from the gallbladder or ducts. Against this background, the intraluminal pressure increases and pain syndrome appears. Its distinctive features are:
- Appearance 1-1.5 hours after eating fatty foods or an episode of excessive overeating, sometimes shaking driving and bending of the body act as provocateurs;
- rapid increase in pain in a short period of time;
- the nature of the pain is constant and bursting;
- duration from several minutes to several hours;
- localization of pain – in the epigastrium and in the hypochondrium on the right, and irradiation may be noted in the right hand, between the shoulder blades and the neck on the right;
- concomitant symptoms – nausea and vomiting without relief, decreased or increased heart rate, fluctuations in blood pressure, a slight increase in body temperature, false urge to defecate or bloating;
- relief of pain sudden independent or as a result of the administration of antispasmodics.
It is also worth paying attention to “night” complaints. Scientists from Denmark have found that pain in the right hypochondrium, which appears several hours after falling asleep, is quite specific for the pathology of the biliary tract. It may not be true biliary colic, but requires an early visit to a gastrologist.
Acute cholecystitis is another clinical manifestation of cholelithiasis. As a rule, they begin to think about this condition if an attack of biliary colic lasts more than 6 hours, and the pain does not go away, but, on the contrary, increases.Pain sensations in this case capture the entire right hypochondrium, intensify with deep breathing and concussion of the peritoneum. Concomitant symptoms are associated with the development of intestinal obstruction:
- lack of appetite;
- repeated vomiting without relief;
The body temperature rises to 38-39 ° C, jaundice may join due to inflammation of the biliary tract (the swelling of their walls disrupts the outflow of bile from the liver).
Cholelithiasis (GSD) – Surgical department – Clinical departments – Departments and specialists – Central Clinical Hospital “Russian Railways-Medicine”
Gallstone disease is a common disease that develops in people over the age of 40. This disease is especially often observed among the urban population of industrially developed countries. According to most researchers, about 10% of men and up to 25% of women in European countries suffer from cholelithiasis.
With gallstone disease, calculi (stones) are formed in the gallbladder and bile ducts. These stones are composed of the usual components of bile – bilirubin, cholesterol, calcium salts. Most often, there are mixed stones containing the specified components in a greater or lesser proportion. If the calculus is 90% cholesterol, then such a stone is called “cholesterol”, if from bilirubin – “pigment”, and if from calcium salts – “lime”. The size and shape of stones in gallstone disease can be different.Sizes generally vary from 1–2 mm to 3–5 cm; the shape can be round, oval, polyhedron, etc.
Causes of gallstone disease
The main place of formation of gallstones is the gallbladder, in very rare cases – the biliary tract. Currently, there are three main reasons for their formation in clinical medicine: stagnation of bile in the bladder, metabolic disorders, inflammatory changes in the wall of the gallbladder . With metabolic disorders, there is a change in the ratio of the concentrations of cholesterol, phospholipids (lecithin) and bile acids in bile.The concentration of cholesterol increases, while the concentration of phospholipids decreases. Such bile is considered to be lithogenic. Under such conditions, bile cholesterol easily precipitates in the form of crystals, these crystals group, combine with each other, which leads to the formation of stones. It is known that gallstone disease often develops in patients with metabolic diseases such as diabetes, obesity, and hemolytic anemia. With prolonged stagnation of bile in the bladder, it becomes infected. Infection leads to damage to the wall of the gallbladder, desquamation of its epithelium.All this contributes to a more rapid deposition of cholesterol crystals and the formation of gallstones. In the damaged wall of the gallbladder, the process of absorption of some components of bile is disrupted, their physicochemical ratio changes, which also contributes to stone formation. In addition, with cholestasis in the bile in the gallbladder, the concentration of cholesterol, bilirubin, calcium may increase, which increases the lithogenicity of bile. This is facilitated by the intake of food rich in cholesterol, obesity, and the use of oral contraceptives.
Clinical manifestations of gallstone disease
Gallstone disease can be asymptomatic (the so-called latent form of gallstone disease). In this case, stones in the gallbladder are detected as an accidental finding when examining patients for another disease.
Patients with gallstones may be worried about dyspeptic disorders : an unpleasant metallic taste, bitterness in the mouth, nausea, bloating, a feeling of heaviness in the right hypochondrium, especially after eating fatty foods.Such phenomena are caused by impaired motility of the biliary tract and the gastrointestinal tract with the throwing of bile into the stomach and esophagus. This form of gallstone disease is called dyspeptic.
The classic clinical manifestation of cholelithiasis is hepatic (biliary) colic, which is characterized by intense cutting, stabbing, tearing, less often paroxysmal pain in the right hypochondrium and epigastric region. These pains often radiate to the lumbar region, right shoulder blade, right forearm.Also, pain can spread to the region of the heart and be mistakenly perceived as an attack of angina pectoris. Pain occurs most often after an error in the diet (intake of fatty, spicy foods), with physical exertion, psycho-emotional overstrain, shaking driving. The occurrence of pain is associated with the movement of stones in the biliary tract and their infringement in the neck of the gallbladder or cystic duct, increased pressure in the gallbladder or ducts as a result of impaired outflow of bile. Often an attack of hepatic colic is accompanied by nausea and repeated vomiting with an admixture of bile, which does not bring relief to the patient.Colic can last from a few minutes to several hours. At the same time, patients are restless, often change their posture, trying to find a comfortable position in which the intensity of pain decreases. This form of gallstone disease is called painful paroxysmal.
Diagnosis of gallstone disease
The diagnosis of gallstone disease is made on the basis of: patient complaints, medical history, physical examination by a doctor, and mainly according to instrumental examination data.At the same time, to make a diagnosis, it is often enough to conduct only one ultrasound examination (ultrasound) of the abdominal organs, in which calculi are found in the lumen of the gallbladder or in the ducts. The examination of the patient can also be supplemented with an X-ray examination. In this case, radiopaque techniques are used, such as oral cholecystography or intravenous cholecystocholangiography. In the first method, the patient takes a special X-ray contrast agent inside a few hours before the X-ray is taken, which is captured by the liver cells and released into the bile.With cholecystocholangiography, a radiopaque drug is injected intravenously, it is also captured by the liver cells and excreted into the bile. After contrasting, an X-ray is taken and if a defect in the filling of the lumen of the gallbladder or ducts is detected, then this may indirectly indicate the presence of calculi (stones) in them, although the same X-ray picture can be given by both polyps and cancer of the gallbladder. Currently, the X-ray method for diagnosing gallstone disease is practically not used due to its low information content, low efficiency, and lack of ease of use.
Treatment of gallstone disease
Currently, surgical treatment is the only possible way to radically get rid of cholelithiasis.
Until now, there are no effective drugs that can cause the dissolution of calculi in the gallbladder and bile ducts. Certain drugs can dissolve only certain types of stones, however, with prolonged use, they cause serious side effects and complications.
There is an alternative, less traumatic surgical method for the treatment of gallstone disease, such as extracorporeal shock wave lithotripsy. The essence of the method lies in the destruction of gallstones by a shock wave reproduced by a special device. The shock wave is strictly focused on the gallbladder, under its influence, the stones are crushed into small fragments and sand, which in some cases, together with the bile, go into the duodenum. Despite the simplicity of this method of treatment and its low invasiveness, the effectiveness of the treatment remains very low even today.This is due to the fact that not all calculi lend themselves to crushing. In 10-30% of cases, fragments of destroyed stones are large and cannot come out through the natural opening of the common bile duct. In this case, they can pinch in the neck of the gallbladder and lead to a pronounced attack of hepatic colic, or get stuck in the common bile duct and disrupt the outflow of bile into the duodenum, which will lead to the development of obstructive jaundice. Both of these conditions require immediate hospitalization in a surgical hospital! The shock wave not only destroys stones, but in some cases causes serious damage to the liver and the walls of the gallbladder.The use of extracorporeal lithotripsy in patients with cholelithiasis should be carried out according to certain indications: single cholesterol (X-ray negative) stones with a diameter of no more than 3 cm, occupying no more than half of a well-functioning gallbladder. This bloodless method is especially indicated in the treatment of elderly and senile patients. Contraindications for lithotripsy are: X-ray positive stones (with the inclusion of calcium salts), stones more than 3 cm in diameter, multiple stones occupying more than half of the gallbladder, a disabled gallbladder, a history of frequent renal colic, inflammatory diseases of the hepatoduodenal zone.
To date, many methods of surgical treatment of gallstone disease have been developed. With any type of surgical treatment, complete removal of stones is performed along with the gallbladder – the main pathogenetic substrate of the disease! This completely excludes the return of the disease.
The absolute indications for surgical treatment of gallstone disease are:
- a history of severe bouts of hepatic colic;
- the presence of large stones that can cause a pressure ulcer of the bladder wall;
- the risk of developing gallbladder cancer, which occurs in 5% of patients with long-term gallstone disease;
- small bladder stones that can block the cystic duct, enter the common bile duct and cause obstructive jaundice, cholangitis, biliary acute or chronic pancreatitis.
A relative indication for surgical treatment is the presence of latent and dyspeptic forms of gallstone disease.
The main type of surgery for cholelithiasis is the traditional (open) cholecystectomy (removal of the gallbladder). At the same time, various types of approaches (incisions) are performed through the anterior abdominal wall, penetrate into the abdominal cavity. After intraoperative revision of the gallbladder, extrahepatic bile ducts, duodenum and pancreas, assessment of the nature of pathological changes, its complete removal is performed.The classical approach provides wide access to the hepatobiliary zone and a good overview of all interested organs, however, it is associated with significant tissue trauma (especially the anterior abdominal wall), which causes a rather long period of postoperative rehabilitation and a higher risk of complications from the operating room compared to minimally invasive techniques. wounds.
Currently, the most popular are minimally invasive surgical interventions in the treatment of gallstone disease, such as cholecystectomy from a mini-access and laparoscopic cholecystectomy.
Benefits of Laparoscopic Surgery
Pain in the postoperative period is insignificant, and, as a rule, is noted only on the first day.
The patient can walk and take care of himself immediately after coming out of anesthesia (a few hours after the operation).
The length of stay in the hospital is much reduced (up to 1–4 days), as well as the terms of restoration of working capacity.
The number of incisional hernias is reduced by several times.
Laparoscopic surgery is a cosmetic surgery; after a few months, the scars after punctures in most patients become almost invisible.
Cholecystitis – inflammation of the gallbladder
It often develops in cases of cholelithiasis (so-called stone cholecystitis, up to 80–90% of the total number of diseases ), after viral hepatitis and other infectious diseases, in the presence of a chronic focal infection (for example, tonsillitis) or parasitic diseases (for example, opisthorchiasis).The development of cholecystitis is facilitated by stagnation and changes in the composition of bile, which may be associated with dietary habits. Cholecystitis is often combined with cholangitis.
Distinguish between calculous (the presence of gallstones in the bladder) and acalculous, acute and chronic cholecystitis.
Diagnostics of the cholecystitis
- Ultrasound of the abdominal organs with examination of the gallbladder, bile ducts, pancreas.
- General and biochemical blood test.
- X-ray examination (with the development of obstructive jaundice and suspicion of calculi in the bile ducts).
The main signs of acute cholecystitis: paroxysmal pain in the right half of the abdomen, radiating to the right shoulder, scapula; nausea and vomiting; chills and fever; jaundice and itching of the skin are possible. A dangerous complication of acute cholecystitis is peritonitis. Cholecystostomy is shown (Greek.chole bile + kystis bladder + stoma hole, passage) – external drainage of the gallbladder when other interventions are impossible.
The presence of stones in the gallbladder is an indication for surgery.
This is due to the fact that the presence of calculi in the gallbladder can at any time lead to acute cholecystitis, its necrosis with the development of complications:
- empyema of the gallbladder – infection of the contents of the gallbladder;
- dropsy of the gallbladder – a violation of the outflow of bile, but without its infection, while the elements of bile are absorbed, and the bladder remains filled with transparent contents;
- phlegmon of the gallbladder – purulent inflammation of the wall of the gallbladder;
- subhepatic abscess;
- biliary fistula;
- peritonitis, sepsis are deadly complications that can develop with the progression of the above complications.
With the development of complications, the operation is performed on an emergency basis and is associated with a high risk of complications, and the rehabilitation period ranges from several weeks to several months !!!
Chronic cholecystitis can be stoneless and calculous, from the Latin word “calculus”, which means “stone.” Calculous cholecystitis is one of the results of cholelithiasis. Chronic cholecystitis is manifested by nausea, dull pain in the right hypochondrium, etc.discomfort after eating. In the recognition of cholecystitis, laboratory data and cholecystocholangiography play an important role.
The most formidable complication of calculous cholecystitis is hepatic colic. If a medium-sized (less than 1 cm) stone does not pass in the biliary tract, plugging the flow of bile, then bile pigments enter the blood and subhepatic jaundice develops.
Colic symptoms are very similar to the onset of acute cholecystitis.However, colic is much more painful and usually begins at night or early in the morning.
After some time, the symptoms of jaundice appear: yellowing of the sclera and skin occurs – a peculiar lemon-yellow color appears, urine darkens and becomes similar to beer, and the feces noticeably brighten, up to whiteness.
Patients in this condition are subject to emergency hospitalization.