Gallstones – familydoctor.org

What are gallstones?

Gallstones are hard deposits that can form inside the gallbladder. The gallbladder is a small, pear-shaped organ just under your liver. It stores bile, the digestive fluid that is made by the liver. Sometimes the bile becomes solid and forms stones. Some are as small as a grain of sand. Others can be the size of a golf ball.

Symptoms of gallstones

Most people who have gallstones never experience symptoms. These are called silent gallstones. Sometimes, a gallstone can leave your gallbladder and go into a bile duct. If a gallstone gets stuck in that passageway and blocks it completely, you may experience:

• Severe pain in the right upper part of your belly.
• Pain in your upper back.

This is known as a gallbladder attack. The pain usually starts suddenly and lasts for several hours. Complete or partial blockage can also cause your gallbladder to get irritated and inflamed. If this happens, you may:

• Have pain that lasts several hours.
• Develop a fever.
• Vomit or feel nauseated.

In addition, your skin may turn a yellowish color, known as jaundice.

Gallbladder attacks tend to happen after heavy meals. They’re more likely to happen in the evening or during the night. They stop when the gallstones move and are no longer lodged in the duct. If the duct remains blocked for more than a few hours, complications can occur. Call your doctor right away if you’re experiencing a gall bladder attack that lasts more than several hours.

What causes gallstones?

Gallstones are causes by imbalances in the substances that make up bile.

Most gallstones (80%) are made of cholesterol. Normally, acids in the bile break down cholesterol. But a high-fat diet can lead the liver to produce extra cholesterol that the acids can’t break down. This leads the excess cholesterol to solidify. Other gallstones are made of bilirubin. Bilirubin is a yellowish pigment in bile that is produced when red blood cells break down. These stones are formed when there is too much bilirubin in the bile.

Gallstones may also form if the gallbladder doesn’t empty itself completely.

You’re more likely to get gallstones if you:

• Are a woman.
• Are more than 60 years of age.
• Have diabetes.
• Have a family history of gallstones.
• Are pregnant.
• Take birth control pills.
• Eat a diet high in fat.
• Are overweight or obese.
• Are on a low-calorie diet and have recently lost weight very quickly.

How are gallstones diagnosed?

Gallstones can be hard to diagnose because they share symptoms with other conditions. Your doctor will do a physical exam to look for signs of gallstones. This will include looking for yellowing of the skin and tenderness in the abdomen. He or she may order blood tests. They may also order imaging tests. These could include an ultrasound or CT scan, which will make pictures of your gallbladder and bile ducts. If your doctor thinks you have a gallstone stuck in a bile duct, they could try to remove the stone.

Can gallstones be prevented or avoided?

In most cases, gallstones can’t be prevented or avoided. Eating a healthy diet, maintaining a healthy weight, and avoiding rapid weight loss could reduce your risk.

Gallstones treatment

Your treatment depends on the severity of your symptoms and what the doctor finds from the tests.

• No treatment.If the gallstones are floating free and you have no pain, you won’t need treatment.
• Wait and see.If you have one gallbladder attack, your doctor may want to take a wait-and-see approach. The problem may solve itself. Then if you have more attacks, your doctor may recommend surgery.
• Surgery. Once you have one gallbladder attack, the chance of having another one is high (up to 70%). Many doctors will suggest surgery to remove your gallbladder to prevent a future attack. If your gallbladder is irritated or inflamed, most doctors will want to take it out right away. The surgery is most often done with laparoscopic surgery. This means that small tools are inserted into small incisions in your abdomen to remove your gallbladder. The surgery is safe and effective. It limits your hospital stay to about 1 day. Without surgery, the gallbladder can get infected. It might even burst, causing further problems.

Are there other treatments?

Other treatments are available for people who would have a high risk in surgery. This could be because they are elderly, or have heart problems or lung disease. However, gallstones usually return when they aren’t treated with surgery. Other options include:

• Sound wave therapy.This can break up the stones so they can move into the intestine without problem. But not everyone can receive this treatment. If you have more than 1 gallstone, if your gallstone is large, or if you have other medical conditions, you may not be able to receive sound wave therapy.
• Medicine. You might be able to take a pill to dissolve the stones. This pill doesn’t work for everyone and can be expensive. It can take 2 years or longer to work, and gallstones could return after you finish treatment.

Surgery is the best way to cure symptomatic gallstones. Talk with your doctor about what is right for you.

Living with gallstones

If your gallstones aren’t causing symptoms, you may live the rest of your life without any problems. If you do experience symptoms, your doctor may want to remove your gallbladder. You don’t need your gallbladder to live. So when it’s removed, you won’t notice much difference. You may have diarrhea at first. If you have diarrhea that lasts more than 3 months after surgery, talk to your doctor. Some people may find they need to eat a lower-fat diet.

Questions to ask your doctor

• Are there lifestyle changes I can make to prevent gallstones?
• Am I at risk of having another gallstone?
• What should I do if I have a gallbladder attack?
• Is there any kind of medicine that will make a gallbladder attack less painful?
• Will I need surgery to remove my gallbladder? Are there other options?
• Is having a gallstone a sign of another condition?

Resources

National Institutes of Health, MedlinePlus: Gallstones

National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases: Gallstones

Gallstones: Symptoms, diagnosis and treatment

The gallbladder is a pear-shaped pouch that sits just below the liver. It collects bile, a fluid made to help with digestion, as it flows from the liver to the intestine through the bile ducts. Gallstones are hardened bits of bile that form inside the gallbladder.

Bile makes it easier for you to digest fat. It also contains some waste products, including cholesterol and bilirubin, a substance created when old red blood cells are destroyed.

Gallstones form when cholesterol or bilirubin particles cluster together into a solid lump. The stone grows in size as the bile fluid washes over it, much like a pearl forms inside an oyster.

Most gallstones don’t cause any symptoms or problems. Small ones can leave the gallbladder and its draining ducts, then pass out of the body through the intestines.

Gallstones can cause symptoms if they get caught in the narrow outlet of the gallbladder, or in the ducts that drain the gallbladder. After meals, especially meals high in fat, muscles in the wall of the gallbladder contract to help release bile into the intestines. It can be very painful if the gallbladder squeezes against a gallstone, or if a gallstone blocks bile from being released into the intestines.

More serious problems can develop if a gallstone gets into the drainage-duct system but doesn’t make it all the way through to the intestines. In this case, the stone can cause a blockage, causing a buildup of bile in the gallbladder or liver. Since the digestive tract is teeming with bacteria, blocked fluid can lead to a very serious infection. If a gallstone lodges low down in the draining ducts, it can also block drainage of digestive enzymes from the pancreas. This can lead to inflammation of the pancreas (pancreatitis).

Gallstones are very common. About 1 in 5 women and 1 in 10 men have a gallstone by age 60. They are more likely to happen to older people, those who are overweight, and those who suddenly lose weight. Women who have had multiple pregnancies, taken birth control pills, or took estrogen after menopause are also more likely to develop gallstones.

Symptoms

Eighty percent of people with gallstones do not have any symptoms and do not need treatment. When gallstones do cause symptoms, they include:

• abdominal pain, usually high in the abdomen and often on the right side (where the gallbladder is located). The pain can spread to the back. Pain from gallstones can be steady or come and go. It can last between 15 minutes and several hours each time it occurs.
• sensitivity to high fat meals. Fats trigger the gallbladder to contract and can worsen pain.
• unexplained belching, gas, nausea, or a general decrease in appetite.

Gallstones can sometimes cause more serious problems such as pancreatitis or infections in the gallbladder or bile ducts. These can cause fever, more severe abdominal pain, or jaundice (a yellow color of the skin or whites of the eyes).

Diagnosis

Most gallstones do not show up on regular X-rays, but they are seen easily with an ultrasound. Gallstones often don’t cause symptoms. If you have symptoms that may or may not be due to gallstones, it may be difficult for your doctor to know if the stones are causing your symptoms even if you they show up on an ultrasound or CT scan.

If a stone is blocking the movement of bile, an ultrasound might show widened bile ducts. Your doctor may also order blood tests to evaluate injury to the liver and pancreas.

Prevention

You are less likely to form gallstones if you avoid becoming overweight. If you are a dieter, try to avoid diets that cause you to lose weight very quickly, such as diets restricted to fewer than 500 calories daily.

Birth control pills and estrogen can increase the likelihood of gallstones. Consider avoiding these medications if you already have other risk factors for gallstones. Groups at high risk of gallstones include American Indians, Hispanics, people with sickle cell anemia and women who have had multiple pregnancies.

Treatment

Gallstones require treatment only if they are causing symptoms. Smaller gallstones sometimes float out of the gallbladder on their own and are eliminated from the body in feces. Gallstone attacks can also calm down on their own if the bothersome stones shift position within the gallbladder. Even when gallstone symptoms go away on their own, they return within two years in about two of three people.

Most people whose gallstones cause symptoms will continue to have symptoms until the gallbladder is removed, although medications or procedures to break up the stones may also be used.

Surgery

Surgical treatment for gallstones is highly effective. In most people, symptoms go away completely and stay away. The gallbladder is not a necessary organ and most people do not notice any digestive changes after it is removed. Sometimes abdominal pain or diarrhea develop after the gallbladder is removed, and additional treatment or changes in the diet are needed.

Removing the gallbladder is usually done with a minimally invasive (“keyhole) operation known as laparoscopic cholecystectomy. In this procedure, a surgeon makes one or more small openings in the abdomen. A camera, called a laparoscope, is placed into the abdomen through one of these openings. It lets the surgeon see what he or she is doing during the operation.

Using small instruments inserted into the abdomen through other small openings, the surgeon removes fluid and stones from the gallbladder to deflate it. The gallbladder can then be detached from the digestive system and removed through one of the openings.

People tend to recover very quickly from laparoscopic surgery because the surgical wounds are very small.

Open cholecystectomy can be a better option for gallbladder removal among people who have significant abdominal scarring from prior surgery or those who are very obese.

About 5% of the time, a surgeon starts a laparoscopic procedure but changes to an open cholecystectomy for technical reasons.

For stones caught in the common bile duct, an additional treatment called endoscopic retrograde cholangiopancreatography (ERCP) might be needed. A doctor uses miniature instruments attached to a camera at the end of a flexible tube called an endoscope. The endoscope is passed maneuvered from the mouth down the esophagus and into the intestine. The doctor can tug stones out of the bile duct, or can widen the lower part of the duct so they pass into the intestine on their own.

Medication

When surgery is not a good option, an oral medication known as ursodeoxycholic acid (Actigall) may help. It usually takes about six months to see results, and is effective only about half the time. Once the medication is stopped, gallstones are likely to return.

Other procedures

Two other ways to break up gallstones include:

• shockwaves (lithotripsy) to break apart the gallstones so they can pass out of the body on their own
• dissolving gallstones with chemicals injected directly into the gallbladder

Surgery is strongly preferred over these other treatments because stones are likely to form again if the gallbladder is not removed.

causes, symptoms and treatment in FSCC FMBA

Gallbladder stones: causes, symptoms and treatment in FSCC FMBA

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

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

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

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

Types of gallstones

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

Symptoms

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

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

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

Causes of cholelithiasis

Responsible for the development of gallstones:

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

Risk factors:

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

Diagnosis

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

• Laboratory tests
• Instrumental diagnostics
• Endoscopic methods

Laboratory tests

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

Instrumental diagnostics

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

Endoscopic methods

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

Complications

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

Treatment of the gallbladder in the Federal Scientific and Practical Center

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

Treatment of the gallbladder includes:

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

Medical therapy

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

Laparoscopic surgery

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

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

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

Endoscopic retrocholangiopankeratography (ERCP)

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

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

Extracorporeal shock wave lithotripsy

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

Prophylaxis

Following simple recommendations reduces the risk of developing gallstones:

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

Information verified by an expert

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

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Ultrasound of the gallbladder, treatment and diagnostics

Stones in the gallbladder are quite an unpleasant phenomenon. Previously, these formations were detected in people of advanced age. But lately, the disease has become very rejuvenated. It is increasingly being detected in young and middle-aged people.

The identification of these formations in the gallbladder tells you that you need to seek the help of a professional surgeon. Such specialists work in our clinic.

Symptoms of disease

Symptoms of gallstone disease can be different. In some, even large stones do not cause any symptoms. They live with them, and stones can be found incidentally on an ultrasound or x-ray. And for others, even small stones bring discomfort. The main symptoms of this disease are:

• Pain that occurs in attacks and can be of varying intensity. The pains appear in the right side and may radiate to the nearby organs and back;

• The patient feels an unpleasant aftertaste of bitterness in the mouth;

• Nausea or vomiting may occur;

• There is flatulence and violation of bowel movements;

• There may be an eructation of air alone.

Sometimes the pains may not be strong and the patient can often confuse them with other diseases. Very often, the symptoms of the disease appear or worsen after taking too fatty, spicy food, various physical activities.

If the stones remain in the gallbladder for too long, they will begin to injure its membranes. As a result, an inflammatory process may occur, the temperature rises, and fatigue appears. Since the presence of stones is not an infectious disease, such people are absolutely safe for society.

The appearance of any of these symptoms is a reason to see a doctor. After all, by delaying the disease, you exacerbate its course. By contacting us in time, we will be able to diagnose your problem in a short time and prescribe an effective treatment. At the initial stages, you can not undergo a surgical method for solving this problem. But having tightened the disease and aggravated it, you will have only one way – the surgical table. So contact us and you will receive professional help and quickly get rid of this unpleasant disease that causes and brings you discomfort.

About illness

When stones appear in the gallbladder, this disease is called gallstone disease. The gallbladder is an organ located near the liver. It serves as a reservoir for collecting bile. When a certain amount of it has gathered there, it is excreted from the body. Stones are formed from cholesterol crystals. Their size can be different: from the smallest to large, the size of a walnut. They can also have a different composition and location (some are in the gallbladder, others can move through the bile ducts).

In order to identify this disease, you need to examine the gallbladder well and carry out its diagnosis. All these services you can get in our clinic. High-precision equipment will help to detect even the beginning stage of stone formation. This will help minimize the treatment and increase its effectiveness.

Causes

The main reasons that lead to the formation of stones are:

• Excessive intake of female hormones;

• A large number of births;

• Very fast weight loss, as well as a diet that virtually eliminates fiber intake;

• Treatment of certain diseases with certain drugs;

• Some diseases, such as, for example, cirrhosis of the liver.