Treatment, Definition, Risk Factors & Symptoms

Overview

Do You Have Gallstone Pain?

What are gallstones?

Gallstones are stone-like objects that develop in the gallbladder or bile ducts (the pipe-like system within the liver). Gallstones can range dramatically in size, from tiny grains of sand to golf ball-sized objects. Interestingly, small stones can often cause the most trouble. These are stones that can leave the gallbladder and get stuck. Larger stones tend to remain quietly in the gallbladder. It is important to know that many people who have gallstones are never bothered by them and may not know the stones are even there. In these cases, no treatment is needed.

What are gallstones made of?

Gallstones are made up of hardened materials in your body. Typically, there are two types:

• Cholesterol: Made up of fatty substances in the blood, cholesterol is found throughout the body. These are the most common type of gallstones.
• Pigment Stones (mainly made of bilirubin): This substance is created when red blood cells break down in the liver. Too much bilirubin can actually leak into the bloodstream and cause the skin and eyes to turn yellow (jaundice).

Gallstones that are made up of cholesterol tend to be greenish in color. It is more common to have gallstones made of cholesterol than other types of stone.

Where do gallstones develop?

Gallstones are most commonly found in the gallbladder, as cholesterol stones. Gallstones can also travel from the gallbladder to the common bile duct, which is the largest of the ducts (pipes) in the liver.

Common bile duct stones are much less common than gallstones. Stones that find their way into the common bile duct can create more serious medical situations than just gallstones that remain in the gallbladder. Common bile duct stones can block the common bile duct, resulting in a serious infection called cholangitis. These stones can also cause pancreatitis, a painful condition caused by inflammation of the pancreas. Stones in the common bile duct can be removed without surgery by using a scope. Removal of the gallbladder requires surgery, which is typically done laparoscopically (a minimally invasive surgical procedure).

Gallstones are stone-like objects that develop in the gallbladder.

What is the gallbladder?

The gallbladder is a small organ tucked up under the liver, on the right side of your body. It is shaped like a swollen pea pod. The gallbladder’s job is to store and dispense bile—a fluid that helps digest fats in the food you eat. Similarly to a pea pod, the gallbladder is green. This is due to the bile inside the gallbladder. Bile is a mixture of cholesterol, bilirubin, bile salts and lecithin.

The gallbladder is connected to other parts of the digestive system through a series of ducts, or tunnels. These ducts help to carry bile and aid in the entire process of breaking down food. Ultimately, the bile finds its way into the common bile duct, where it passes through a special sphincter (a valve made of muscle), into the small intestine. Once there, the bile can mix directly with food that’s waiting to be digested. The common bile duct then empties bile into the duodenum, the first portion of the very lengthy small intestine.

Not all bile travels directly from the liver into the duodenum. Another portion of bile moves from the liver into the gallbladder through a special duct called the cystic duct. The gallbladder stores bile, which is available to be used for digestion on very short notice. If a fatty meal is eaten, then the gallbladder is signaled to contract and to squeeze some stored bile into the common bile duct where it’s passed into the small intestine to mix with food. All bile ends up in the small intestine, where it helps digest food.

What is bile and what is it used for?

Produced in the liver, bile is a combination of cholesterol, bilirubin, bile salts and lecithin. This solution helps break down fat during the digestion process. Bile is either released directly to the small intestine from the hepatic duct (coming straight from the liver) or from the bile ducts after being stored in the gallbladder. The entire system of ducts is called the biliary system. Bile is an important part of digestion and exits the body with your feces.

Symptoms and Causes

Why do gallstones develop?

Gallstones can develop for several reasons, including:

• Forming when there is a critical concentration of cholesterol or bilirubin in the bile.
• Developing if the gallbladder is lazy and does not completely empty itself of bile.
• Occurring in people with other conditions, like:
• During pregnancy.
• When you rapidly lose weight.

What are the symptoms of gallstones?

The symptoms of gallstones can vary based on the size of the gallstone. Most gallstones do not cause any symptoms at all. These gallstones are known as silent stones and require no treatment.When the gallstones cause symptoms, they may include:

• Pain in the upper mid abdomen or upper right abdomen.
• Associated pain in the right shoulder.
• Chest pain.
• Nausea and vomiting.
• Repeated similar episodes.
• Jaundice (a yellow tint to the skin and eyes).

Pain is the main symptom most people experience with gallstones. This pain is steady and can last from around 15 minutes to several hours. The episodes, which can be severe, generally subside after one to three hours or so. People who have these painful attacks, while uncomfortable, are not in any medical jeopardy. Gallstones can cause acute cholecystitis, which is a more serious condition when the gallbladder is actually inflamed. This happens if a stone blocks off the cystic duct, which increases the pressure within the gallbladder. This condition may require antibiotics, hospitalization and even urgent surgery. Stones that pass out of the gallbladder and into the common bile duct can cause a complete blockage of the duct with jaundice, infection and pancreatitis.You may feel pain in several places, including:

• Upper part of the abdomen, on the right side.
• Between the shoulder blades.
• Under the right shoulder.

When people experience pain with gallstones, it is sometimes referred to as a gallbladder attack or biliary colic.There are two special conditions that could mimic gallstone symptoms. First, some gallbladders contain a thick sludge, which has not formed into actual stones. Sometimes sludge is felt to cause symptoms similar to actual gallstone pain. Secondly, there is an uncommon condition called acalculous cholecystitis, when the gallbladder becomes inflamed, but no stones are present. This is generally treated by surgical removal of the gallbladder.

Who is at risk for gallstones?

You may have an increased risk for developing gallstones if you:

• Are a woman.
• Are over the age of 40.
• Have a family history of gallstones (members of your family have had gallstones).
• Are overweight.
• Have lost a large amount of weight over a short amount of time.
• Have diabetes.
• Have Crohn’s disease.
• Eat a diet that is high in fat and cholesterol.
• Take drugs that lower cholesterol.
• Take various medicines including oral contraceptives.
• Have certain blood disorders.
• Are of Native American or Mexican descent.

Does my diet or weight place me at risk for gallstones?

People who are overweight or planning to lose weight –either through a planned diet program or a surgery—are actually at an increased risk of developing gallstones. The risk is higher for several reasons.

• People who are overweight may have diets that are high in cholesterol. Your bile has cholesterol in it already, but if your diet has excessive amounts of cholesterol, there is a higher chance it will collect in your bile and create a cholesterol gallstone.
• Rapid weight loss is also a concern. The gallbladder is a part of the digestive process. It holds bile to the side like a storage tank. Then the gallbladder releases the bile through the ducts and into the intestine to help break down food. If you go on a diet plan that significantly reduces your calorie intake or you have a weight loss surgery, your liver secretes extra cholesterol into the bile. The gallbladder can sometimes be ‘lazy’ and not able to contract vigorously, which also leads to gallstone formation. Patients who are undergoing a gastric bypass or other surgical procedure that will lead to rapid weight loss are at risk of gallstone formation. For this reason, surgeons may remove the gallbladder prophylactically (a preventive measure) at the time of the weight loss surgery.

If you are considering a weight loss program or surgery, it is important to discuss your risks with a doctor. This could be especially important if you have had stones in the past. It is common for gallstones to happen more than once.

Can children get gallstones?

Gallstones can happen to both children and adults. It is most common to see gallstones in middle-aged adults. However, adults are not the only ones who experience gallstones. One challenge with gallstones in children is identifying symptoms. Young children may have difficulty expressing where the pain is located. If you child has any unusual symptoms or abdominal pain, call your doctor.

Diagnosis and Tests

How are gallstones diagnosed?

The most commonly used test to detect gallstones is an ultrasound. Ultrasound is a painless and accurate procedure that transmits high-frequency sound waves through body tissues. The echoes are recorded and transformed into video or photographic images of the internal structures of the body. While no test is 100%, this is a very accurate test for diagnosing gallstones. There are other radiology tests that are sometimes used, but ultrasound is the main tool for diagnosing gallbladder disease.

In general, ultrasound does not visualize the common bile duct well. Though stones in this duct aren’t as common, they can happen. If they are suspected, the following tests may be done:

• Endoscopic retrograde cholangiopancreatography (ERCP): This is both a test and a possible treatment for common bile duct stones. When used as a test, an endoscope — a flexible tube with a light and a camera attached — is inserted into the patient’s mouth, down the throat, and into the stomach and small intestine. A dye is injected to allow the bile ducts to stand out. If there are gallstones in the bile duct, they can be removed by the endoscope. This scope cannot remove stones contained within the gallbladder.
  
  Endoscopic retrograde cholangiopancreatography (ERCP) can diagnose and sometimes treat gallstones.
  
• Magnetic resonance cholangiopancreatography (MRCP): In MRCP, the bile ducts are examined with magnetic resonance imaging (MRI), a test that uses a large magnet, radio waves, and a computer to produce very clear images of parts of the body. Unlike ERCP, MRCP can only diagnose common bile duct stones. It cannot remove them. However, MRCP’s advantage over ERCP is that it is the safer alternative, so often physicians will opt for MRCP initially.
• Endoscopic ultrasound (EUS): This procedure combines endoscopy with ultrasound (there’s a probe at the tip of the scope). Like ERCP, this scope is passed through the mouth and advanced to the common bile duct and gallbladder region. It visualizes the common bile duct well. Similar to MRCP, gallstones are identified but not removed during this procedure. If common bile duct stones are demonstrated by EUS (or MRCP), then an ERCP will generally follow to remove them.

  Endoscopic ultrasound passes through the mouth to the common bile duct and gall bladder.

Management and Treatment

Incision locations for a laproscopic cholecystectomy

How are gallstones treated?

Silent stones are not treated and should be left alone. Most people who have gallstones are in this category.If you have symptoms, such as pain, you will probably need to be treated. The most common treatment for gallstones is to remove the gallbladder surgically. Removal of the gallbladder is called a cholecystectomy. In the majority of cases (90%), this surgery can be performed laparoscopically, a minimally invasive technique that results in less post-operative pain and a faster recovery than conventional cholecystectomy.Gallstones that are found in the bile ducts may need to be removed even if there are no symptoms. This procedure is commonly done with the endoscopic retrograde cholangiopancreatography (ERCP) procedure.

What is a laparoscopic cholecystectomy?

Laparoscopic cholecystectomy is known as a minimally invasive procedure because it uses several small incisions instead of one large one. A laparoscope is a narrow tube with a camera. This surgical tool is inserted through one incision. The camera allows your doctor to see your gallbladder on a TV screen. Your gallbladder is then removed through another small incision.

What happens if a laparoscopic cholecystectomy does not work or if there are complications during surgery?

If the patient has certain complications associated with gallstones, the surgeon may need to remove the gallbladder with an open cholecystectomy. This surgery involves an incision in the abdomen and requires a longer hospital stay (three to five days). Medical issues that could lead to open cholecystectomy include:

• Having severe inflammation of the gallbladder.
• Experiencing difficulties during an attempted laparoscopic surgery.
• Having severe cardiac and respiratory issues.
• Having a late term pregnancy.
• Experiencing major scarring from a previous surgery.
• Having a bleeding disorder or liver disease.
• Having suspected gallbladder cancer, a very rare condition.

What is an endoscopic retrograde cholangiopancreatography (ERCP) procedure?

An endoscopic retrograde cholangiopancreatography (ERCP) procedure is another minimally invasive option for removing gallstones. The endoscope is a tube-like tool. Your doctor will need to move it throughout your digestive system during the treatment. The path the endoscope travels is:

• In the mouth.
• Down the throat.
• Through the stomach.
• Into the duodenum (beginning of the small intestine) where the common bile duct empties its bile.

Once there, the endoscope is used to remove any blockages in the bile duct.

Can I digest food without a gallbladder?

You don’t need a gallbladder in order to digest food properly. If your gallbladder is removed, bile will flow directly from your liver through the hepatic duct and the common bile duct to the small intestine. After the surgery, you may experience some softer stools, which generally resolve over time.

Are there any non-surgical treatments for gallstones?

In most cases where gallstones need treatment, your healthcare provider will use a minimally invasive technique to remove the stone. There are medications that can be used to dissolve the stones. However, as minimally invasive methods have advanced, these drugs haven’t been used as often. Dissolving medications can take months—or possibly even years—to get rid of the gallstones. By contrast, a procedure resolves the issue quickly. Using these medications to treat gallstones could be an option if you are unable to have surgery because of another condition. Talk to your doctor about all treatment options and which one is the best fit for you.

What are the complications of gallstones?

There are several complications of a gallstone attack, including:

Gallstones can also cause the gallbladder or bile ducts to become infected. A blockage in the common bile duct can cause jaundice (yellowing of your skin or eyes) or can irritate the pancreas.

Prevention

Can gallstones be prevented?

Gallstones cannot be prevented. However, you can decrease your risk factors by following healthy lifestyle tips. It is important to maintain a healthy weight through exercise and a balanced diet. Talking to your doctor about weight loss and cholesterol management is also a big part of preventing gallstones.

What foods should I avoid if I have had gallstones in the past?

Many gallstones are formed from cholesterol. Though you cannot prevent gallstones, you can try and limit the amount of fatty foods in your diet. Several tips for limiting cholesterol in your diet include:

• Eating less meat.
• Adding fish.
• Limiting the amount of fried foods.
• Adding more whole grains.
• Choosing low-fat dairy products (cheese, milk).
• Adding fresh vegetables and fruit.

Can I have gallstones more than once?

Yes. If you have experienced a gallstone attack once, it is more likely that you will have them again. The multiple attack nature of gallstones is why your doctor may suggest removing the gallbladder.

Outlook / Prognosis

When can I return to my normal activities after having gallstones?

If you have a gallstone that does not require treatment (silent stone) you can continue on with your normal activities right away. If you have a minimally-invasive procedure, you will need a short amount of time to recover before starting your activities again. Two major advantages of minimally-invasive procedures include a much faster recovery time and less pain. Larger, open surgeries traditionally mean more time in the hospital and a longer recovery at home. Speak with your doctor about a realistic plan for your recovery.

Living With

When should I call my doctor?

If you are experiencing pain in your abdomen, call your doctor, especially if the pain increases over time and is associated with fever, nausea or vomiting. Abdominal pain has many causes and your doctor will evaluate your symptoms carefully in order to make the correct diagnosis. If your symptoms are severe, then you may be directed to an emergency department for immediate evaluation.Are gallstones fatal?Gallstones themselves are not fatal. However, they can cause many complications that could be fatal. Fortunately, this is a rare event. If a large stone blocks your bile ducts after leaving the gallbladder, there could be a build-up of bile in the gallbladder and ducts, causing severe pain and an infection within the ducts. This is an urgent medical situation that needs prompt treatment, such as an emergency endoscopic retrograde cholangiopancreatography (ERCP). Of course, all medical procedures—such as ERCP and cholecystectomy—have risks.

How quickly will I recover from gallstones?

If gallstones cause symptoms, then you may need surgery. If you have a laparoscopic cholecystectomy (minimally invasive procedure to remove the gallbladder) without any complications, you may be home within 24 hours. If there are complicating factors—swelling of the gallbladder, infection, a blocked duct or other medical conditions may need to have an open surgery. If that happens, your hospital stay could be about three to five days.

Gallstones – causes, symptoms, treatment

Gallstones are crystal-like deposits that form in the gallbladder – a small organ under the liver that stores bile (a fluid used by the digestive system).

The stones may stay in the gallbladder and cause no symptoms, or they may irritate the gallbladder wall or block gallbladder ducts, resulting in infection, inflammation and upper abdominal pain. It is possible for the infection to spread to the liver or pancreas. Treatment can range from pain relief to surgery. 

In New Zealand, the proportion of the population with gallstones may be as high as 20%.

Causes

The gallbladder is part of the digestive system. It is a pear-shaped, sac-like structure approximately 8 cm long and 2.5 cm wide, located alongside the stomach and attached to the lower surface of the liver. The function of the gallbladder is to concentrate, store, and excrete bile ( a fluid that helps in the digestion of fat). 

Bile has several components including cholesterol, bile salts, and bile pigments (eg: bilirubin). Gallstones are thought to develop because of an imbalance in the chemical composition of bile inside the gallbladder, such as when the levels of cholesterol or bilirubin in the bile become too high. The excess cholesterol or bile forms crystals, which eventually form stones. 

The two main types of gallstones are: 

• Cholesterol gallstones: The majority of all gallstones are cholesterol stones. The amount of cholesterol that can dissolve in bile depends on how much bile salt it contains. Too much cholesterol, or too little bile salt, tends to cause cholesterol stones to form in the gallbladder.    
• Pigment gallstones: These stones are formed by calcium and bilirubin when there is an excess of bilirubin in the gallbladder. Pigment stones tend to form in patients with certain blood or liver disorders. 

Risk factors

The risk of developing gallstones tends to increase with age (especially after age 40 years) and they’re more common among people of European ethnicity than Maori, Pacific or Asian New Zealanders.

Women develop gallstones more commonly than men and at a younger age, and there is frequently a family history of the disease.

Other factors that increase the risk of developing gallstones include:

• Being overweight or obese – particularly when the extra weight is carried around the waist
• Eating a high-fat, low-fibre diet
• Having diabetes
• Having high blood cholesterol levels
• Heavy drinking
• Smoking.

As pregnancy and contraceptive pills can slow down gallbladder activity, women who have had multiple pregnancies or long-term contraceptive pill use are at higher risk of developing gallstones.

Signs and symptoms

Gallstones vary greatly in size. Some people may form one large stone, whereas others may have hundreds of tiny stones. Most commonly, gallstones are 5–10 mm in diameter.

Most people with gallstones do not experience any symptoms. If symptoms are present, the most common early sign of gallstones is upper abdominal pain. This pain usually occurs in the upper right side of the abdomen, is often sudden and severe, and may radiate to the chest, back, or the area between the shoulders. Other symptoms that may occur include:

• Indigestion 
• Nausea or vomiting
• Jaundice (the yellow appearance of skin and the whites of eyes caused by bilirubin build-up in the blood) when gallstones block the passage of bile
• Light-coloured stools.

The abdominal pain associated with gallstones is referred to as biliary colic. This type of pain is commonly set off by eating fatty foods and often occurs in the middle of the night. The symptoms experienced may be so severe that people need to seek immediate medical attention.

When infection of the gallbladder is present it is possible to also experience low-grade fever, sweats, and chills.

Diagnosis

If gallstones are suspected, it is important to consult a doctor for an accurate diagnosis and treatment. The doctor will look for signs of jaundice and will assess the abdomen for swelling and pain. Blood tests are usually performed to check the function of the liver and pancreas and to rule out other conditions that may be causing the symptoms. 

The most common test used to definitively diagnose gallstones is an abdominal ultrasound scan to create pictures of the gallbladder, which are then analysed to look for signs of gallstones.

An endoscopic ultrasound (EUS) is a procedure that can help identify smaller stones that may be missed by an abdominal ultrasound. A thin, flexible tube (endoscope) is passed through the mouth and into the digestive tract, to provide a precise image of the gallbladder and nearby tissues.

If it is suspected that gallstones are blocking the ducts, then a test called endoscopic retrograde cholangiopancreatography (ERCP) may be performed. This test involves inserting an endoscope with a light and camera at its tip through the mouth into the digestive tract. A special dye is injected through the endoscope into the bile ducts allowing the outline of the ducts to be highlighted. Gallstones found in the ducts can sometimes be removed during the ERCP procedure.

Other specialised scans or x-rays are sometimes used to confirm the diagnosis and highlight the location of the gallstones.

Treatment

In general, treatment will depend on the frequency and severity of the symptoms experienced. Because it is possible that people who experience biliary colic will not experience a further episode, your doctor may advise a wait and see approach.

If attacks are occasional and mild, they may be able to be managed with pain-relieving medications, applying heat to the affected area, resting and taking sips of water. Reducing the amount of fat in your diet and maintaining a healthy body weight may also be beneficial. If attacks are frequent or severe surgery is usually recommended.

Surgery

Cholecystectomy is the surgical removal of the gallbladder and is a common and routine procedure. It may be recommended when the symptoms of gallstones are problematic. If there is infection or acute inflammation of the gallbladder, this may need to be treated with antibiotics before the gallbladder can be removed.

The gallbladder is not essential to live or to digest food. When the gallbladder is removed, bile is still produced by the liver and flows directly into the small intestine.

The two cholecystectomy techniques are:

Open cholecystectomy

This is the “traditional” but now-a-days less common surgical technique for removing the gallbladder and is performed under a general anaesthetic. A single incision is made below the rib cage. Through the incision, the surgeon can view the area and remove the gallbladder.  

Laparoscopic cholecystectomy

Laparoscopic cholecystectomy is also performed under general anaesthetic but is less invasive and much more commonly used than the open cholecystectomy technique. It has a faster recovery time and a shorter hospital stay (usually just one night). A telescope-like instrument (a laparoscope) is inserted through one incision (allowing the surgeon to view the inside of the abdominal cavity on a television monitor) and surgical instruments are inserted through other incisions. The gallbladder is located and removed through an incision in the belly button.

Surgery risks and complications

As with any surgery, there are possible risks and complications which you should discuss with your doctor before surgery. These include:

• Anaesthetic complications
• Bleeding
• Wound infection
• Injury to or leakage from the bile duct
• Discomfort or numbness around the area of incision
• Jaundice.

Medication

For small gallstones that don’t contain calcium, it may be possible to dissolve them by taking ursodeoxycholic acid tablets. However, ursodeoxycholic acid tablets are not often recommended because they are not always effective, need to be taken for a long time (up to 2 years), and gallstones are likely to form again once treatment is stopped. They are usually used for people who are unable to undergo surgery. Occasionally, they may be used to prevent gallstones in people at high risk of developing them.

References

Chapman, B.A., et al. (2003). Gallstone prevalence in Christchurch: risk factors and clinical significance. N Z Med J. 2000;113(1104):46–8. 
Mayo Clinic (2019). Gallstones (Web Page). Rochester, MN: Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/gallstones/symptoms-causes/syc-20354214 [Accessed: 23/08/19]
NHS (2015). Gallstones (Web Page). Redditch: National Health Service (NHS) 
England. https://www.nhs.uk/conditions/gallstones/ [Accessed: 23/08/19]
O’Toole, M.T. (Ed.) (2017). Cholelithiasis. Mosby’s Dictionary of Medicine, Nursing & Health Professions (10th ed.). St Louis: Elsevier. 
O’Toole, M.T. (Ed.) (2017). Choledocholithiasis. Mosby’s Dictionary of Medicine, Nursing & Health Professions (10th ed.). St Louis: Elsevier. 
Stringer, M.D., et al. (2013). Gallstones in New Zealand: composition, risk factors and ethnic differences. ANZ J Surg. 2013 Jul;83(7-8):575–80.

Last Reviewed – September 2019

4 Things You Should Know About Gallstones

Do you have severe abdominal pain? You could have gallstones. Learn more about the signs and symptoms.

Tucked beneath your liver, the gallbladder is a seemingly inconsequential organ that stores bile from your liver. When this bile passes to your small intestine, it helps digest fatty foods. However, when gallstones occur, the pain can be debilitating.

1. What are gallstones and their symptoms?

Gallstones form, when small bits of crystalized bile clump together. These stones can be as small as a grain of salt or as large as an egg. When they stay put in the gallbladder, these “silent” gallstones go unnoticed and do not require treatment. When they try to pass through the tiny bile duct to the small intestine, inflammation and severe pain set in. Lasting from a few minutes to a few hours, the pain can feel like indigestion or similar to a feeling of fullness.

Additional symptoms include:

• Severe abdominal pain, with no relief from pain relievers
• Pain that worsens after eating a meal, particularly foods high in fat
• Chest pain
• Excessive gas and heartburn
• Tenderness in the abdomen, especially on the upper right side
• Jaundice
• Nausea
• Pancreatitis

 “While pain can be a symptom of gallstones, it’s important to know that they often manifest as more of a vague discomfort rather than pain,” says Hector C. Ramos, MD, clinical professor of surgery (clinician educator) at the Keck School of Medicine of USC. “They’re most often found when a primary care doctor does an ultrasound, because a patient comes in with what they believe to be indigestion or abdominal distress.”

2. Who is at risk for gallstones?

Gallstones have become increasingly common, and all age groups can be affected.

Factors that contribute to gallstones include:

• Obesity
• An increase in estrogen, from pregnancy or hormone therapy
• A diet high in fat and refined carbohydrates, and a decrease in fiber

A family history of gallstones, as well as multiple pregnancies, can increase risk. Likewise, there is a higher percentage in older people; about 25% of women age 60 or older will develop them.

3. How are gallstones treated?

An X-ray, CT scan or ultrasound will confirm whether you have gallstones. If you don’t have any symptoms, most likely you’ll simply live with them, until you do. After treating your gallstones, changing to a vegetarian diet or one that includes preventative factors, like polyunsaturated fat, monounsaturated fat, fiber and caffeine is suggested.

“A vegetarian diet will prevent gallstones,” says Ramos. “However, if you have already been diagnosed with gallstones, it’s best not to change suddenly to a strict vegetarian diet. The rapid shift from the gallbladder being very active and frequently digesting fats to not being used at all can aggravate your condition and produce more gallstones. Crash-diet plans that cause a rapid loss of a great deal of weight can also produce or aggravate gallstones. If you’re considering weight management surgery, talk to your surgeon about the potential for gallstones.”

If your doctor decides to remove your gallbladder, a cholecystectomy might be suggested. For this procedure, a surgical incision is made, and then the gallbladder is removed by laparoscopic surgery. Most patients experience a quick recovery with little pain and discomfort.

“Not all gallstones need to be surgically removed,” says Ramos, who is also a hepatobiliary and pancreatic surgeon at USC Surgery at Keck Medicine of USC. “Sometimes a physician will find gallstones, when doing a procedure for kidney stones, for example. If they aren’t causing you symptoms, the gallbladder may not need to be removed. But if you have persistent pain, surgery is the best option. Patients who are immunosuppressed are also advised to get surgery, as gallstones can lead to a potentially fatal infection.”

4. Are there complications with gallstones?

Even if you aren’t in pain from your gallstones, they may still present a health risk. Jaundice, where your skin itches and appears yellow, is one side effect. Another is acute cholecystitis, where the stone blocks the cystic duct, preventing the gallbladder from emptying bile into the bile duct. Nausea, vomiting and severe pain are usually present. In the most serious cases, patients may develop acute pancreatitis, also treated with surgery. Usually, patients return to normal lives, after having their gallbladder removed.

“The best way to prevent gallstones is to eat a moderate diet that is low in fat and simple carbohydrates, such as sugar and refined flour,” says Ramos. “Obesity is associated with gallstones, so do your best to keep your weight in a healthy range. The best prevention is a moderate, balanced diet that is low in fat. Get your carbohydrates from fresh, whole fruits and vegetables. You should also drink lots of water to keep your bile fluid.”

by Anne Fritz

Unsure whether your symptoms are gallstones or something else? If you are in the Los Angeles area, consult with the experts at USC Surgery at Keck Medicine of USC. Call (800) USC-CARE (800-872-2273) or make an appointment.

Gallstones – Diagnosis and Treatment

Gallstones are solid build-ups of crystallized bile, which is produced by the liver, stored in the gallbladder and secreted into the bowel through the bile ducts to help digest fats. Some gallstones do not produce symptoms. However, they can cause a blockage within the bile duct or gallbladder which may result in pain and inflammation, a condition called cholecystitis.

Your doctor may use abdominal CT, magnetic resonance cholangiopancreatography (MRCP), or abdominal ultrasound to help diagnose your condition. Treatment may not be necessary if you do not have symptoms. If, however, you are diagnosed with cholecystitis, your doctor may prescribe antibiotics and surgical removal of the gallbladder. If a gallstone has blocked a bile duct, your doctor may prescribe biliary interventions such as endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) to locate and/or remove the blockage.

What are gallstones?

Gallstones are solid particles that develop in the gallbladder. Stones are formed from the crystallization of bile, a fluid made by the liver and secreted into the bowel through the bile ducts to help digest fats.

Some gallstones do not produce noticeable symptoms. However, if a gallstone causes blockage of the gallbladder or the bile duct, it can cause inflammation and pain in the right upper abdomen, upper right shoulder or between the shoulder blades, lasting from a few minutes to several hours. Other symptoms include nausea and vomiting, fever, and chills. Inflammation of the gallbladder is called cholecystitis.

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How are gallstones diagnosed and evaluated?

Imaging is used to provide your doctor with valuable information about gallstones, such as location, size and effect on organ function. Some types of imaging that your doctor may order include:

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How are gallstones treated?

Treatment of gallstones may not be necessary if you do not have symptoms. However, if you have cholecystitis, or if you are having symptoms related to gallstones, the standard treatment is intravenous antibiotics and surgical removal of the gallbladder (cholecystectomy). In most cases, your surgeon will perform a cholecystectomy laparoscopically (with endoscopes placed through small incisions in your abdomen).

If the gallstones have also caused blockage of the biliary ducts, other procedures may be performed, including:

• Endoscopic retrograde cholangiopancreatography (ERCP): ERCP is used to examine the bile ducts using an endoscope, a flexible tube that is passed from the mouth through the stomach and into the duodenum. Iodinated contrast material is injected into the bile ducts to locate gallstones that may be causing blockage. Some stones may be successfully removed during ERCP.
• Percutaneous transhepatic cholangiography (PTC): PTC is performed by making a small incision on the skin, and advancing a needle into the bile ducts. Iodinated contrast material is injected into the bile ducts to locate gallstones that may be causing blockage. Some stones can be removed during a PTC and others may be bypassed by leaving a catheter or small thin tube in place.

If your doctor decides that you are too sick to undergo surgery, there are other procedures that may be done until surgery can be performed.

• Cholecystostomy tube placement: A cholecystostomy tube is a small plastic tube (catheter) placed into your gallbladder through a small incision in the skin. The aim of this procedure is to decompress the distended, blocked and inflamed gallbladder by emptying out the backed up, under pressure bile in your gallbladder and diverting it outside the body into a bag attached to the tube. This allows decrease in pain and inflammation in the gallbladder and allows time for the antibiotics to work and for the surgery to be performed at a later date. However, it does not treat the underlying cause (the stones).

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This page was reviewed on January, 21, 2020

“GALLSTONES” might be more severe if it is left untreated!

Gallstones are one of the most common digestive diseases which small stones are formed in the gallbladder. If gallstones lodge in a bile duct and cause a blockage, it eventually results in severe life-threatening complications such as bile duct inflammation and infection, pancreatitis or cholecystitis (an inflammation of gallbladder). In addition, if left untreated, it might increase risk of “gallbladder cancer”. Statistical data reviews that gallstones have been commonly found in women rather than men, age between 30-50. Since signs and symptoms are quite similar, patients with gallstones often misunderstand that they might have “peptic ulcer”. Self-treatment by taking antacid and anti-ulcer medications without having an accurate diagnosis results in an increased severity, frequently presented with emergency conditions that require immediate treatments. Knowing the early signs of gallstones must be aware in order to get the disease diagnosed in due time and receive appropriate medical treatment.

Function of Gallbladder

Gallbladder is a small, pear-shaped, hollow structure located under the liver on the right side of the abdomen. The gallbladder stores and concentrate a digestive fluid called “bile” which is a yellowish-brown fluid used to break up and digest fatty foods in the small intestine. 

Get to Know “Gallstones”

Gallstones (or cholelithiasis) are responsible for one of the most prevalent biliary disorders. Gallstones are hardened deposits of digestive fluid (bile) that can form in the gallbladder. The stones are mainly caused from the precipitation of either calcium salts or cholesterol in bile.The appearance of gallstones may vary depending on their types. Classification by compositions, there are 3 main types of gallstones: 

Cholesterol gallstones: 

The most common type of gallstone is called “cholesterol gallstones”, often appearing in chalk white or greenish-yellow due to undissolved cholesterol as the main component. 

Pigment gallstones: 

Pigment gallstones are dark brown or black stones containing bilirubin. Major causes might originate from the abnormalities of blood such as hemolytic anemia and liver diseases such as jaundice and cirrhosis. 

Mixed gallstones: 

Mixed gallstones are the mixture of both cholesterol and pigment gallstones with a sticky mud-like appearance. They typically arise secondary to the infection of the biliary tract, liver and pancreas.

​

Signs and Symptoms of Gallstones:

Gallstones range in size from as small as a grain of sand to the size of a golf ball. The size of stones may increase with time. There might be only a single stone or up to several hundreds of stones at the same time. The risk to develop gallbladder cancer is strongly associated with a larger size of gallstones. 

Gallstones may cause no signs or symptoms. However, if a gallstone lodges in a duct and causes a blockage, the consequent signs and symptoms may include:

• Flatulence
• Bloating or having chronic digestive problems after consuming high-fat diets
• Severe and sudden pain in the upper right abdomen.
• Pain that radiates to right shoulder or back (between shoulder blades)
• Nausea and vomitting (mainly from cholecystitis or inflammation of gallbladder)
• High fever and chills
• Jaundice, dark urine or pale stool (if there is an obstruction in bile duct, affecting the draining of biliary system)

Risks Factors of Gallstones 

• Being female age 40 or older
• Being the elderly over 60
• Obesity and overweight 
• Hypercholesterolemia (high level of blood cholesterol)
• Diabetes 
• Hematologic disorders such as anemia and thalassemia
• Being pregnant or having had several children
• Taking medications that contain estrogen such as oral contraceptives or hormone replacement therapy
• Losing weight very quickly or having fasting period (e.g. Ramadan)
• Taking some lipid lowering drugs  (some side effects on bile composition and cholesterol gallstone formation)
• Having a family history of gallstones

Diagnosis of Gallstones

Combined with physical and full abdominal examinations, diagnosis of gallstones is typically confirmed by an upper abdominal ultrasound, a radiological imaging test which is performed by gastrointestinal specialists. By using the high-frequency sound waves to create the images of the inside of abdomen, the images created from ultrasound scan clearly reveal the detail of gallstones. However, MRI scan (magnetic resonance imaging) might be additionally recommended if some stones remain invisible. Gallstone complications may be further detected by blood tests.

​

Treatment of Gallstones

If the patient is an appropriate candidate for surgery, surgical  removal of gallbladder is mostly advised to all cases in order to  reduce disease severity and recurrence of stones which is very  common. There are 2 types of gallbladder surgery:

• Open surgery (open cholecystectomy): a surgery to remove the gallbladder via a single, large open incision (5- to 7-inch) in the abdomen. Open surgery might be indicated if severe inflammation of bile duct or gallbladder is presented which might lead to the ruptures of gallbladder. Due to the size of incision, patients usually experience more pain and need a longer recovery time.
• Laparoscopic surgery (laparoscopic cholecystectomy or LC): a minimally invasive surgery to remove gallbladder which is performed through 4-5 small incisions (each one inch or less in length) instead of making an open large cut in the abdomen. The surgical instruments are inserted via these small incisions such as a laparoscope, a narrow tube with a camera. This allows surgeons to clearly visualize all dimensions of gallbladder on a screen before having it removed accurately and safely. 

With laparoscopic cholecystectomy, smaller incisions cause less pain after surgery with fewer complications such as less blood loss and lower rates of post-operative infections. Cosmetic benefits gained from laparoscopic surgery is additionally superior to the open procedure. Furthermore, surgery to remove the gallbladder with a laparoscope does not require the muscles of abdomen to be cut whereas open surgery does. Patients thus have a faster recovery time and shorter of hospital stay resulting in a quick return to daily activities.

After gallbladder removal surgery, patients do not have to be concerned about their digestive functions since gallbladder only holds bile acid and it is not essential to healthy digestion. However, to enhance the digestive health and avoid abdominal bloating, the consumption of high fat diets must be controlled with the proper amount of vegetables, fruits and easy-to-digest foods such as fish. 

“Gallstones … Watch Out! If you are a woman over 40+”

Amazingly, cholesterol gallstones have been commonly found in women above 40 mainly owning to elevated estrogen levels, resulting in increased hepatic secretion of biliary cholesterol and cholesterol supersaturated bile. Other risk factors include hypercholesterolemia (high level of blood cholesterol), taking medications that contain estrogen such as oral contraceptives or hormone replacement therapy, having had several children, being diabetic or being diagnosed with thalassemia. 

Prevention of Gallstones

The most effective way to reduce risk of “gallstones” is to remain healthy including weight reduction if obese, avoiding the consumption of fatty diets with high calories, taking high-fiber containing foods such as vegetables and fruits. Hypercholesterolemia (high level of blood cholesterol) and diabetics must be strictly well controlled. More importantly, having  a regular health checkup every year helps to early screen gallstones before its symptom arises. If any suspected signs and symptoms of gallstones are manifested, a full physical examination and upper abdominal ultrasound scan are immediately recommended. 

If gallstones remain negligently untreated, it might lead to life-threatening conditions such as cholecystitis and sepsis. Moreover, it might potentially trigger the risk to develop “gallbladder cancer” in the future.

Reference: Dr. Komdej Thanavachirasin, Laparoscopic and Endoscopic Surgeon, Bangkok Hospital.

For more information:
Laparoscopic Surgery Center, Bangkok Hospital

1^st floor, D Building, Bangkok Hospital

Call 0 2310 3000 or 1719

Email: [email protected]

What’s the Difference Between Gallbladder and Kidney Stones?: Stone Relief Center: Kidney Stone Specialists

Gallstones and kidney stones — they sound similar, and they’re often easily confused. They’re both called stones, but the truth is that they are two very different conditions.

Gallstones and kidney stones differ in location, causes, symptoms, and treatment. But they do have one thing in common: abdominal pain. If you’re suffering sharp, intense pain in your abdomen, it’s crucial to know the difference between the two.

At Stone Relief Center, W. Cooper Buschemeyer, III, MD, and our team specialize in treating kidney stones. We offer the latest in kidney stone treatments and pain management to give you relief, fast.

Understanding gallstones

Your gallbladder is a small organ located on the right side of your abdomen below your liver. Its job is to hold bile, a digestive fluid, and release it into your small intestine.

Sometimes, fluids inside your gallbladder harden into deposits called gallstones. Gallstones can be caused by cholesterol buildup or high levels of bilirubin in bile. They range in size, with some growing as large as golf balls. 

About 10-15% of Americans have gallstones at some point in their lives. Gallstones don’t always cause symptoms, but when they do, symptoms can include:

• Sudden, intense pain in the upper right or center of the abdomen
• Back pain between shoulder blades
• Pain in the right shoulder
• Nausea or vomiting

Gallstones are more common in women than in men. Gallstones that cause painful symptoms don’t go away independently, and the most common treatment is gallbladder removal surgery.

Recognizing kidney stones

You have two kidneys. They’re located on either side of your spine, just below your ribcage. Your kidneys filter waste from your blood, and that waste becomes urine.

Kidney stones form when your kidneys collect higher-than-normal levels of certain minerals, salts, and other substances. The most common types of kidney stones are made from calcium, oxalate, and phosphate. 

Unlike gallstones, kidney stones are more common in men than women. An estimated 19% of men will experience kidney stones in their lifetime, compared to about 9% of women.

Kidney stones generally don’t cause symptoms when they form. But when they move inside your kidneys or move into your ureter, it’s often painful. 

Symptoms of kidney stones include:

• Sharp pain in your side or back, below the ribcage
• Radiating pain in lower abdomen or groin
• Bloody or cloudy urine
• Pain with urination
• Nausea or vomiting

Because the kidneys are connected to your bladder and your urethra through your urinary system, kidney stones can exit your body on their own — unlike gallstones. However, kidney stones can be excruciating, and large ones may not pass on their own.

Treating kidney stones

At Stone Relief Center, Dr. Buschemeyer and our team are experts in treating kidney stones. We use extensive diagnostic testing to evaluate kidney stones and develop an effective treatment plan.

Even small kidney stones can take several weeks to pass naturally. We can recommend at-home care, such as drinking plenty of water and managing discomfort with over-the-counter pain relievers. There are also medications available that can speed up the stone’s movement through your urinary tract.

Large kidney stones may require more advanced treatment to pass. We offer various non-invasive kidney stone treatments like extracorporeal shock wave lithotripsy (ESWL) and minimally invasive surgery, including ureteroscopy, to treat large stones and stop your discomfort.

Find relief from your pain at Stone Relief Center. Call us at 281-674-8021, request an appointment online, or send our team a message today.

Gallstones | HealthLink BC

Topic Overview

What are the gallbladder and gallstones?

The gallbladder is a small sac found just under the liver. It stores bile made by the liver. Bile helps you digest fats. Bile moves from the gallbladder to the small intestine through tubes called the cystic duct and common bile duct.

Gallstones are made from cholesterol and other things found in the bile. They can be smaller than a grain of sand or as large as a golf ball.

Most gallstones do not cause problems. But if they block a duct, they usually need treatment.

What causes gallstones?

Gallstones form when cholesterol and other things found in bile make stones. They can also form if the gallbladder does not empty as it should. People who are overweight or who are trying to lose weight quickly are more likely to get gallstones.

What are the symptoms?

Most people who have gallstones do not have symptoms.

If you have symptoms, you may have pain in the pit of your stomach or in the upper right part of your belly. Pain may spread to your right upper back or shoulder blade area. Sometimes the pain is more severe. It may be steady, or it may come and go. Or it may get worse when you eat.

When gallstones keep blocking a bile duct, you may have pain with fever and chills. Or your skin or the whites of your eyes may turn yellow. Call your doctor right away. Having stones in your bile duct increases your chance of having a swollen pancreas (pancreatitis). These symptoms may also be a sign of an infected gallbladder.

Call your doctor right away if you have sudden or bad pain in your belly or chest and you are not sure what is causing it. Symptoms of gallstones may feel like chest pain caused by a heart attack or other serious problems.

How are gallstones diagnosed?

You may decide to go to the doctor because of pain in your belly. In this case, your doctor will ask you questions about when the pain started, where it is, and if it comes and goes or is always there. Your doctor may order imaging tests. These take pictures of the inside of your body. An ultrasound of the belly is the best test to find gallstones. This test does not hurt.

Your ultrasound may not show gallstones. But if your doctor still thinks you have a problem with your gallbladder, he or she may order a gallbladder scan. In this test, a doctor injects dye into a vein in your arm. Then a machine takes X-rays as the dye moves through your liver, bile duct, gallbladder, and intestine.

Most people have gallstones but don’t know it because they do not have symptoms. Gallstones may be found when you have tests for other health problems or when a woman has an ultrasound during pregnancy.

How are they treated?

If you do not have symptoms, you probably do not need treatment.

If your first gallstone attack causes pain, your doctor may tell you to take pain medicine and wait to see if the pain goes away. You may never have another attack. Waiting to see what happens usually will not cause problems.

If you have a bad attack, or if you have a second attack, you may want to have your gallbladder removed. A second attack means you are more likely to have future attacks.

Many people have their gallbladders removed, and the surgery usually goes well. Doctors most often use laparoscopic surgery. For this, your surgeon will make small cuts in your belly and remove your gallbladder. You will probably be able to go back to work or your normal routine in a week or two, but it may take longer for some people. Sometimes the surgeon will have to make a larger cut to remove the gallbladder. It will take longer for you to recover from this type of surgery.

Do you need your gallbladder?

Your body will work fine without a gallbladder. Bile will flow straight from the liver to the intestine. There may be small changes in how you digest food, but you probably will not notice them.

Cause

Gallstones develop when cholesterol and other substances in the bile form crystals that become hard stones in the gallbladder. The gallbladder is a small sac located just under the liver. Gallstones can occur when your gallbladder does not empty properly or if you have too much cholesterol in your bile. Too much cholesterol in your bile is not caused by eating too much cholesterol or having high cholesterol (in the blood).

Most doctors believe that even microscopic gallstones in the gallbladder can cause symptoms. These tiny stones can form a type of sediment called biliary sludge that often can be seen on an abdominal ultrasound. For more information on an abdominal ultrasound, see the Examinations and Tests section of this topic.

Symptoms

The most common symptom of gallstones is pain in the stomach area or in the upper right part of the belly, under the ribs.

The pain may:

• Start suddenly in the centre of the upper belly (epigastric area) and spread to the right upper back or shoulder blade area. It is usually hard to get comfortable. Moving around does not make the pain go away.
• Prevent you from taking normal or deep breaths.
• Last 15 minutes to 24 hours. Continuous pain for 1 to 5 hours is common.
• Begin at night and be severe enough to wake you.
• Occur after meals.

Gallstone pain can cause vomiting, which may relieve some of the belly (abdominal) pain and pressure. Pain that occurs with a fever, nausea, and vomiting or loss of appetite may be a sign of inflammation or infection of the gallbladder (acute cholecystitis). Symptoms that may mean that a gallstone is blocking the common bile duct include:

• Yellowing of the skin and the white part of the eyes (jaundice).
• Dark urine.
• Light-coloured stools.
• A fever and chills.

There are many other conditions that cause similar symptoms, including heartburn, pain caused by a heart attack, and liver problems. Stomach flu (gastroenteritis) and food poisoning also can cause symptoms similar to gallstones. Diarrhea and vomiting occur with the flu and foodborne illness, but the pain tends to come and go rather than be constant. Also, pain with these conditions may be felt all over the belly, rather than in one spot.

Belly pain that comes and goes (rather than being constant) and that occurs with nausea and vomiting and possibly a mild fever is more likely to be caused by stomach flu or foodborne illness than by gallstones. This is especially true if others around you are sick with similar symptoms.

What Happens

The progression of gallstones depends on whether you have symptoms. Most people with gallstones have no symptoms and do not need treatment. Those who do have symptoms often have surgery to remove the gallbladder.

Gallstones that do not cause symptoms

Most people who have gallstones never have symptoms. Most people with gallstones that do not cause symptoms remain free of symptoms.

Gallstones that cause symptoms

The most common problem caused by gallstones occurs when a gallstone periodically blocks the cystic duct, which drains the gallbladder. It often causes bouts of pain that come and go as the gallbladder contracts and expands. The bouts of pain are usually severe and steady, lasting from 15 minutes to up to 6 hours. And the pain may get worse after a meal. Symptoms usually improve within a few days.

If this is your first attack of gallbladder symptoms, your best option may be to see whether the pain goes away without surgery. But if the pain is severe or if you have had gallbladder pain before, you may need to have your gallbladder removed.

Depending on where a stone blocks the flow of bile, symptoms can include nausea, vomiting, fever, and severe abdominal pain that lasts longer than 6 hours. If you have these symptoms, you may need surgery to remove your gallbladder or the gallstone causing the blockage.

In rare cases, gallstones can cause pancreatitis, an inflammation of the pancreas. Gallstones back up the flow of digestive enzymes made by the pancreas. Pancreatitis may cause sudden, severe abdominal pain, loss of appetite, nausea and vomiting, and fever.

Do you need surgery or other treatment for your gallstones?

The first attack of gallstone symptoms is often not severe. Serious complications (such as a blocked duct) rarely occur. So you and your doctor may decide to delay treatment to see whether symptoms go away on their own. This is especially true if your doctor is not sure that the symptoms were caused by gallstones. Sometimes surgery for gallstone problems is needed right away. But in most cases, it appears safe to delay treatment until you have a second episode of pain. If you have two attacks, you are likely to have more attacks in the future. In that case, surgery to remove the gallbladder is usually the best option.

People who have gallstone symptoms are at higher risk of having future pain and problems than those who do not have symptoms. It is not possible to predict how often the pain may come back or how severe it might be. Many people who decide not to have treatment do not have future problems. About 1 out of 3 people with a single attack of pain has no other episode of pain.^{footnote 1}

What Increases Your Risk

Your chances of forming gallstones that can cause symptoms are higher if you:

• Are female. Females are twice as likely as males to have gallstones.
• Are older than 55.
• Are Indigenous or Hispanic.
• Have a family history of gallstones.

You may also be increasing your risk for gallstones if you:

• Are overweight.
• Lose weight rapidly or lose weight by dieting and then gain weight back again.
• Are pregnant.
• Are taking estrogen (after menopause) or high-dose birth control pills.
• Get very little or no exercise.
• Do not eat for a period of time (fast).

When should you call your doctor?

Abdominal pain can be a sign of a serious or even life-threatening condition, especially if you have a heart condition or are older than 60. If you are having sudden or severe pain and are not sure what is causing it, you may need immediate medical treatment. You should be especially concerned if you are having trouble breathing or you faint or lose consciousness. For more information, see the topic Abdominal Pain, Age 12 and Older. For more information on abdominal pain in children, see the topic Abdominal Pain, Age 11 and Younger.

Call your doctor immediately if you have:

• Pain that may be caused by gallstones (continuous moderate to severe pain in the upper right abdomen) along with a fever of 38°C (100.4°F) or higher and chills that are clearly not caused by stomach flu or any other reason.
• Pain in the upper midsection or upper right abdomen, along with a yellow tint to your skin and the white part of your eyes, dark yellow-brown urine, or light-coloured stools.
• Diabetes or an impaired immune system and you have symptoms that may be caused by gallstones.

If you have symptoms of gallstones but no fever, chills, or yellowing of your skin or the white part of your eyes, you may still require evaluation and treatment. Schedule an appointment with your doctor.

Watchful waiting

Watchful waiting is a period of time during which you and your doctor watch your symptoms or condition to see whether you need treatment. Watchful waiting is often the first approach to a first attack of gallstone pain.

Who to see

Your family doctor or general practitioner can evaluate symptoms caused by gallstones. You may be referred to a specialist:

Examinations and Tests

Gallstones may be found during tests that evaluate abdominal pain or during tests for another condition, such as an ultrasound test during pregnancy. The doctor will ask questions about your medical history and your symptoms. And he or she will do a physical examination. Although your medical history and physical examination may suggest that you have gallstones, other tests can confirm the diagnosis.

Tests for gallstones

• Abdominal ultrasound
  . An abdominal ultrasound is the best test to confirm gallstones. In this test, a technologist moves a wand across your belly to create pictures on a video monitor. This test may reveal other problems with the gallbladder or bile ducts. An ultrasound image of a gallstone often is the only test needed to find and evaluate gallstones.

• Gallbladder scan
  . If your gallbladder looks normal on an abdominal ultrasound, but your doctor still thinks that you may have a problem, your doctor may request a gallbladder scan. In this test, a doctor injects a special radioactive dye into a vein in your arm and takes pictures to see whether the gallbladder is working normally. This test can also reveal other problems, such as blocked bile ducts (bile ducts are tubes attached to your gallbladder).

• Endoscopic retrograde cholangiopancreatogram (ERCP)
  . This test is used if your doctor thinks that you may have a gallstone in one of the ducts that connect your liver with your gallbladder, pancreas, and small intestine. In an ERCP, a doctor gently moves a flexible, lighted viewing instrument called an endoscope down the throat and through your stomach to examine the tubes that drain your liver, gallbladder, and pancreas. If a gallstone is blocking your common bile duct, the doctor can sometimes remove the stone with instruments inserted through the endoscope.

Blood tests

Blood tests. Tests such as a complete blood count and tests for liver function and pancreatitis can help a doctor evaluate symptoms of abdominal pain that may be caused by gallstones. The tests may be able to detect whether your symptoms are being caused by a condition other than gallstones.

Other tests

• Endoscopic ultrasound (EUS). This test can be used to see gallstones in the common bile duct. A doctor gently moves a thin, flexible, lighted viewing instrument (endoscope) with an ultrasound probe down the throat and through your stomach to examine the tubes that drain the liver, gallbladder, and pancreas.

• Magnetic resonance cholangiogram (MRC)
  . This test uses a magnetic field and pulses of radio wave energy (MRI) to provide pictures of organs and structures inside the belly. Doctors can use an MRC to locate gallstones before surgery to remove the gallbladder or to detect problems with the bile duct or gallbladder.

Treatment Overview

If gallstones don’t cause pain or other symptoms, you most likely will not need treatment. In rare cases, doctors may advise surgery for gallstones that don’t cause symptoms.

If gallstones do cause symptoms, you and your doctor may decide that your best choice is to see whether symptoms go away on their own (watchful waiting). It is usually safe to wait until you have had another attack before you consider having surgery. Watchful waiting may be the best choice if:

• This is your first episode of gallstone pain.
• Gallstone pain is mild. If your gallstones cause severe pain, surgery may be considered to prevent future attacks and possible complications.
• You do not have complications, such as a blocked duct.
• You are not at high risk for future problems.

If you need treatment for gallstones, in most cases the best treatment is surgery to remove the gallbladder (cholecystectomy). In many cases, laparoscopic surgery is the best method to remove the gallbladder. Open surgery requires a longer recovery period and causes more pain because it creates a larger incision.

Your doctor can help you assess the severity of your gallstone attacks and can help you decide whether you should have surgery or other treatment.

Prevention

There is no sure way to prevent gallstones. But you can reduce your risk of forming gallstones that can cause symptoms.

Maintain a healthy weight

Stay close to a healthy weight. If you need to lose weight, do so slowly and sensibly. When you lose weight by dieting and then you gain weight back again, you increase your risk for gallstones, especially if you are a woman. If you diet, aim for a weight loss of only 0.5 kg (1 lb) to 0.7 kg (1.5 lb) a week. For more information, see the topic Weight Management.

Eat regular, balanced meals

Try not to skip meals. Eat on a regular schedule. And eat meals that contain some fat (which causes the gallbladder to empty). This can help prevent gallstones. Eat plenty of whole grains and fibre. And be sure to often have servings of foods that contain calcium (milk products and green, leafy vegetables). Limit saturated (animal) fat and foods high in cholesterol.

Exercise regularly

If you exercise more, you may be able to reduce your risk for gallstones. Along with eating a healthy diet, exercise is an effective way to help you stay close to a healthy weight and lower your cholesterol and triglyceride levels.

Deciding whether to take estrogen

Some evidence shows that taking hormones such as estrogen after menopause or taking high-dose birth control pills may increase a woman’s risk of gallstones that cause symptoms. If you are taking such hormones, talk with your doctor.

Home Treatment

There is no specific home treatment for gallstones, but be sure to call your doctor if:

• You think you have symptoms that may be caused by gallstones. If your doctor finds that you do have gallstones but your symptoms are mild, it is generally safe to wait until you have more than one attack before you consider having surgery.
• You develop symptoms of a gallstone attack again, especially if they are severe or occur with fever, chills, or yellowing of your skin or the white part of your eyes.
• You have new belly pain or other belly symptoms. Pain in the belly can be a symptom of many health problems.

You may be able to help prevent gallstones if:

• You stay close to a healthy weight by eating a balanced diet and getting regular exercise.
• You avoid rapid weight loss. Intentional weight loss (dieting, as opposed to weight loss from illness) followed by weight gain may increase your risk of gallstones, especially if you are a woman. If you need to lose weight, do so slowly and sensibly.

If you have recently had surgery to remove your gallbladder:

• Watch for signs of infection. Call your doctor if the area around the incision is red and puffy or if you have a fever.
• Call your doctor if you have yellowing of the skin or the white part of the eyes (jaundice), light-coloured stools, and dark urine. These symptoms may be signs that gallstones are blocking the common bile duct.

Medications

Medicines are rarely used to treat gallstones.

Medicine choices

Bile acids can be used to dissolve gallstones. They usually are reserved for people who have symptoms of gallstones and for whom surgery would be risky.

What to think about

Gallstones often come back when treatment with bile acids is stopped. Over time, gallstones return in about half of those who stop taking the medicine.^{footnote 2}

This form of treatment works better on small gallstones than on large ones. It does not work on calcified gallstones. Tests such as an abdominal X-ray may be used to find out whether gallstones contain calcium.

Surgery

Surgery to remove the gallbladder (cholecystectomy) is the treatment of choice for gallstones that cause moderate to severe pain or other symptoms. Symptoms usually do not return after the gallbladder has been removed. In a small number of cases, surgery may be done to prevent complications of gallstones.

Laparoscopic surgery is often the best method to remove the gallbladder. Open gallbladder surgery requires a longer recovery period and causes more pain.

Surgery may be done for:

Surgery choices

Laparoscopic gallbladder surgery is the most common surgery done to remove the gallbladder. In this type of surgery, a doctor inserts a lighted viewing instrument called a laparoscope and surgical tools into your abdomen through several small cuts (incisions). This type of surgery is very safe, and people who have it usually recover enough in about one week to go back to work or to their normal routines.

Open gallbladder surgery involves one larger incision through which the gallbladder is removed. It may be done if laparoscopic surgery is not an option or when complications are found during laparoscopic surgery. Most open surgeries occur after trying to do a laparoscopic cholecystectomy. Open surgery also may be the best choice if the blood won’t clot well, the anatomy is not normal, or there is too much scarring from previous surgery.

Other Treatment

Other treatment choices

Other treatments for gallstones in the gallbladder include:

• Lithotripsy. This procedure uses ultrasound waves to break up gallstones. It may be used alone or along with bile acids to break up stones. The procedure, which is now rarely performed, has been used for people who have long-term (chronic) inflammation of the gallbladder (cholecystitis) and who are not strong enough for surgery. But it is not appropriate in treating sudden (acute) cholecystitis.
• Contact dissolution therapy. This treatment uses a thin, flexible tube called a catheter to place a chemical in the gallbladder to dissolve gallstones. This therapy is rarely used because of the risk of complications. And unlike with surgery, gallstones may return.
• Percutaneous cholecystostomy. This procedure may provide temporary relief for an inflamed gallbladder until an endoscopic retrograde cholangiopancreatogram (ERCP) or surgery can be performed. During percutaneous cholecystostomy, a doctor places a tube through the abdomen and into the gallbladder to drain its contents. This sometimes is done for people who are not strong enough for surgery.

Other treatments for gallstones in the common bile duct include:

• Endoscopic retrograde cholangiopancreatogram (ERCP) with endoscopic sphincterotomy. In an ERCP, a doctor gently moves a flexible, lighted viewing instrument (endoscope) down your throat and through your stomach to examine the tubes that drain your liver and gallbladder. If you have a gallstone in the common bile duct, the gallstone can sometimes be removed through the endoscope.

References

Citations

1. Wang DQH, Afdhal NH (2010). Gallstone disease. In M Feldman et al., eds., Sleisenger and Fordtran’s Gastrointestinal and Liver Disease, 9th ed., vol. 1 , pp. 1089–1120. Philadelphia: Saunders.
2. Huang CS, Lichtenstein DR (2006). Biliary tract stones. In MM Wolfe et al., eds., Therapy of Digestive Disorders, 2nd ed., pp. 395–408. Philadelphia: Saunders Elsevier.

Other Works Consulted

• Sanders G, Kingsnorth AN (2007). Gallstones. BMJ, 335(7614): 295–299.
• Society of American Gastrointestinal and Endoscopic Surgeons (2010). SAGES guidelines for the clinical application of laparoscopic biliary tract surgery. Available online: http://www.sages.org/publication/id/06/.

Credits

Current as of:
August 12, 2019

Author: Healthwise Staff
Medical Review:
E. Gregory Thompson MD – Internal Medicine
Brian D. O’Brien MD – Internal Medicine
Adam Husney MD – Family Medicine
Arvydas D. Vanagunas MD – Gastroenterology

90,000 Stomach stones: why are they dangerous and what to do about it

Irina Sturova

From September 27 to October 18, the planet Mercury will be retrograde. This will affect the emotions and personal relationships of each zodiac sign.

Aries
During this period, you can become capricious and not notice it yourself. You will want to sort things out from scratch, argue, prove. Relations between Aries and Aries, as well as between Aries and Capricorns, will be especially aggravated.And if you have a union in Virgo or Gemini, then it can come to a break in relations.

Taurus
Everything is more or less stable. But problems from the past may emerge. Here, your prudence will help you not to step on the same rake. You know what you want and you won’t just take the risk. Family Taurus is not in danger. For those who are not yet married, some test of loyalty awaits.

Gemini
This is a very difficult time for you. You will begin to stir up the past, gravitate over the lost, compare.All this is not good, but will only exacerbate the existing contradictions. Be careful with your words. Speak more often and remember good things, leave criticism for another period. Otherwise, a long and nervous parting process may begin.

Cancer
You will be emotionally unstable. It will be difficult to sort things out with you, as you tend to go into the “shell” and keep silent. It will be especially difficult for Cancer-Gemini, Cancer-Libra, Cancer-Virgo couples. Even if they are not married couples, but colleagues, relatives, friends – your relationship will undergo a test of strength.The stars advise to speak frankly about what worries, but to be restrained.

Leo
Not a bad period overall. You are resilient enough to the criticism that comes down on you these days. You have the wisdom to discuss all contradictions calmly and in a confidential atmosphere. There is also a chance to regain past love and passion. But this is not for long.

Virgo
A difficult period for you. You must decide who is dear to you and what you want. Do not try to find support in the past, this is history.We must look forward, without looking back, without comparisons. Then you have a chance to find confidence and happiness, build a good relationship. Married couples will quarrel seriously. Lonely Virgos can be rejected.

Balance
Everything is not so complicated as to be afraid of insoluble problems. You will smooth things over, turn on your diplomacy and charm. You will have to compromise again, but it will be worth it. As a result, gently, but persistently, you turn everything in your direction.What you’ve been looking forward to from your relationship will come true these days.

Scorpio
Emotionally unstable period. You will be thrown to extremes. Your mistrust, jealousy will have a very bad effect on the relationship. Try to trust more and be more confident in yourself. Otherwise, you can lose not only time and chance, but also a really good person next to you.

Sagittarius
You will feel quite comfortable in a relationship. If this is a new relationship, then you will be more and more fascinated.In an established relationship, stagnation will appear, from which you want to escape. But not for long. You will find an idea of ​​how to improve and rekindle old feelings. The best ideas will come from the past.

Capricorn
You can experience some unpleasant moments, from stress to frustration. But you will definitely understand what you want from the relationship. You may decide to make a change, especially when it comes to an emerging romance. Contradictions can occur in the tandem Capricorn-Gemini, Capricorn-Cancer, Capricorn-Aries.

Aquarius
Problems from the past will make you anxious. Relationships will be severely tested. You will probably find out some unpleasant secret. The return of the former is also possible. Although there is no guarantee that reconciliation will happen. In a new relationship, there may be misunderstandings. Some of you will think that you have a future together, while the other did not even think.

Pisces
It’s not easy. Don’t force yourself to do what you don’t want to do.Nothing good will come of it. You also tend to be late or late for your dates. It is better not to make important decisions about your personal life now.

horoscope retrograde Mercury

90,000 possible causes of the sensation, symptoms, diagnostic methods and therapy

The fact that this is a very rare disease does not mean that it cannot appear in you. Because there are many provocative points that can generally create a problem.Many are interested in what to do if the stomach is like a stone. What are the causes of this phenomenon and its symptoms?

Causes

The main factor is a violation of motor functions, which are responsible for the evacuation of food lumps from the stomach into the intestinal tract. A typical disease provocateur is complicated diabetes mellitus (diabetic gastroparesis, partial gastric paralysis). There are also other, no less important, causes of stones in the stomach:

• Weakened secretion of the gastric glands, low acidity.
• Population of the intestinal tract and stomach with microorganisms that violate the microflora (yeast-like fungi).
• Increased viscosity of mucus.

Anyone who chews food poorly, abuses coarse and fatty foods, those who have had stomach surgery (partial resection, vagotomy) and those who do not pass a control examination can get sick with this disease.

The stone can be in the body for a long time without causing any unpleasant symptoms.As a result, a person does not even know about his illness for many years. When a stone reaches a certain size, it can provoke an attack or cause discomfort. As a rule, discomfort is observed from a stone in the stomach after eating. Patients with this disease are prescribed a special diet.

Sensations

With stones, the patient constantly feels discomfort in the stomach, it manifests itself as follows:

• Constant feeling of a full stomach and vomiting after eating.
• Feelings of heaviness in the stomach, persisting more than two hours from the moment of eating.
• Temporary relief may occur after vomiting or diarrhea, but then everything repeats with renewed vigor.
• The patient begins to feel weakness, rapid fatigability, indifference, loss of appetite.
• Increasingly, there is a feeling as if you have swallowed something large.
• When the stone begins to pass through the gastrointestinal tract, a wild pain in the abdomen is added to the vomiting.

Symptoms

Symptoms of stones in the stomach do not appear immediately. But as the formation increases, they begin to damage the lining of the stomach with their sharp edges. The first signs of the disease include:

• involuntary release of gases from the esophagus through the mouth as a result of contraction of the diaphragm – belching;
• gag reflex during and after meals;
• heaviness in the stomach, manifested during meals and persists for more than two hours.

Small stones may come out with vomiting and diarrhea. This brings temporary relief. But if the patient continues to lead the old way of life, to use the same products, does not protect himself from harmful factors at work, then new symptoms of the disease appear. The size of the stomach decreases, food is more difficult to digest. New signs of the disease appear, which include weight loss, indifference and fatigue, a decrease in hemoglobin in the blood, and loss of working capacity. When the stone seeks out of the stomach, it can block the passage to the intestines.This causes abdominal pain and vomiting.

The behavior of a stone depends on its size and structure. A small, even stone can leave the gastrointestinal tract on its own. Large and rough, it can completely block the small intestine, which in most cases requires surgery.

Types of stones

There are several types of stones in the human body:

• Phytobezoar is the main type of stones. The main reason for their appearance is the accumulation of plant fiber as a result of eating foods rich in it (figs, persimmons, grapes, etc.).It develops as a result of poor digestion of food (gastritis, disruption of the digestive tract).
• Trichobezoar – formed due to the accumulation of hair, as a rule, in people who have a habit of sucking their hair and those whose work is directly related to hairstyles.
• Lactobesoar is a disease common in premature infants who are fed a formula and high-calorie diet high in lactose and casein.
• Sebobezoar – appears due to the formation of lumps of fat glued together with mucus.
• Hemobezoar – occurs in patients with systemic lupus erythematosus or portal hypertension when blood is swallowed.
• Pixobezoar – Formed due to the use of resin.
• Shchellakobezoar – occurs due to the ingestion of nitro-varnish, varnishes, alcohol varnishes and other harmful agents into the body.

Patients after surgery on the stomach are more likely to develop stones. People with diabetes are also at risk of getting sick, since they already have serious health problems.

Diagnostics

If stomach stones are suspected, a complete examination is required. Among the techniques that will allow you to establish where the stone is located, there are endoscopy, ultrasound studies, X-ray diagnostics, MRI, computed tomography and ultrasound. The stomach also hurts with stones in the gall, so experts advise to check all organs.

Treatment

Only after listening to the patient’s complaints, carefully studying the symptoms and research results, the doctor can develop an individual treatment regimen.After the diagnosis has been clarified, most patients have a number of questions. How to remove a stone from the stomach? Do I need to remove it with the help of an operation, or just conduct conservative therapy?

Treatment is prescribed purely individually. It can be complex and include both surgical intervention and drug therapy. The operation can be performed by laparotomy or pancreatectomy. The methods are relevant when seizures occur, accompanied by depletion of the body; inflammation develops; the body is depleted; vivid symptoms are observed.

Operation

Surgical intervention is relevant in cases where there are complications or the resulting stones are large in size. The operation is performed under general anesthesia, then the formation is removed through small incisions in the abdominal cavity.

Small stones are also removed laparoscopically. Bezoar is eliminated by introducing a special apparatus into the abdominal cavity through small incisions. The intervention is performed under general anesthesia. The advantages of laparoscopic surgery for stones in the stomach are as follows:

• Fast recovery period.
• Total removal of bezoars.
• Prevention of the development of dangerous complications.
• No scars remain after the surgery.
• Internal organs are not damaged during the procedure.

It is also worth noting that thanks to the modern development of medicine, the operation is carried out with the latest lasers, as a result of which, after the manipulation, no scars remain on the patient’s skin. Contraindications to the use of this method for removing bezoars in the stomach:

• Inflammatory diseases of the gallbladder.
• Hemophilic infection.
• Atrophy.
• Presence of oncological formations.
• Tuberculosis in its active phase.
• Cirrhosis of the liver.

Quite often, patients with stones in the stomach resort to alternative medicine. No one disputes traditional methods, however, one must approach such treatment wisely and be sure to consult a specialist in advance, get tested and undergo an examination.

Rosehip from stones in the gastrointestinal tract

You need to thoroughly grind two tablespoons of dried rosehip fruit, pour half a liter of boiling water into a thermos and leave overnight.In the morning, mix one tablespoon of the broth with two tablespoons of sorbitol and drink on an empty stomach. Finish the rest of the infusion after forty minutes, not forgetting to add one teaspoon of honey to it.

Cinquefoil

This herb is excellent for pain in the intestines, stomach or liver ailments. Pour 0.5 liters of boiled water over two tablespoons of dry crushed leaves. Drink one hundred milliliters three times a day. And in order to quickly get rid of stones in the body, you need to mix in a fifty to fifty ratio of the herb infusion with the juice of the green shoot of rye.You can drink in any quantity.

Watermelon seeds during an attack of gallstone disease

Grind watermelon seeds in a mortar and pour cold water in the ratio of din to ten. Insist for six to eight hours, do not forget to shake sometimes. Or grind the seeds, adding water gradually (for one part of the seeds from five to ten parts of water). After twenty minutes, filter the solution.

Diet

If you feel heaviness in the stomach, as if a stone had been swallowed, the following recommendations must be strictly observed:

• Count calories, pay attention to the energy value of the foods you eat.The calorie norm is calculated purely individually, but on average this figure is about 2000-2500. It is also important to maintain a balance of proteins, carbohydrates and fats.
• Keep in mind that if there is a stone in the stomach or gallbladder, fatty or fried foods may be most harmful.
• No need to overeat.
• Food should not be hot or cold, eat everything warm.
• You need to eat small amounts six times during the day.
• It is necessary to remove fats from the diet, as well as various stimulants. These include: spices, additives, foods high in cholesterol and essential oils.
• The main thing in the diet is fruits and vegetables.
• You cannot eat fried food.
• Food should be steamed, boiled and rarely baked.

You need to eat the following foods:

• Fermented milk (yoghurts, kefir, fermented baked milk, cottage cheese, etc.), which contain calcium and protein, improve the intestinal microflora.
• It is also necessary to introduce fish and lean meat, eggs (protein), vegetable oils, such as olive, into the diet.
• Vitamins A, B and C are required.

Prevention

Proper nutrition is the main preventive measure against the formation of stones in the stomach. In addition, doctors recommend the following:

• an active lifestyle with a sufficient level of physical activity;
• Thorough and slow chewing of food;
• Getting rid of the bad habit of biting nails, sucking hair;
• revision of the diet, restriction of fruits and vegetables with a hard skin, berries, rough food, as well as baked goods, white bread, which is best replaced with bran;
• Periodic examination by a gastroenterologist.

You do not need to completely exclude meat products from your diet, but you do not need to get carried away with them either. You need to drink at least two liters of liquid every day (clean water, tea, rosehip decoction, etc.), so you will prevent dehydration.

It is important to empty the intestines on time so that feces do not accumulate. It is useful to massage your tummy in the morning and drink warm boiled water. You can also sit down a couple of times. They do all this in order to form the habit of going to the toilet every time at the same time.

what is it, reasons what to do

Food on the run

When we eat fast, snacks between important things, constantly glancing at the clock, insufficiently processed food – poorly chewed food – can enter the stomach. The stomach is forced to spend more time and effort on its processing, therefore, a feeling of heaviness may arise, which is also often observed in older people, only a violation of the chewing function in them can already be noted due to age ⁶ .

Incorrect power supply

First of all, it is overeating, which can exceed the digestive capacity of the stomach. If food stays in it longer than necessary, it can lead to a feeling of heaviness in the abdomen ¹ .

In addition, many patients with functional digestive disorders * may refuse to eat certain foods due to the possible appearance of more pronounced complaints, including a feeling of heaviness.The foods that are worst tolerated by patients include hot peppers, caffeinated and carbonated drinks, mayonnaise, nuts, citrus fruits, chocolate ⁵ .

Age transformations

With age, secretory and motor functions may decrease, and there may be a thinning of the muscle wall of the stomach. Changes in the vascular bed lead to disruption of gastric blood supply, which may be one of the reasons for a decrease in the number of parietal cells.The stomach lining of the elderly can be easily injured when the risk of developing ulcers increases. Structural changes in combination with secretory insufficiency can lead to a feeling of heaviness in the stomach ^{6, 9} .

Food poisoning

There is a variant of a functional digestive disorder * that may be associated with a past food poisoning. According to the results of examinations of patients after acute infectious gastroenteritis, 20% of patients developed complaints from the gastrointestinal tract, including heaviness in the stomach, which is associated with delayed gastric emptying due to food poisoning ³ .

Food allergy

Among the pathological reactions to food that can lead to unpleasant sensations in the abdomen, including heaviness, are food intolerances and food allergies. Food intolerance can develop with pathology of the gastrointestinal tract, liver and gallbladder, hereditary and acquired enzymopathies (lactase deficiency, celiac disease) associated with enzyme deficiency ^{2, 4, 10} .

Food allergy can develop due to an increase in the permeability of the intestinal walls, noted with a lack of digestive enzymes of the pancreas, bile secretion, inflammatory diseases of the gastrointestinal tract ^{2, 4, 10} .

90,000 Abdominal pain – causes, symptoms and diagnosis, indications for seeking medical attention

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Abdominal pain is one of the most common and most neglected complaints. They come to the doctors with her, but much more often they prefer to drink anesthetic, endure, wait out. Discomfort and other unpleasant sensations in the abdomen can be really not a dangerous sign and even a manifestation of the norm.But in many cases – the pain speaks of a serious illness. Then the wasted time, improper self-medication can aggravate the problem and lead to complications.

To understand how dangerous pain is, why it appeared, you need to take into account many factors. Where, how, how long it hurts, what other symptoms there are – all this will help to understand the situation and make the right decision – to treat at home, go to the doctor, or even call emergency help. We have compiled this short guide to the possible causes of abdominal pain with the help of different doctors – gastroenterologist, gynecologist, urologist, therapist and cardiologist.Listen to your feelings to try to figure out the situation yourself. And for more specific help – we invite you to the Kutuzovsky Medical and Diagnostic Center. Our specialists correctly diagnose any pathology and prescribe competent measures for treatment and rapid improvement in well-being.

What can have stomach pain

The abdomen is the place where a large number of internal organs are located. These are bodies such as:

• Stomach.
• Liver.
• Pancreas.
• Spleen.
• Gallbladder.
• Intestines.
• Organs of the reproductive system in men and women – the uterus and its appendages, the prostate gland.
• Bladder and others.

In addition, complaints of abdominal pain can occur with circulatory disorders in the abdominal cavity, pathologies of the spine and nervous system, and even with diseases in the organs adjacent to the abdominal cavity.With such radiating pains, cardiac and pulmonary pathologies can be given. This is due to the connection of the abdominal organs with the central nervous system. Because of this, it is difficult to accurately diagnose only from the patient’s words and after an external examination with palpation of the abdomen. It is advisable to remember and tell the doctor in detail your feelings – where the pain began, how other features changed in your well-being and condition.

How exactly the stomach hurts

Stomach pain can be in different ways, and the nature of the pain can tell a lot about the cause.It could be:

• Sharp, stabbing – arises abruptly and immediately quite strong.
• Chronic – worries for a while, can pass and reoccur after a while.
• Aching – may resemble hunger or heaviness.
• Cutting, burning – acute attack.
• Tonic – with tension and uncontrolled muscle contractions, spasms.

Pain may be the only symptom or be accompanied by others: nausea, flatulence, stool disorders, frequent urination, vaginal discharge, fever.Such symptoms complement the picture of the disease and allow you to more accurately determine the problem.

By where it hurts, you can at least roughly understand which organ to examine. So:

• Pain in the upper abdomen is highly likely to indicate gastrointestinal diseases. Less often – about developing myocardial infarction.
• Pain in the left side of the abdomen – mainly signals a problem with the pancreas or spleen.
• Pain in the right side of the abdomen – attention to the liver and bile.
• Pain at the bottom – pathology of the organs of the genitourinary system, intestines.

Causes of abdominal pain

Consider the main options for what and why the stomach hurts.

Stomach

Pathologies in it appear due to malnutrition, infections, injuries and other factors. The main diseases of the stomach that can manifest as pain:

• Gastritis – inflammation of the mucous membrane of the entire organ or part of it. Discomfort often occurs after eating, there is a characteristic burning sensation, a feeling of overeating (or vice versa, hunger).
• Ulcers – are formed on the affected mucosa, the symptoms are similar to gastritis.
• Gastroesophageal reflux disease (GERD or simply reflux) – heartburn due to a weakening of the valve between the stomach and the esophagus, which causes stomach contents to be thrown into it.

Intestine

Major diseases:

• Ulcerative colitis is an inflammation of the mucous membrane in the colon or rectum. With this disease, intoxication of the body occurs, blood may be present in the feces.
• Enteritis is an inflammation of the small intestine similar to food poisoning.
• Crohn’s disease – inflammation of one or more parts of the intestine, dangerous by the development of intestinal obstruction.
• Dysbacteriosis, inflamed bowel syndrome – disorders of the normal intestinal microflora. Digestion is disturbed, flatulence, stool disorders occur.
• Prolonged constipation, intestinal obstruction.

Pancreas

Most common:

• Pancreatitis is inflammation in which the production of enzymes for the digestion of fats or proteins is reduced.
• Cystic fibrosis is a hereditary pathology of the pancreas.

Hernias

There are the following types of hernias: umbilical, diaphragmatic, inguinal. They appear due to heavy physical exertion, improper functioning of the intestines. Symptoms of diaphragmatic hernias may resemble gastritis, heartburn, and belching. It is possible to determine a hernia by external signs or ultrasound.

Gallbladder

In case of problems with it, abdominal pain on the right is characteristic.Major diseases of the bile duct and its ducts:

• Cholecystitis is a sharp pain, often after a fatty meal. May be accompanied by vomiting with bile, increased gas production in the intestines.
• Cholangitis – with this inflammation of the gallbladder ducts, there is a sharp pain in the right side of the abdomen.
• Cholelithiasis – cramping attacks occur due to the movement of stones in the gallbladder and its ducts.

Gynecological diseases

Abdominal pain in women (especially in its lower part) – may be a sign of pathologies of the uterus and its appendages, or … the norm.Soreness can be caused by physiological causes (for example, before menstruation). You don’t have to worry if the unpleasant sensations are insignificant, have always been and go away on their own after a day or two. In a situation where the stomach began to hurt with previously painless menstruation, the pain is very strong and is not relieved by painkillers, the nature of bleeding has changed (its duration, abundance, blood color) – it is worth undergoing examination by a gynecologist. Such a clinical picture can be with endometriosis, inflammation in the uterus and other situations.

The main gynecological diseases in which the stomach may hurt:

• Uterine fibroids – a benign tumor in the uterus causing aching, chronic abdominal pain.
• Inflammation – adnexitis, salpingitis, oophoritis and others. May be accompanied by profuse or thick vaginal discharge, fever, general weakness.
• Growth of the endometrium of the uterus (adenomyosis, endometriosis), polyps. Pain often worsens after or during intercourse.
• Polycystic, ovarian cysts, their ruptures – there is pain in the left abdomen in women (or on the right – depending on which side the ovary is damaged). From a cyst – aching pain, chronic, with a rupture – acute. In this case, there is internal bleeding and its signs – a decrease in pressure, dizziness, weakness, nausea.
• An ectopic pregnancy in which the embryo becomes entrapped in the fallopian tube and ruptures over time. Symptoms are similar to an ovarian cyst, only everything develops more rapidly.

Pregnant women may also experience abdominal pain. In the normal course of pregnancy, a slight feeling of heaviness is quite normal. The uterus increases in size, gradually squeezes the adjacent organs. Sharp and unexpectedly onset pain and bleeding are signs of danger. Its causes can be placental abruption, miscarriage and other situations. A gynecologist’s consultation is urgently needed.

Kidney

Major diseases:

• Inflammation of one or both kidneys, which is indicated by pain in the abdomen on the left (or on the right) as well as in the lumbar region, a rise in temperature.
• Urolithiasis – acute colic from the movement of stones.

Other diseases

This could be:

• Appendicitis – pulling pain that appears above or in the umbilical region, and ends with a sharp pain in the abdomen.
• Neuroses – a condition in which it often “twists” in the stomach.
• Injuries to the muscles of the abdominal wall, lumbar spine.
• Neoplasms of a different nature that form in the abdomen.
• Myocardial infarction – an attack can begin with intense pain in the upper, middle abdomen and shortness of breath.
• Testicular torsion in men – pain from the groin radiates to the abdomen.

When you need medical attention

Seek emergency help if:

• The pain is very severe, it does not subside from taking the pills within an hour.
• During pregnancy.
• The abdomen became hard, the muscles on it were tense.
• The attack is accompanied by nausea, vomiting, bleeding from the vagina, rectum, ureter.
• A high temperature has risen.

Do not neglect the visit to doctors and with less severe symptoms. To understand why the stomach is worried, examination with the help of ultrasound, MRI, laboratory tests will help. The list of diagnostic methods and measures for treatment will differ greatly for different diseases. You can start with the consultation of a therapist or immediately contact a narrow specialist if there is a suspicion of a specific disease.

Medical center “Kutuzovsky” is a multidisciplinary clinic, where doctors of various directions are ready to see them seven days a week. Sign up online at a convenient time and come to the address: st. Davydkovskaya, 5. We will find the cause of disturbing symptoms and how to help in any situation.

The content of this article has been checked and confirmed for compliance with medical standards by a general practitioner Butskikh Yulia Vladimirovna.

Publication checked:

90,000 Urolithiasis.Symptoms How to treat kidney stones

Urolithiasis disease. We all heard something about this disease. The phrases “urolithiasis”, “kidney stones” are now on hearing. But how much do we know about the severity of urolithiasis and which of us is at risk? In modern urology, this is the most acute, pressing and widespread problem. Now the diagnosis of “urolithiasis” is received from 25 to 40% of patients who consulted a urologist. Every year, doctors observe a steady increase in the incidence, and ignoring the first symptoms threatens with serious complications.

Urolithiasis (or urolithiasis) is a chronic pathology caused by metabolic disorders and accompanied by the formation of calculi (stones). The disease develops and disrupts the full outflow of urine, an inflammatory process begins in the body. The most dangerous thing is that sometimes the disease proceeds absolutely asymptomatic (in about 13% of cases).

The disease can occur at any age.But more often it is diagnosed in people 30-50 years old. Moreover, men get sick 3 times more often than women.

What are the symptoms of urolithiasis?

The first sign is renal colic, that is, acute pain in the lumbar region. The ureter is clogged with calculus, due to which the pressure in the pelvis sharply increases and it stretches.

Symptoms and their severity depend on where the stone is located in the kidney:

1. If the stone is in the renal calyx, then the patient has aching pains in the lumbar region from the corresponding side.Often there are traces of blood in the urine.
2. If the stone is at different levels of the ureter, then the pain is shifted to the groin area. The patient complains of frequent and painful urination.
3. When a stone completely blocks the lumen of one of the ureters, the pain syndrome becomes unbearable. Renal colic appears. The pain radiates to the lower abdomen, genitals, perineum or rectum. Frequent and painful urination appears, which may be interrupted suddenly (“jet interruption” symptom).

The most important question for us arises – how to treat urolithiasis?

If conservative therapy is ineffective (medications, physiotherapy, diets), surgery is necessary.

Previously, open surgery was the only option for removing stones from the urinary tract. But these days, this method is used extremely rarely, since it is traumatic. The main indications for open surgery are developing renal failure and large calculi.

Today, specialists more often resort to minimally invasive and endoscopic operations. They are characterized by low trauma and a short rehabilitation period for the patient. Endoscopic operations are performed through how many small punctures in the abdominal cavity (laparoscopic operations).

The most advanced and safest method now is minimally invasive procedures that are carried out using electromagnetic waves.Among them, two types are distinguished:

Lithotripsy is performed using a special apparatus.

Remote lithotripsy (SWL) is performed without external intervention, and contact litripsy (CLT) is performed with minimal invasion through the urethra.

How does it work?

Under the influence of electromagnetic waves, kidney stones are crushed.

What are the benefits of this treatment?

• low-trauma (operation without incisions)
• absolute painless treatment – without anesthesia (quick rehabilitation of the patient, the procedure is carried out without hospitalization).

Today EBRT and CRT are a reliable and safe method of curing urolithiasis.

In the SOVA clinic, the DLT procedure is carried out using innovative equipment – the Compact Sigma apparatus from Dornier MedTech , manufactured in Germany.

The company is a recognized world leader in the market for urological equipment and surgical lasers.

Dornier Compact Sigma is a quality device that is characterized by high efficiency, wide range of applications and safety for the patient.During lithotripsy, the harmful effects of the shock wave on the human body are practically excluded due to precise focusing on the stone. The procedure is performed with minimal pain and does not require anesthesia.

Bladder stones

Bladder stones

At the Research Institute of Urology and Interventional Radiology named after N.A. Lopatkin, a branch of the Federal State Budgetary Institution “National Medical Research Center of Radiology” of the Ministry of Health of Russia, all modern methods of treating urolithiasis are used.Bladder stones are one of the varieties of human urolithiasis. We bring to your attention a short but very detailed description of this disease. It was prepared by specialists of the Department of Urolithiasis of the Research Institute of Urology and Interventional Radiology named after N.A. Lopatkina

Have you been diagnosed with bladder stones?

Cystolithiasis or bladder stones, along with stones in the kidneys, ureters and urethra, are one of the manifestations of urolithiasis.Their formation can be due to both a violation of the physicochemical properties of urine (the solubility of organic and inorganic compounds contained in it), and physiological factors (congenital or acquired metabolic disorders: metabolic, inflammatory, medicinal, etc.).

Depending on the location and mechanism of formation, bladder stones can vary in size, quantity, consistency, surface type, shape, color and chemical composition.Bladder stones can be single (solitary) and multiple, small (microliths) and large (macroliths), smooth, rough and faceted, soft and very hard; contain uric acid, uric acid salts, calcium phosphates or oxalates.

Bladder stones are observed mainly in the male population in childhood (in the first 6 years of life) and old age (over 50). In adult patients, bladder stones are composed primarily of uric acid, while in children they include uric acid crystals, calcium phosphates and oxalates.

Practical urology distinguishes between primary bladder stones (formed directly in its cavity) and secondary (formed in the kidneys and ureters, then migrate to the bladder). Secondary stones in the bladder may further increase in size.

Causes of the formation of bladder stones

The most common cause of bladder stones in adult patients is bladder obstruction – a violation of the free flow of urine due to an obstruction in the bladder neck or urethra.Blockage of the lower urinary tract can be caused by stenosis of the bladder neck (Marion’s disease), prostatic hyperplasia or prostate cancer in men, urethral strictures (after injury, surgery, inflammation).

The mechanism of stone formation is associated with the inability to completely empty the bladder, stagnation and concentration of residual urine, leading to the loss of salt crystals. Stone formation is facilitated by a neurogenic bladder, its prolapse in women with a cystothelium, existing defects of the inner muscular membrane, incl.including diverticula.

Sometimes, in the presence of calculi in the kidneys and upper urinary tract, migration of small stones along the ureter is observed with their further appearance and persistence in the bladder. The presence of foreign bodies (stents, ligatures, catheters and other foreign objects) in the bladder can cause salt deposition and the formation of stones.

Bladder stones can be the result of reconstructive surgery for stress urinary incontinence and inflammatory changes in genitourinary infections, the result of parasitic diseases (urogenital schistosomiasis) and radiation therapy.In children, existing balanoposthitis, complicated by phimosis and narrowing of the external opening of the urethra, often leads to the appearance of bladder stones.

Symptoms of bladder stones

In some cases, the presence of bladder stones, even of rather large sizes, does not show any signs. Clinical symptoms occur with constant contact of the stone with the walls of the bladder, the development of irritation of the mucous membrane or blockage of the outflow of urine.

The symptoms of bladder stones are varied, but not pathognomonic. It can be pain syndrome in the lower abdomen, above the pubis, in men – discomfort, sharp or dull pain in the penis. Minor at rest, pain becomes unbearable when moving, changing the position of the patient’s body and urinating, can radiate to the perineum and external genitals, thigh area.

Bladder stones cause urinary disturbance with frequent, sharp urge when moving, interruption of the stream of urine or an acute delay in its outflow in case of stone migration into the urethra, as well as urinary incontinence when the internal sphincter of the bladder does not close due to a stone stuck in its narrowed neck.In the case of large stones, some patients may only empty their bladder while lying down. Children sometimes develop priapism and enuresis.

Due to the addition of a microbial infection, bladder stones can be complicated by cystitis and pyelonephritis. Hematuria and pyuria develop as a result of trauma and inflammation of the bladder mucosa with stones. When a stone is pinched in the region of the bladder neck, blood may appear in the last portion of urine; with trauma to the dilated venous vessels of the neck, profuse total hematuria may develop.

Diagnosis of bladder stones

Diagnosis of bladder stones includes the analysis of anamnesis data and patient complaints, the results of instrumental and laboratory examinations. It is necessary to clarify the nature of pain, the degree of manifestation of dysuria and hematuria, to identify cases of sand and stones discharge, the presence of concomitant diseases: hyperplasia and prostate cancer, urethral stricture, diverticulum, bladder tumor, neurogenic dysfunction.

Only very large bladder stones can be found on vaginal (bimanual) or rectal examination.Rectal palpation of the prostate gland in men reveals its enlargement. In patients with bladder stones, in the general analysis of urine, leukocytes and erythrocytes, bacteria, and salts can be detected. Bacterial urine culture allows you to identify the microflora and its sensitivity for the selection of antibiotic therapy.

During ultrasound of the bladder, stones can be seen as hyperechoic formations with an acoustic shadow, which move in the bladder cavity when the patient’s position changes.Cystoscopy is one of the main methods for examining the internal structure of the bladder (the state of the mucous membrane, the presence of diverticula, tumors, strictures), to determine the presence of stones in its cavity, their number and size.

With the help of cystography and excretory urography, it is possible to assess the state of the urinary tract, to identify urolithiasis, the presence of X-ray-positive calculi, prostatic hyperplasia, and bladder diverticula. The radiopacity of bladder stones depends on their chemical composition, first of all, the presence and percentage of the calcium component in them.With spiral, multispiral CT, one of the most sensitive methods for detecting various bladder stones, one can distinguish between very small and X-ray-negative calculi, as well as concomitant pathology.

Treatment of bladder stones

Sometimes small bladder stones leave on their own through the urethra with urine. In the absence of complications with a small size of bladder stones, conservative treatment is carried out, which consists in adhering to a special diet (depending on the mineral composition of the stones) and taking medications to maintain the alkaline balance of urine.

In the operative removal of stones from the bladder, endoscopic litho extraction, stone crushing (contact transurethral cystolithotripsy, percutaneous suprapubic litholapaxy, remote cystolithotripsy) and stone cutting (open suprapubic cystolithotomy) are used.

Transurethral lithotripsy is performed for adult patients during cystoscopy, while the detected stones are crushed under visual control with a special device (ultrasonic, pneumatic, electrohydraulic or laser lithotripter), and their fragments are removed through a cystoscope by washing and suction.Transurethral cystolithotripsy can be performed on its own or in conjunction with other endoscopic procedures, such as transurethral resection of the prostate. Transurethral cystolithotripsy is contraindicated with a small bladder volume, during pregnancy, and with a pacemaker.

Remote lithotripsy is performed using a shock wave method in the absence of bladder outlet obstruction and prostate enlargement in the patient, as well as in secondary bladder stones and a burdened background, when transurethral intervention is contraindicated.Percutaneous suprapubic litholapaxy is indicated for pediatric patients, as it allows you to quickly and safely fragment the bladder stone and remove its parts.

In the absence of a result from drug therapy and stone crushing, with acute urinary retention, persistent pain syndrome, hematuria, recurrent cystitis and large bladder stones, open extraperitoneal suprapubic cystolithotomy is performed. For the postoperative period, a catheter is installed in the bladder, and antibacterial drugs are prescribed.

Biopsy and histological examination of the tissues of the bladder is performed after the operation in case of noticeable changes from the side of its wall with long-term and untreated urolithiasis. Observation for 3 weeks after stone cutting is supplemented by ultrasound of the kidneys and bladder to exclude the remaining stone fragments.

Complications of surgical treatment of bladder stones

There may be urinary tract infection, fever, trauma to the walls of the bladder, hyponatremia, bleeding.

Prognosis after removal of bladder stones

In the future, it is necessary to observe the urologist, metabolic examination and ultrasound of the kidneys and bladder once every six months.

With the elimination of the underlying disease, the prognosis after treatment of bladder stones is favorable. With unresolved causes of stone formation, a relapse of the formation of stones in the bladder and kidneys is possible.

Departments in which urolithiasis is treated.

At the Research Institute of Urology and Interventional Radiology named after N.A. Lopatkin, the scientific department deals with the treatment of urolithiasis:
Department of urolithiasis , which is headed by Ph.D., urologist Mikhail Yuryevich PROSYANNIKOV. Patients, depending on the methods of treatment of urolithiasis, can be hospitalized in the departments of the clinic: Department of X-ray shockwave remote crushing of stones Head of the department LYKOV Andrey Vladimirovich 1st urological department Head of the department, urologist of the highest category PROKHOROV Sergey Arkadievich Call- center +7 (499) 110- 40 67 Call us today so we can help you!

90,000 Doctors told what kind of food produces kidney stones

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Doctors told what kind of food forms kidney stones

Doctors told what kind of food forms kidney stones – RIA Novosti, 13.12.2019

Doctors told what kind of food forms kidney stones

According to statistics, five percent of Russians have kidney stones. In some regions – the Caucasus, the Urals, the Volga region and Siberia – people suffer from this disease more often. In … RIA Novosti, 13.12.2019

2019-12-13T08: 00

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2019-12-13T08: 06

Science

Leningrad Region

Moscow

St. -Petersburg State University

first MGMU named after Sechenov

Volga region

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MOSCOW, 13 Dec – RIA Novosti, Alfiya Enikeeva. According to statistics, five percent of Russians have kidney stones. In some regions – the Caucasus, the Urals, the Volga region and Siberia – people suffer from this disease more often. In the coming years, the indicators will only grow, experts say. RIA Novosti understands what contributes to the formation of stones and who is at risk. Heavy foods “In Russia, more than 550 cases of urolithiasis are registered annually per hundred thousand of the population, and its growth over the past ten years has exceeded 25 percent.But the prevalence varies greatly depending on the region of residence – from one to ten percent. Most of the patients with such a diagnosis are among the inhabitants of the Caucasus, Siberia and the Urals: there is an increased content of minerals in the water here, and a lot of calcium salts in the soil. This leads to the formation of salt crystals in the urinary tract. In addition, there is a hereditary predisposition to the disease. The formation of urinary stones is also facilitated by a violation of diet and an unhealthy lifestyle, pathology of the endocrine system, “said Dmitry Korolev, senior researcher at the Institute of Urology and Human Reproductive Health at Sechenov University, urologist, to RIA Novosti.According to Alina Izatulina, a senior researcher at the Department of Crystallography, St. But the main cause of the disease is still in metabolic disorders. “There are three main types of kidney stones: phosphate, oxalate and urate. In St. Petersburg and the Leningrad region, it is oxalate stones that are most often removed from patients. They consist of oxalic acid salts containing in many foods, such as tomatoes and sorrel.In addition, the popular flavor enhancer monosodium glutamate can cause stones to appear. In our model experiments, this substance stimulated the formation of sediment in a liquid that mimics human urine. Therefore, depending on the mineral composition of the stone, urologists prescribe a special diet for patients with urolithiasis so that there is no relapse. But it’s not just about nutrition: the process of stone formation can be influenced by various inflammations in the body, “the researcher explained. Age rings” There are at least five theories of stone formation.The most common are colloidal and matrix. According to the first, salts in urine pass from a soluble state to an insoluble one, as a result of which crystals are formed. Of these, urinary stones are subsequently formed. The second theory assumes that first a nucleus is formed from leukocytes, and then salts gradually settle on it according to the principle of a snowball. Therefore, if the kidney stone is cut, layers like rings on the cut of the tree trunk will be visible. Such formations are more common in people with chronic inflammation of the urinary tract – for example, pyelonephritis, “explained Dmitry Korolev.Pathogenic infections really stimulate the formation of crystals, confirms Alina Izatulina. While investigating the crystallogenesis of kidney stones with a grant from the Russian Science Foundation, she and her colleagues showed on model systems that pathogenic microorganisms can accelerate the crystallization of salts contained in urine. Conducted similar experiments with staphylococcus, Escherichia coli, rotavirus and Coxsackie virus.In model systems, the presence of bacteria leads to a change in the composition of the resulting sediment, for example, to crystallization of apatite and struvite. After all, if there are pathogenic microorganisms in the urine, they change its physicochemical parameters, which can accelerate the formation of kidney stones, “the researcher clarified. Crush and eliminate Now Alina Izatulina’s team is developing ways to prevent the formation of stones, even if the environment in the kidney favors this.” In oxalate stones and urate stones – formed from uric acid and its salts – we study the formation of metastable hydrated phases.They appear at the very beginning of stone formation. If we find substances that can interfere with the formation of these phases, then perhaps we will not allow the stone to form. On model systems, we add various compounds and see if they interfere with crystallization. Several such substances have already been isolated, now it is necessary to test their effect on more complex systems. If all goes well, our developments can be used to prevent urolithiasis. After all, a large proportion of kidney stones is due to a hereditary predisposition, and is also often recurrent, so prevention is relevant.However, if the stones have already appeared, then our developments will be powerless. They will have to be removed from the body, “- explained an employee of St. Petersburg State University. According to Dmitry Korolev, depending on the mineral composition, the stones can either be dissolved by alkalizing urine, or remotely crushed using special equipment and the resulting fragments can be made to move independently through the urinary tract. – surgical operation – they resort if the stones are large and are located in an inconvenient place for crushing.”Today, most operations for urinary stones are performed endoscopically. That is, there are no incisions on the body, as it was before. There are methods that allow you to remove stones through the natural urinary tract. The instrument is passed through the urethra, inserted into the ureter and contact crushing is performed – either In the ureter, or in the kidney.It happens that the stone is very large.Then a small puncture is made in the lower back and the calculus is removed with a laser or ultrasound.In the Institute of Urology and Human Reproductive Health for such operations, as a rule, we use thulium fiber laser developed by us.It is more effective, “- said the urologist. However, in the coming years, more advanced methods of treatment may appear.” Do you know how a magnet moves an iron ball in one direction or another? Techniques are now being actively developed that will allow changing the location of the stone in the same way. That is, using a special device to bring the stone down to that part of the kidney or ureter where it is easiest to get it, “the doctor noted.

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Leningrad Region, Moscow, St. Petersburg State University, Sechenov First Moscow State Medical University, Volga Region

MOSCOW, December 13 – RIA Novosti, Alfiya Enikeeva. According to statistics, five percent of Russians have kidney stones. In some regions – the Caucasus, the Urals, the Volga region and Siberia – people suffer from this disease more often. In the coming years, the indicators will only grow, experts say. RIA Novosti understands what contributes to the formation of stones and who is at risk.

Heavy foods

“More than 550 cases of urolithiasis are registered annually in Russia per one hundred thousand of the population, and its growth over the past ten years has exceeded 25 percent.But the prevalence varies greatly depending on the region of residence – from one to ten percent. Most of the patients with such a diagnosis are among the inhabitants of the Caucasus, Siberia and the Urals: there is an increased content of minerals in the water here, and a lot of calcium salts in the soil. This leads to the formation of salt crystals in the urinary tract. In addition, there is a hereditary predisposition to the disease. The formation of urinary stones is also facilitated by a violation of diet and an unhealthy lifestyle, pathology of the endocrine system, “said Dmitry Korolev, senior researcher at the Institute of Urology and Human Reproductive Health at Sechenov University, urologist, to RIA Novosti.

According to Alina Izatulina, a senior researcher at the Department of Crystallography of St. Petersburg State University, who has been studying kidney stones for the eighth year, their growth can be stimulated by substances that make up food additives and food. But the main cause of the disease is still in metabolic disorders.

“There are three main types of kidney stones: phosphate, oxalate and urate. In St. Petersburg and the Leningrad region, oxalate stones are most often removed from patients. They consist of oxalic acid salts found in many products, such as tomatoes and sorrel.In addition, the popular flavor enhancer monosodium glutamate can cause stones to appear. In our model experiments, this substance stimulated the formation of sediment in a liquid that mimics human urine. Therefore, depending on the mineral composition of the stone, urologists prescribe a special diet for patients with urolithiasis so that there is no relapse. But it’s not just about nutrition: the process of stone formation can be influenced by various inflammations in the body, “the researcher explained.

Age rings

” There are at least five theories of stone formation.The most common are colloidal and matrix. According to the first, salts in urine pass from a soluble state to an insoluble one, as a result of which crystals are formed. Of these, urinary stones are subsequently formed. The second theory assumes that first a nucleus is formed from leukocytes, and then salts gradually settle on it according to the principle of a snowball. Therefore, if the kidney stone is cut, layers like rings on the cut of the tree trunk will be visible. Such formations are more common in people with chronic inflammation of the urinary tract – for example, pyelonephritis, “explained Dmitry Korolev.

Pathogenic infections really stimulate the formation of crystals, confirms Alina Izatulina. While researching the crystallogenesis of kidney stones with a grant from the Russian Science Foundation, she and her colleagues showed on model systems that pathogenic microorganisms can accelerate the crystallization of salts contained in urine.

12 August 2019, 03:00 ScienceFrom the kidneys to the exit: scientists have learned to safely remove drugs

“In experiments, we proved that in the presence of Pseudomonas aeruginosa, calcium oxalate crystallization begins twice as fast.Conducted similar experiments with staphylococcus, Escherichia coli, rotavirus and Coxsackie virus. In model systems, the presence of bacteria leads to a change in the composition of the resulting sediment, for example, to crystallization of apatite and struvite. After all, if there are pathogenic microorganisms in the urine, they change its physical and chemical parameters, which can accelerate the formation of kidney stones, “the researcher clarified.

Crush and eliminate

Now Alina Izatulina’s team is developing ways to prevent the formation of stones, even the environment in the kidney favors this.

“In oxalate stones and urate stones – formed from uric acid and its salts – we study the formation of metastable hydrated phases. They arise at the very beginning of stone formation. If we find substances that can prevent the formation of these phases, then perhaps we will not allow the stone to form On model systems, we add various compounds and see if they interfere with crystallization. We have already isolated several such substances, now we need to test their effect on more complex systems.If all goes well, our developments can be used to prevent urolithiasis. After all, a large proportion of kidney stones is due to a hereditary predisposition, and is also often recurrent, so prevention is relevant. However, if the stones have already appeared, then our developments will be powerless. They will have to be removed from the body, “an employee of St. Petersburg State University explained.

12 September 2018, 10:54 with the help of special equipment and force the resulting fragments to move independently through the urinary tract.The third option – surgery – is resorted to if the stones are large and located in an inconvenient place for crushing.

“Today, most operations for urinary stones are performed endoscopically. That is, there are no incisions on the body, as it was before. There are methods that allow you to remove stones through the natural urinary tract. The instrument is passed through the urethra, inserted into the ureter and contact crushing is performed. – either in the ureter or in the kidney It happens that the stone is very large.Then a small puncture is made in the lower back and the calculus is removed with a laser or ultrasound. At the Institute of Urology and Human Reproductive Health, for such operations, as a rule, the thulium fiber laser developed by us is used.