What are gallstones and what causes them? Discover the symptoms, risk factors, and diagnostic procedures for gallstones from the experts at Johns Hopkins Medicine.

What are Gallstones?

Gallstones are hardened deposits that form in the gallbladder, a small organ located just below the liver. These stones can range in size from as small as a grain of sand to as large as a golf ball. Gallstones are typically made up of cholesterol, bile salts, or bilirubin (a waste product of red blood cells).

What Causes Gallstones?

Gallstones can form when there is an imbalance in the components of bile, the fluid produced by the liver and stored in the gallbladder. Cholesterol stones are the most common type and are believed to form when bile contains too much cholesterol, too much bilirubin, or not enough bile salts. Pigment stones, on the other hand, tend to develop in people with certain medical conditions such as cirrhosis, biliary tract infections, and hereditary blood disorders like sickle cell anemia.

Symptoms of Gallstones

Many people with gallstones do not experience any symptoms, and these are referred to as “silent stones.” However, when gallstones become larger or start to block the bile ducts, symptoms can arise. The most common symptoms of gallstones include:

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

Who is Affected by Gallstones?

There are several risk factors that can increase the likelihood of developing gallstones:

1. Obesity: Obesity is a major risk factor, especially in women.
2. Estrogen: Excess estrogen from pregnancy, hormone replacement therapy, or birth control pills can increase cholesterol levels in bile and decrease gallbladder movement, leading to gallstone formation.
3. Ethnicity: Native Americans have the highest rates of gallstones in the United States and seem to have a genetic predisposition to secrete high levels of cholesterol in bile.
4. Gender: Women are twice as likely to develop gallstones than men.
5. Age: People over the age of 60 are more likely to develop gallstones.
6. Cholesterol-lowering drugs: Drugs that lower cholesterol in the blood can actually increase the amount of cholesterol secreted in bile, which can lead to gallstone formation.
7. Diabetes: People with diabetes generally have high levels of fatty acids, called triglycerides, which increase the risk for gallstones.
8. Rapid weight loss: As the body metabolizes fat during rapid weight loss, it can cause the liver to secrete extra cholesterol into bile, leading to gallstones.
9. Fasting: Fasting decreases gallbladder movement, causing the bile to become overconcentrated with cholesterol and leading to gallstone formation.

Diagnosing Gallstones

Gallstones are often discovered accidentally during tests for other medical conditions. However, when persistent or recurring pain is present, healthcare providers may order the following diagnostic procedures:

• Ultrasound: A diagnostic technique that uses high-frequency sound waves to create an image of the internal organs, including the gallbladder.
• Cholecystography: An X-ray that shows the flow of contrast fluid through the gallbladder and bile ducts.

Preventing and Treating Gallstones

Maintaining a healthy weight, eating a balanced diet, and exercising regularly can help reduce the risk of developing gallstones. In some cases, medications or surgery may be necessary to treat gallstones, especially if they are causing symptoms or complications. It is important to consult with a healthcare provider to determine the best course of action for managing gallstones.

Conclusion

Gallstones are a common health condition that can cause a range of symptoms and complications if left untreated. Understanding the causes, risk factors, and diagnostic procedures for gallstones is crucial for maintaining good overall health and seeking appropriate medical care. By working closely with healthcare providers, individuals can take steps to prevent and manage gallstones effectively.

Gallstones | Johns Hopkins Medicine

What are gallstones?

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

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

What causes gallstones?

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

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

What are the symptoms of gallstones?

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

• Steady, severe pain in the upper abdomen that increases rapidly and
  may last from 30 minutes to several hours

• Pain in the back between the shoulder blades

• Pain in the right shoulder

• Nausea

• Vomiting

• Fever

• Chills

• Jaundice. A yellowing of the skin or eyes.

• Abdominal bloating

• Intolerance of fatty foods

• Belching or gas

• Indigestion

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

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

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

Who is affected by gallstones?

The following are suggested risk factors for gallstones:

• Obesity.
  Obesity is a major risk factor for gallstones, especially in women.

• Estrogen.
  Excess estrogen from pregnancy, hormone replacement therapy, or
  birth control pills appears to increase cholesterol levels in bile
  and decrease gallbladder movement, both of which can lead to
  gallstones.

• Ethnicity.
  Native Americans have the highest rates of gallstones in this
  country and seem to have a genetic predisposition to secrete high
  levels of cholesterol in bile.

• Gender.
  Women are twice as likely to develop gallstones than men.

• Age.
  People over 60 are more likely to develop gallstones than younger
  people.

• Cholesterol-lowering drugs.
  Drugs that lower cholesterol in blood can actually increase the
  amount of cholesterol secreted in bile, which, in turn, increases
  the risk of gallstones.

• Diabetes.
  People with diabetes generally have high levels of fatty acids,
  called triglycerides, which increase the risk for gallstones.

• Rapid weight loss.
  As the body metabolizes fat during rapid weight loss, it causes the
  liver to secrete extra cholesterol into bile, which can cause
  gallstones.

• Fasting.
  Fasting decreases gallbladder movement, which causes the bile to
  become overconcentrated with cholesterol.

How are gallstones diagnosed?

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

• Ultrasound.
  A diagnostic technique that uses high-frequency sound waves to
  create an image of the internal organs.

• Cholecystography.
  X-ray that shows the flow of contrast fluid through the
  intestines into the gallbladder.

• Blood tests.
  These look for signs of infection, obstruction, jaundice,
  and/or pancreatitis.

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

• 
  Endoscopic retrograde cholangiopancreatography (ERCP).
  
  A procedure that involves inserting an endoscope (viewing tube)
  through the stomach and into the small intestine. A special dye
  injected during this procedure shows the ducts in the biliary
  system.

• Sphincterotomy.
  Opening the muscle sphincter, a ring of muscle around a natural
  opening that acts like a valve, wide enough so stones can pass
  into the intestine.

Treatment for gallstones

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

• Your age, overall health, and medical history

• Extent of the condition

• Your tolerance of specific medicines, procedures, or therapies

• Expectations for the course of the condition

• Your opinion or preference

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

• Gallbladder removal (cholecystectomy).
  Once removed, the bile flows directly from the liver to the
  small intestine. Side effects of this may include diarrhea
  because the bile is no longer stored in the gallbladder.

• Oral dissolution therapy.
  Drugs made from bile acid are used to dissolve the stones.

• Methyl-tert-butyl ether.
  A solution injected into the gallbladder to dissolve stones.

• Extracorporeal shockwave lithotripsy (ESWL).
  A procedure that uses shock waves to break stones up into tiny
  pieces that can pass through the bile ducts without causing
  blockages.

• Contact dissolution therapy.
  An experimental procedure that involves injecting a drug
  directly into the gallbladder to dissolve the stones.

Gallstones Picture, Causes, Age, & Symptoms

Written by WebMD Editorial Contributors

• What Causes Gallstones?

Gallstones are crystal-like deposits that develop in the gallbladder — a small, pear-shaped organ that stores bile, a digestive fluid produced by the liver.

These deposits may be as small as a grain of sand or as large as a golf ball; they may be hard or soft, smooth or jagged. You may have several gallstones or just one.

Some 30 million American adults suffer from gallstones. Yet most of those who have the condition do not realize it. In this case, what you don’t know probably won’t hurt you; gallstones that are simply floating around inside the gallbladder generally cause no symptoms and no harm.

These “silent” stones usually go unnoticed unless they show up in an ultrasound exam conducted for some other reason. However, the longer a stone exists in the gallbladder, the more likely it is to become problematic. People who have gallstones without symptoms have 20% chance of having an episode of pain during their lifetime.

When symptoms do occur, it’s usually because the gallstone has moved and become lodged within a duct that carries bile, such as the cystic duct, a small conduit that connects the gallbladder to another tube called the common bile duct. The typical symptom is abdominal pain, perhaps accompanied by nausea, indigestion, or fever. The pain, caused by the gallbladder’s contraction against the lodged stone, generally occurs within an hour of eating a large meal or in the middle of the night. Stones can also clog the common bile duct, which carries bile into the small intestine, and the hepatic ducts, which take bile out of the liver.

Obstructions in the bile pathway may cause a duct to become inflamed and possibly infected. Blockage of the common bile duct, which merges with the pancreatic duct at the small intestine, can also lead to inflammation of the pancreas (gallstone pancreatitis).

In a rare but dangerous condition that occurs most often in older women, gallstones migrate into the small intestine and block the passageway into the large intestine; symptoms include severe and frequent vomiting. Although gallstones are present in about 80% of people with gallbladder cancer, it is uncertain whether gallstones play a role, except when really large stones (greater than 3 centimeters in diameter) are present.

About a million new cases of gallstones are diagnosed in the U.S. each year. For reasons that are still unclear, women are two times more likely than men to be afflicted. Native Americans have the highest rates of gallstones in the U.S. because they have a genetic disposition to secrete high levels of cholesterol in bile (a contributing factor to gallstones.) Mexican-Americans also have high rates of gallstones.

Gallstones are also more common in people over age 60, in those who are obese or have lost a lot of weight in a short amount of time, in those who have diabetes or sickle cell disease, and in women who have had multiple pregnancies and who take hormone replacement therapy or birth control pills.

The primary function of the gallbladder is to store bile, a brown or yellowish fluid that helps the body break down fatty food. When you eat a meal, the gallbladder releases its stored bile into the cystic duct. From there the fluid passes through the common bile duct and into the small intestine to mix with food.

Chief among the ingredients of bile are cholesterol and bile acids. Normally, the concentration of bile acids is high enough to break down the cholesterol in the mixture and keep it in liquid form. However, a diet high in fat can tip this delicate balance, causing the liver to produce more cholesterol than the bile acids are able to handle. As a result, some of this excess cholesterol begins to solidify into crystals, which we call gallstones. About 80% of all gallstones are called cholesterol stones and are created this way. The remaining 20% consist of calcium mixed with the bile pigment bilirubin and are called pigment stones. Sickle cell and other blood disorders where red blood cells are destroyed can often lead to pigment gallstones

Gallstones can form even in people who eat properly. And as researchers have found, a diet extremely low in fat can also contribute to gallstone formation: With little fatty food to digest, the gallbladder is called into play less frequently than usual, so the cholesterol has more time to solidify. Other factors that can reduce activity in the gallbladder, possibly leading to gallstone formation, include cirrhosis, the use of birth control pills or hormone replacement therapy, and pregnancy.

Family history, diabetes, sudden weight loss, and cholesterol drugs, and older age can also increase risk for gallstones.

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symptoms and when to see a doctor

Gallstone disease (GSD) is the formation of stones (calculi) in the gallbladder and bile ducts. Gallstones are hardened deposits of digestive fluid that most commonly form in your gallbladder. Your gallbladder is a small, pear-shaped organ on the right side of your abdomen, just below your liver. The gallbladder contains a digestive fluid called bile, which is secreted into the small intestine to aid in the digestion of food.

Gallbladder stones range in size from a grain of sand to a golf ball. Some people develop only one gallstone, while others develop many small stones at the same time.

The presence of stones carries the risk of developing dangerous conditions and severe complications.

Symptoms

Gallstones often cause no signs or symptoms. If a gallstone gets stuck in the duct and causes a blockage, the following symptoms develop:

• Sudden and rapidly increasing pain in the center of the abdomen, just below the sternum, on the right
• Pain in the back between the shoulder blades
• Right shoulder pain
• Nausea or vomiting
• Pain associated with gallstone disease can last from several minutes to several hours

When to see a doctor

Make an appointment with your doctor if you have any signs or symptoms that worry you.

Read about the diagnosis and treatment of cholelithiasis at the link.

Seek care right away if you develop signs and symptoms of a serious complication associated with gallstones, for example:

• Abdominal pain so severe that you cannot sit still or find a comfortable position
• Yellowing of the skin and whites of the eyes (jaundice)
• High fever with chills

Number for calling an ambulance in Moscow – 103

Causes of cholelithiasis

It is unclear what causes gallstones. Doctors believe that gallstones can occur in the following cases:

Your bile contains too much cholesterol . Normally, your bile contains enough chemicals to dissolve the cholesterol secreted by your liver. But if your liver secretes more cholesterol than bile can dissolve, the excess cholesterol can turn into crystals and eventually stones.

Your bile contains too much bilirubin . Bilirubin is a chemical produced when red blood cells are broken down in the body. Under certain conditions, the liver produces too much bilirubin, including cirrhosis of the liver, biliary tract infections, and certain blood disorders. Excess bilirubin contributes to the formation of gallstones.

Your gallbladder is not emptying properly. If the gallbladder does not empty completely or often enough, the bile can become very concentrated, which promotes the formation of gallstones.

Types of gallstones

Types of gallstones that can form in the gallbladder include:

Cholesterol stones in the gallbladder. The most common type of gallstones, called cholesterol gallstones, are often yellow in color. These gallstones are made up primarily of undissolved cholesterol, but may contain other components.

Pigment stones in the gallbladder. These dark brown or black stones form when your bile contains too much bilirubin.

Risk factors

Factors that may increase the risk of gallstones include:

• Female sex
• Age 40 and over
• Overweight or obese
• Sedentary
• Pregnancy
• High fat diet
• High cholesterol diet
• Low fiber diet
• Family history of gallstones
• Diabetes
• Presence of certain blood disorders such as sickle cell anemia or leukemia
• Very fast weight loss
• Taking medications containing estrogen, such as oral contraceptives or hormone therapy drugs.
• Liver disease

Complications

Complications of gallstones may include:

Inflammation of the gallbladder . A gallstone lodged in the neck of the gallbladder can cause inflammation of the gallbladder (cholecystitis). Cholecystitis can cause severe pain, peritonitis.

Blockage of the common bile duct . Gallstones can block the channels (ducts) that carry bile from the gallbladder or liver to the small intestine. This can lead to severe pain, jaundice, and bile duct infection.

Obstruction of the pancreatic duct . The pancreatic duct is a tube from the pancreas and joins the common bile duct just before entering the duodenum. The pancreatic juices that aid digestion pass through the pancreatic duct.

A gallstone can cause blockage of the pancreatic duct, which can lead to inflammation of the pancreas (pancreatitis). Pancreatitis causes severe, persistent abdominal pain and usually requires hospitalization. Severe forms of pancreatitis often end in the death of the patient.

Gall bladder cancer . People with gallstones have an increased risk of developing gallbladder cancer.

Prevention of gallstones

You can reduce the risk of gallstones:

Do not skip meals . Try to stick to your regular meal times every day. Skipping meals or fasting can increase your risk of gallstones.

Lose weight slowly . If you need to lose weight, take your time. Rapid weight loss can increase the risk of gallstones.

Eat more high fiber foods . Include more fiber-rich foods in your diet, such as fruits, vegetables, and whole grains.

Maintain a healthy weight . Obesity and overweight increase the risk of gallstones. Work towards a healthy weight by cutting calories and increasing physical activity. Once you reach a healthy weight, work on maintaining it by continuing to eat a healthy diet and keep exercising.

Stones in the gallbladder – is it necessary to operate?

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Stones in the gallbladder – is it necessary to operate?

11/28/2018

The formation of stones in the gallbladder is the main symptom of gallstone disease (GSD). In Russia and Europe, this disease is registered in 10-15% of the population. The source of the development of stones are cholesterol, salts and other components of bile, which is formed in the liver and then accumulates in the gallbladder. The formation of gallstones is promoted by stagnation of bile, inflammation in the wall of the gallbladder and ducts, hormonal and metabolic disorders. Sometimes gallstones may not manifest themselves, but most often they cause pain and other concerns. The greatest danger is the complications of gallstone disease.

Why is cholelithiasis dangerous?

– The presence of stones in the gallbladder constantly maintains inflammation in its wall. In the presence of provoking factors – the intake of fatty foods, alcohol, physical activity – the inflammation worsens, and an attack of acute cholecystitis develops, which may require emergency surgery. It is impossible to completely cure chronic cholecystitis in the presence of gallstones.

– The contraction of the gallbladder after a meal can lead to wedging of the stone into the excretory duct of the bladder, as a result of which the gallbladder becomes clogged and creates the effect of a “disabled gallbladder”.

– Small stones can pass from the gallbladder into the bile ducts, causing jaundice and acute pancreatitis. These diseases require emergency surgical treatment and so far often lead to death.

– Large stones can cause bedsores in the wall of the gallbladder. In this case, a fistula usually develops between the gallbladder and the intestines. The constant reflux of intestinal contents into the gallbladder and bile ducts leads to the development of severe inflammation in them.

– With a long course of calculous cholecystitis, chronic pancreatitis inevitably develops. In this case, even the elimination of cholecystitis (removal of the gallbladder) does not give a complete recovery, since pancreatitis continues to cause pain and other complaints.

– Prolonged trauma to the wall of the gallbladder stones in it can lead to the development of gallbladder cancer.

Ways to treat cholelithiasis?

The main treatment for gallstone disease is surgery. Methods of dissolution and crushing of gallstones have not justified themselves due to low efficiency, a large number of complications and high cost of treatment.

For more than 100 years, the main operation used for cholelithiasis has been cholecystectomy – the removal of the gallbladder. It does not make sense to remove the stones alone, since the cause of the disease is that the diseased gallbladder forms stones, and it is not the stones that cause gallbladder disease.

Previously, the gallbladder was removed through a large incision in the abdominal wall. Now the “gold standard” in the treatment of cholelithiasis is laparoscopic cholecystectomy, performed through small punctures. The operation takes about an hour. Postoperative hospital stay – 1-2 days. After the operation, it is recommended to limit excessive physical activity and follow a diet for 1-2 months.

Today, laparoscopic cholecystectomy is a fairly safe operation. The complication rate does not exceed 0.1-0.3%, which is lower than in open operations.

What to do if cholelithiasis is detected?

Don’t expect complications! The first step on the road to recovery is to call us and come for a consultation with a surgeon. The specialist of our multidisciplinary clinic will determine the need for surgical treatment and answer all your questions.

To date, only one list of life-threatening complications of cholelithiasis dictates the need for urgent treatment of this disease. It should be recognized as hopelessly outdated recommendations “do not remove stones if they do not bother.”

Learn more about the possibilities of the Center for Minimally Invasive Surgery of the Reaviz multidisciplinary clinic.

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