What are gallstones and how do they form. Who is at risk of developing gallstones. What complications can arise from untreated gallstones. How are gallstones diagnosed and treated. What lifestyle changes can help prevent gallstone formation.

Understanding Gallstones: Formation and Types

Gallstones are hard, pebble-like deposits that form in the gallbladder. These stones can vary in size, ranging from a tiny grain of sand to as large as a golf ball. The gallbladder may contain one large stone, hundreds of small ones, or a combination of both. But what exactly are gallstones made of?

There are two main types of gallstones:

• Cholesterol stones: These are the most common type, accounting for about 75% of gallstones. They are typically yellow-green in color and primarily composed of hardened cholesterol.
• Pigment stones: These are darker in color and are made of bilirubin, a substance produced when red blood cells break down.

Some individuals may have a mix of both types. Interestingly, the medical term for gallstones is cholelithiasis.

How do gallstones form?

Gallstones form when there’s an imbalance in the substances that make up bile. Bile is a fluid produced by the liver and stored in the gallbladder. It’s primarily composed of cholesterol, bile salts, and bilirubin. When the liver produces too much cholesterol or the gallbladder doesn’t empty properly, the excess cholesterol can crystallize and form stones.

The Biliary Tract: A Crucial Digestive System

To understand gallstones, it’s essential to grasp the role of the biliary tract. This system consists of the gallbladder and bile ducts, playing a vital role in digestion by releasing bile.

The key components of the biliary tract include:

• Gallbladder: A small, pear-shaped organ located in the upper right abdomen, below the liver. It stores bile until needed.
• Bile ducts: These include the hepatic ducts, common bile duct, and cystic duct. They transport bile from the liver and gallbladder to the small intestine.

When you eat, your body signals the gallbladder to release bile into the duodenum (the first part of the small intestine) to aid in digestion. The bile ducts facilitate this process by carrying bile from the gallbladder to the duodenum.

Can gallstones interfere with this process?

Yes, when gallstones block the bile ducts, they can disrupt the normal flow of bile. This blockage can lead to a sudden, intense pain in the upper right abdomen, known as a gallbladder attack or biliary colic. If left untreated, these blockages can cause serious complications.

The Prevalence of Gallstones: More Common Than You Might Think

Gallstones are surprisingly common, affecting a significant portion of the population. In the United States alone, about 10 to 15 percent of people have gallstones, which translates to nearly 25 million individuals. Each year, approximately 1 million people are diagnosed with gallstones, and about a quarter of these cases require treatment, typically through surgery.

Are all gallstones symptomatic?

No, many gallstones are asymptomatic. These are often referred to as “silent” gallstones and usually don’t require medical treatment. However, it’s important to be aware of their presence as they can potentially cause problems in the future.

Risk Factors: Who’s More Likely to Develop Gallstones?

While gallstones can affect anyone, certain groups are at a higher risk of developing them. Understanding these risk factors can help individuals take preventive measures or seek early diagnosis and treatment.

Demographic Factors

• Gender: Women are more likely to develop gallstones than men. This increased risk is partly due to estrogen, which can increase cholesterol in bile and decrease gallbladder movement.
• Age: The risk of developing gallstones increases with age.
• Ethnicity: American Indians have the highest rate of gallstones in the United States, largely due to genetic factors that increase cholesterol in their bile. Mexican Americans also have a higher risk.
• Family history: If your family members have had gallstones, you’re at a higher risk of developing them yourself.

Health Conditions

Certain health conditions can increase the likelihood of developing gallstones:

• Cirrhosis
• Infections in the bile ducts
• Hemolytic anemias (e.g., sickle cell anemia)
• Intestinal diseases affecting nutrient absorption (e.g., Crohn’s disease)
• High triglyceride levels
• Low HDL cholesterol
• Metabolic syndrome
• Diabetes and insulin resistance

Diet and Weight-Related Factors

Your diet and weight can significantly impact your risk of developing gallstones:

• Obesity, especially in women
• Rapid weight loss, often associated with weight-loss surgery
• Diets high in calories and refined carbohydrates but low in fiber

Complications of Gallstones: When to Seek Medical Attention

While many gallstones remain asymptomatic, they can sometimes lead to serious complications. It’s crucial to be aware of these potential issues and seek medical attention if you experience symptoms.

What are the potential complications of gallstones?

• Inflammation of the gallbladder (cholecystitis): This occurs when a gallstone blocks the cystic duct, leading to bile buildup and inflammation.
• Damage or infection of the gallbladder, bile ducts, or liver: If left untreated, gallstones can cause severe damage to these organs or lead to infections.
• Gallstone pancreatitis: This is inflammation of the pancreas caused by a gallstone blocking the pancreatic duct.

These complications can be serious and may require immediate medical intervention. If you experience severe abdominal pain, fever, or yellowing of the skin or eyes, seek medical attention promptly.

Diagnosis and Treatment: Navigating Gallstone Management

If gallstones are suspected, your healthcare provider will likely perform a series of tests to confirm the diagnosis and assess the severity of the condition.

How are gallstones diagnosed?

• Ultrasound: This is the most common and preferred method for diagnosing gallstones. It uses sound waves to create images of your gallbladder and can detect even small stones.
• CT scan: This can provide detailed images of your gallbladder and surrounding tissues.
• HIDA scan: This nuclear medicine test can show how well your gallbladder is functioning.
• Blood tests: These can help detect signs of infection or inflammation.

What treatment options are available for gallstones?

Treatment for gallstones depends on the severity of symptoms and the presence of complications. Options include:

• Watchful waiting: For asymptomatic gallstones, your doctor may recommend monitoring the condition without immediate treatment.
• Medications: Certain drugs can help dissolve small gallstones over time, but this method is less common and takes longer to work.
• Cholecystectomy: This surgical procedure to remove the gallbladder is the most common treatment for symptomatic gallstones. It can be performed laparoscopically in most cases, resulting in shorter recovery times.

Prevention Strategies: Reducing Your Risk of Gallstones

While some risk factors for gallstones are beyond our control, there are several lifestyle changes that can help reduce the likelihood of developing them.

How can you lower your risk of gallstones?

• Maintain a healthy weight: Obesity increases the risk of gallstones, but lose weight gradually as rapid weight loss can also trigger stone formation.
• Eat a balanced diet: Focus on foods high in fiber and low in cholesterol and fat.
• Exercise regularly: Physical activity can help maintain a healthy weight and may reduce the risk of gallstones.
• Stay hydrated: Drinking plenty of water may help prevent bile from becoming too concentrated.
• Avoid crash diets: If you need to lose weight, do so gradually and under medical supervision.

Remember, while these strategies can help reduce your risk, they don’t guarantee prevention. Regular check-ups with your healthcare provider can help detect potential issues early.

Living with Gallstones: Managing Symptoms and Quality of Life

For those diagnosed with gallstones, understanding how to manage symptoms and maintain a good quality of life is crucial. While some may require immediate treatment, others might be able to manage their condition through lifestyle modifications and careful monitoring.

How can you manage gallstone symptoms?

• Dietary changes: Avoiding fatty, greasy foods can help reduce the frequency and severity of gallbladder attacks.
• Pain management: Over-the-counter pain relievers can help manage mild discomfort, but always consult your doctor for persistent or severe pain.
• Stress reduction: Some people find that stress can trigger gallbladder attacks, so stress management techniques may be helpful.
• Regular check-ups: Even if your gallstones are asymptomatic, regular monitoring can help catch any potential complications early.

Can you live without a gallbladder?

Yes, it’s entirely possible to live a normal, healthy life without a gallbladder. After gallbladder removal, the liver continues to produce bile, which flows directly into the small intestine. Some people may experience digestive changes initially, but these usually resolve over time.

Living with gallstones or after gallbladder removal may require some lifestyle adjustments, but with proper management and medical care, most people can maintain a high quality of life.

Definition & Facts for Gallstones

In this section:

• What are gallstones?
• Do gallstones have another name?
• What is the biliary tract?
• How common are gallstones?
• Who is more likely to develop gallstones?
• What are the complications of gallstones?

What are gallstones?

Gallstones are hard, pebble-like pieces of material, usually made of cholesterol or bilirubin, that form in your gallbladder. Gallstones can range in size from a grain of sand to a golf ball. The gallbladder can make one large gallstone, hundreds of tiny stones, or both small and large stones.

When gallstones block the bile ducts of your biliary tract, the gallstones can cause sudden pain in your upper right abdomen. This pain is called a gallbladder attack, or biliary colic. If your symptoms continue and they’re left untreated, gallstones can cause serious complications.

However, most gallstones don’t cause blockages and are painless, also called “silent” gallstones. Silent gallstones usually don’t need medical treatment.

Types of gallstones

The two main types of gallstones are

• cholesterol stones
• pigment stones

Cholesterol stones are usually yellow-green in color and are made of mostly hardened cholesterol. In some countries, cholesterol stones make up about 75 percent of gallstones.¹

Pigment stones are dark in color and are made of bilirubin. Some people have a mix of both kinds of stones.

Gallstones can range in size from a grain of sand to a golf ball.

Do gallstones have another name?

Cholelithiasis is the name doctors sometimes call gallstones.

What is the biliary tract?

Your biliary tract, which is made up of your gallbladder and bile ducts, helps with digestion by releasing bile.

The gallbladder is a small, pear-shaped organ that stores bile and is located in your upper right abdomen, below your liver.

The bile ducts of your biliary tract include the hepatic ducts, common bile duct, and cystic duct. Bile ducts also carry waste and digestive juices from the liver and pancreas to the duodenum.

Your liver produces bile, which is mostly made of cholesterol, bile salts, and bilirubin. Your gallbladder stores the bile until it’s needed. When you eat, your body signals your gallbladder to empty bile into your duodenum to mix with food. The bile ducts carry the bile from your gallbladder to the duodenum.

Your biliary tract, which is made up of your gallbladder and bile ducts, helps with digestion by releasing bile.

How common are gallstones?

Gallstones are very common, affecting 10 to 15 percent of the U.S. population, which is almost 25 million people. About a quarter of the nearly 1 million people diagnosed with gallstones each year will need to be treated, usually with surgery.²

Who is more likely to develop gallstones?

Certain groups of people have a higher risk of developing gallstones than others.³

• Women are more likely to develop gallstones than men. Women who have extra estrogen in their body due to pregnancy, hormone replacement therapy, or birth control pills may be more likely to produce gallstones.
• Older people are more likely to develop gallstones. As you age, the chance that you’ll develop gallstones becomes higher.
• People with a family history of gallstones have a higher risk.
• American Indians have genes that raise the amount of cholesterol in their bile, and have the highest rate of gallstones in the United States.
• Mexican Americans are also at higher risk of developing gallstones.

American Indians have genetic factors that make them more likely to develop gallstones.

People with certain health conditions

You are more likely to develop gallstones if you have one of the following health conditions:

• cirrhosis, a condition in which your liver slowly breaks down and stops working due to chronic, or long-lasting, injury
• infections in the bile ducts, which can also be a complication of gallstones
• hemolytic anemias, conditions in which red blood cells are continuously broken down, such as sickle cell anemia
• some intestinal diseases that affect normal absorption of nutrients, such as Crohn’s disease
• high triglyceride levels
• low HDL cholesterol
• metabolic syndrome, which can also raise the risk of gallstone complications
• diabetes and insulin resistance

People with diet- and weight-related health concerns

You are more likely to develop gallstones if you

• have obesity, especially if you are a woman
• have had fast weight loss, like from weight-loss surgery
• have been on a diet high in calories and refined carbohydrates and low in fiber

Learn more about dieting and gallstones.

What are the complications of gallstones?

Complications of gallstones can include

• inflammation of the gallbladder
• severe damage to or infection of the gallbladder, bile ducts, or liver
• gallstone pancreatitis, which is inflammation of the pancreas due to a gallstone blockage

Many people do not have symptoms of gallstones until they have complications.

If left untreated, gallstones can be deadly. Treatment for gallstones usually involves gallstone surgery.

References

Gallbladder – gallstones and surgery

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Summary

Read the full fact sheet

• Gallstones are small stones made from cholesterol, bile pigment and calcium salts, which form in a person’s gall bladder.
• Medical treatment isn’t necessary unless the gallstones cause symptoms.
• Treatment options include surgery and shattering the stones with soundwaves.

The gallbladder is a small sac that holds bile, a digestive juice produced by the liver that is used in the breakdown of dietary fats. The gallbladder extracts water from its store of bile until the liquid becomes highly concentrated. The presence of fatty foods triggers the gallbladder to squeeze its bile concentrate into the small intestine.

Gallstones (biliary calculi) are small stones made from cholesterol, bile pigment and calcium salts, usually in a mixture that forms in the gallbladder. They are a common disorder of the digestive system, and affect around 15 per cent of people aged 50 years and over.

Some things that may cause gallstones to form include the crystallisation of excess cholesterol in bile and the failure of the gallbladder to empty completely.

In most cases, gallstones don’t cause any problems. However, you might need prompt treatment if stones block ducts and cause complications such as infections or inflammation of the pancreas (pancreatitis).

Surgeons may remove your gallbladder (called a cholecystectomy) if gallstones (or other types of gallbladder disease) are causing problems. Techniques include laparoscopic (‘keyhole’) cholecystectomy or open surgery. The gallbladder is not a vital organ, so your body can cope quite well without it.

Symptoms of gallstones

In approximately 70 per cent of cases, gallstones cause no symptoms. The symptoms of gallstones may include:

• pain in the abdomen and back. Pain is generally infrequent, but severe
• increase in abdominal pain after eating a fatty meal
• jaundice
• fever and pain, if the gallbladder or bile duct becomes infected.

Types of gallstones

There are three main types of gallstones being:

• mixed stones – the most common type. They are made up of cholesterol and salts. Mixed stones tend to develop in batches
• cholesterol stones – made up mainly of cholesterol, a fat-like substance that is crucial to many metabolic processes. Cholesterol stones can grow large enough to block bile ducts
• pigment stones – bile is greenish-brown in colour, due to particular pigments. Gallstones made from bile pigment are usually small, but numerous.

Causes and risk factors for gallstones

Gallstones are more common in women than in men. They are also more common in overweight people and people with a family history of gallstones.

There is no single cause of gallstones. In some people, the liver produces too much cholesterol. This can result in the formation of cholesterol crystals in bile that grow into stones. In other people, gallstones form because of changes in other components of bile or because the gallbladder does not empty normally.

Diagnosis of gallstones

Doctors diagnose gallstones by using a number of tests, including:

• general tests – such as physical examination and x-rays
• ultrasound – soundwaves form a picture that shows the presence of gallstones
• endoscope test – endoscopic retrograde cholangiopancreatography (ERCP). A thin tube is passed through the oesophagus and injects dye into the bowel to improve the quality of x-ray pictures
• hepatobiliary iminodiacetic acid (HIDA) scan – a special type of nuclear scan that assesses how well the gallbladder functions
• magnetic resonance cholangiopancreatography (MRCP) – a form of the body-imaging technique magnetic resonance imaging (MRI). The person’s liver, biliary and pancreatic system is imaged using an MRI unit. The image is similar to an ERCP test.

Complications of gallstones

If gallstones cause no symptoms, you rarely need any treatment.

Complications that may require prompt medical treatment include:

• biliary colic – a gallstone can move from the body of the gallbladder into its neck (cystic duct), leading to obstruction. Symptoms include severe pain and fever
• inflammation of the gallbladder (cholecystitis) – a gallstone blocks the gallbladder duct, leading to infection and inflammation of the gallbladder. Symptoms include severe abdominal pain, nausea and vomiting
• jaundice – if a gallstone blocks a bile duct leading to the bowel, trapped bile enters the person’s bloodstream instead of the digestive system. The bile pigments cause a yellowing of the person’s skin and eyes. Their urine may also turn orange or brown
• pancreatitis – inflammation of the pancreas, caused by a blocked bile duct low down near the pancreas. Pancreatic enzymes irritate and burn the pancreas and leak out into the abdominal cavity
• cholangitis – inflammation of the bile ducts, which occurs when a bile duct becomes blocked by a gallstone and the bile becomes infected. This causes pain, fever, jaundice and rigors (shaking)
• infection of the liver
• cancer of the gallbladder (occurs rarely).

Treatment for gallstones

Gallstones that cause no symptoms, generally don’t need any medical treatment. In certain cases (such as abdominal surgery for other conditions), doctors may remove your gallbladder if you are at high risk of complications of gallstones.

Treatment depends on the size and location of the gallstones, but may include:

• dietary modifications – such as limiting or eliminating fatty foods and dairy products
• lithotripsy – a special machine generates soundwaves to shatter the gallstones. This treatment is used in certain centres only, for the minority of people with small and soft stones
• medications – some medications can dissolve gallstones, but this treatment is only rarely given, due to side effects and a variable success rate
• surgery.

Surgical removal of the gallbladder or gallstones

Around 80 per cent of people with gallstone symptoms will need surgery. Surgeons may remove your entire gallbladder (cholecystectomy), or just the stones from bile ducts.

Techniques to remove the gallbladder include:

• laparoscopic cholecystectomy – ‘keyhole’ surgery. The surgeon makes a number of small incisions (cuts) through the skin, allowing access for a range of instruments. The surgeon removes the gallbladder through one of the incisions
• open surgery (laparotomy) – the surgeon reaches the gallbladder through a wider abdominal incision. You might need open surgery if you have scarring from prior operations or a bleeding disorder.

Medical factors to consider before cholecystectomy

Before the operation, you need to discuss some things with your doctor or surgeon, including:

• your medical history, since some pre-existing conditions may influence decisions on surgery and anaesthetic
• any medications you take on a regular basis, including over-the-counter preparations
• any bad reactions or side effects from any medications.

Laparoscopic cholecystectomy

The general procedure includes:

• The surgeon makes a number of small incisions into your abdomen, so that slender instruments can reach into the abdominal cavity.
• A tube blowing a gentle stream of carbon dioxide gas is inserted. This separates the abdominal wall from the underlying organs.
• The surgeon views the gallbladder on a TV monitor by using a tiny camera attached to the laparoscope.
• Special x-rays (cholangiograms) during the operation can check for gallstones wedged in the bile ducts.
• The ducts and artery that service the gallbladder are clipped shut. These clips are permanent.
• The gallbladder is cut free using either laser or electrocautery
• The gallbladder, along with its load of gallstones, is pulled out of the body through one of the abdominal incisions.
• The instruments and the carbon dioxide gas are removed from the abdominal cavity. The incisions are sutured (closed up) and covered with dressings.

Open gallbladder surgery

The general procedure is the same as for laparoscopic surgery, except that the surgeon reaches the gallbladder through a large, single incision in the abdominal wall. Sometimes, an operation that starts out as a laparoscopic cholecystectomy turns into open surgery if the surgeon encounters unexpected difficulties, such as not being able to see the gallbladder properly.

Immediately after gallbladder surgery

After a gallbladder operation, you can expect to:

• feel mild pain in your shoulder from the carbon dioxide gas
• receive pain-relieving medications
• be encouraged to cough regularly to clear your lungs from the general anaesthetic
• be encouraged to walk around as soon as you feel able
• stay overnight in hospital, if you had a laparoscopic cholecystectomy
• stay up to eight days in hospital, if you had open surgery.

Complications after gallbladder surgery

All surgery carries some degree of risk. Possible complications of cholecystectomy include:

• internal bleeding
• infection
• injury to nearby digestive organs
• injury to the bile duct
• leakage of bile into the abdominal cavity
• injury to blood vessels.

Self-care after gallbladder surgery

Be guided by your doctor, but general self-care suggestions include:

• Rest as much as you can for around three to five days.
• Avoid heavy lifting and physical exertion.
• Expect your digestive system to take a few days to settle down. Common short-term problems include bloating, abdominal pains and changes to toilet habits.

Most people recover within one week of laparoscopic surgery.

Long-term outlook after gall bladder surgery

You will need to see your doctor between seven and 10 days after surgery to make sure all is well. Some rare complications may have to be followed up with another operation.

Where to get help

• Your doctor
• Gastroenterologist
• NURSE-ON-CALL Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)

Things to remember

• Gallstones are small stones made from cholesterol, bile pigment and calcium salts, which form in a person’s gall bladder.
• Medical treatment isn’t necessary unless the gallstones cause symptoms.
• Treatment options include surgery and shattering the stones with soundwaves.

• Gallstones, Gastroenterological Society of Australia (GESA), NSW, Australia. More information hereExternal Link.
• ‘Cholelithiasis’, The Merck Manual of Diagnosis and Therapy, eds R. Berkow, M. Beers, A. Fletcher & R. Bogin. Merck & Co, Whitehouse Station, NJ, USA. More information hereExternal Link.
• Zakko, SF, 2010, Patient information: Gallstones, UpToDate Inc, More information hereExternal Link.
• Afdhal, NH, 2008, Natural history of asymptomatic gallstones, UpToDate Inc, More information hereExternal Link.

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Reviewed on: 31-08-2014

Cholelithiasis, surgery to remove gallbladder stones price in SP

A chronic disease of the biliary tract, in which stones form in the gallbladder (more often) and bile ducts, is called cholelithiasis (GSD).

If stones are detected in the common bile duct, then this form of gallstone disease is called choledocholithiasis .

Historical information

The disease has been known since ancient times. For the first time, gallbladder stones were discovered during the autopsy and described by Galen, the great surgeon, writer and philosopher, who lived in the second half of the 2nd century AD in ancient Rome. During the Renaissance, in the writings of Gentile de Foligno in 1341, there is also a mention of CL.

A detailed description of gallbladder stones appeared in the middle of the 18th century (C. Galeati), and at the same time, the study of their chemical composition was first undertaken. All information about cholelithiasis contained in the works of various authors was summarized by Albrecht Haller (1755). In his works, he showed that gallstones are found not only in humans, but also in horses, pigs, cows, marmots, monkeys and other animals.

He divided all stones of the gallbladder and ducts into 2 groups:

• Large ovoid, often solitary, consisting of “a tasteless yellow substance which, when heated, melts like sealing wax and is liable to burn”.
• Smaller, dark-colored, multifaceted, which are often found not only in the gallbladder, but also in the bile ducts.

Since the middle of the 19th century, there have been various theories of the origin of gallstones. Of these, two main directions can be distinguished.

Supporters of one of them saw the cause of cholelithiasis in an abnormal state of the liver. Such a liver produces bile of a changed composition, as a result of which its dense parts precipitate, forming stones. Other researchers considered bile stasis and inflammation of the biliary tract and gallbladder as the main cause of the disease.

More thorough work on GSD appeared already in the 20th century. In addition to a detailed study of the structure of gallstones, a theory of the occurrence of cholelithiasis was developed. It was based on the concept of “stagnant gallbladder” and metabolic disorders.

The incidence of gallstone disease

The incidence of gallstone disease has increased dramatically in the last decade and continues to increase. According to the National Institutes of Health (1992), 10-15% of the adult population of the world suffers from gallstone disease. Visiting doctors for bile duct and gallbladder stones in the Russian Federation is approximately 1 million people a year.

Women get sick 3-5 times more often than men, and cholelithiasis was also more common in them (5-6 times) than in men.

Modern understanding of the causes leading to gallstones

• First of all, it is a metabolic disorder that affects the chemical composition of bile. The composition of bile, which is a complex chemical solution, includes poorly soluble substances. In order for them not to precipitate, it is necessary to preserve them in strict proportions. If their percentage is violated in one direction or another, then a precipitate forms, which can then turn into stones.
• Secondly, this is a violation of the correct movement of bile along the bile ducts . The occurrence of obstacles to the outflow of bile into the duodenum, long periods of starvation lead to stagnation of bile in the gallbladder, its thickening and precipitation.

In turn, the formation of stones contributes to the disruption of the normal process of digestion: there are failures in the formation, storage and secretion of bile, which is one of the most important components for proper digestion of food. There are groups of people who are at high risk of gallstone disease and chronic calculous cholecystitis.

The following risk factors are distinguished:

• Heredity . The likelihood of developing gallbladder and duct stones increases in the presence of direct relatives suffering from this pathology.
• Diseases associated with metabolic disorders: diabetes mellitus, gout, obesity, atherosclerosis, decreased thyroid function.
• Diseases of the liver : cirrhosis, fatty liver, chronic hepatitis.
• Diseases of the digestive system eg pancreatitis, duodenitis, colitis, dysbacteriosis and others. Sometimes there is the so-called “Saint’s triad” – a combination of cholelithiasis with diaphragmatic hernia and diverticulosis of the colon.
• Physical inactivity.
• Improper diet: abuse of high-fat, high-calorie foods, sweets.
• Prolonged fasting, diets . A break in eating for more than 8 hours, as well as a long diet that does not contain animal fats, leads to stagnation in the gallbladder.
• Taking certain medications, such as steroid hormones and oral contraceptives.
• Changes in hormonal balance during pregnancy.
• Smoking and alcohol abuse .

Symptoms of gallstone disease

The manifestations of the disease are extremely varied. Most often, the following forms of GSD are distinguished:

• latent,
• chronic dyspeptic,
• chronic pain,
• chronic relapsing,
• other forms.

In a certain sense, these forms can be considered as stages in the development of cholelithiasis. In the same patient, after a period of latent course, dyspeptic disorders may appear, after a while – a moderately severe pain syndrome and, finally, typical attacks of hepatic colic. However, such a development of the disease is far from necessary. Often, its first manifestation may be an attack of acute cholecystitis and hepatic colic.

Dyspeptic form of cholelithiasis

It is characterized by complaints associated with a violation of the digestive process. There is a feeling of heaviness in the stomach, heartburn, flatulence, unstable stool. Usually these sensations occur periodically, but can be permanent. They usually occur after meals. Moreover, patients often associate their appearance with the use of certain foods: fatty, fried, spicy dishes. The appearance of complaints can also be associated with taking too large portions of food.

Painful chronic form of cholelithiasis

It proceeds without bouts of acute pain. The pains are aching in nature, localized under the pit of the stomach and in the right hypochondrium, aggravated after eating, especially fatty foods. Their irradiation to the region of the right scapula is characteristic. The long existence of stones in the gallbladder can last indefinitely, but, ultimately, leads to the occurrence of an inflammatory process in it.

Chronic calculous cholecystitis

One of the frequent manifestations of chronic calculous cholecystitis is constant heaviness and pain in the right hypochondrium, nausea, which is aggravated by fatty and spicy foods. Small stones can be manifested by hepatic colic: an attack of acute pain in the right side of the abdomen, sometimes in the epigastric region. An attack can be triggered by the intake of fatty spicy foods or alcohol, as well as shaking while driving or stress. Vomiting and nausea are frequent companions of pain. Characterized by irradiation of pain in the right shoulder blade, right shoulder or right arm. The cause of a painful attack may be wedging a stone into the neck of the gallbladder. This leads to severe spasm. The gallbladder itself at this time is significantly reduced, trying to push out the bile, but a stuck stone prevents it from leaving. The duration of the pain attack is different – from several minutes to many hours and even days. If the obstruction has been removed and the stone has ceased to block the exit from the gallbladder, the symptoms quickly subside. Vomiting stops, temperature normalizes; general well-being improves. For some time, weakness and a feeling of weakness persist, and dyspeptic phenomena are occasionally noted. The patient’s condition may remain quite satisfactory until the next attack, which may develop in a few days, weeks, months or years.

Consequences of chronic cholecystitis

People who suffer from chronic cholecystitis for a long time end up risking their health and even their lives. The inflammatory process from the gallbladder spreads to neighboring organs, primarily the pancreas and liver. Almost all such patients have a chronic form of pancreatitis and changes in the liver. At the same time, irreversible changes occur in the gallbladder, which leads to three options for the development of the disease.

1. 1. The process of gallstone formation does not stop. The addition of infection and inflammation creates favorable conditions for the growth and formation of new stones. The bubble is filled with stones and ceases to be a reservoir for the accumulation of bile. It cannot perform its main functions in the digestive process. Food is poorly digested.
2. 2. Frequent inflammation of the gallbladder due to attacks of hepatic colic leads to a change in the wall of the gallbladder: it becomes overgrown with adhesions, and the muscles are replaced by dense scar tissue. The bladder cavity sharply decreases in size, a “scar-wrinkled bladder” is formed, which also does not participate in the digestion process.
3. 3. When the cystic duct is blocked by a stone, the bladder becomes large and overdistended. Overflowing with bile, which does not find a way out, the bladder loses its ability to contract, and even after the stone leaves the duct, it remains stretched, while it is no longer able to push out the bile. Gradually, the contents become colorless – “white bile”. Hydrocele of the gallbladder develops. Sometimes it is asymptomatic (apparently, the patient simply forgets about the attack). However, if dropsy appeared after an attack of hepatic colic, the enlarged gallbladder remains painful for a long time. Such a gallbladder is also turned off from the digestion process. In addition, bile, which remains in the gallbladder and is not renewed, easily suppurates when an infection joins, gallbladder empyema develops.

It is necessary to carry out a differential diagnosis of biliary (hepatic) colic from an attack of acute calculous cholecystitis. This is inflammation of the gallbladder, provoked by the presence of stones in it, which is manifested not only by severe pain, but also by the presence of fever, signs of intoxication, sometimes positive peritoneal symptoms and requires emergency inpatient treatment. The appearance of a fever, jaundice, and a decrease in blood pressure in a patient with cholelithiasis requires the exclusion of such possible complications as acute cholecystitis, pancreatitis, cholangitis, etc.

Basic methods for diagnosing gallbladder stones

Laboratory studies

1. With an exacerbation of gallstone disease, changes in the clinical blood test are observed: the number of leukocytes increases with the appearance of their young forms, the ESR rises, which indicates the presence of an inflammatory process. There may be changes in the biochemical parameters of the blood: an increase in the level of hepatic transaminases, amylase, lipase, total bilirubin. In most cases of asymptomatic stone carrying, the blood test may not be changed. Also, without changes in laboratory parameters, short attacks of biliary colic can pass.

Instrumental diagnostics

1. 1. The most accessible and effective method for screening diagnostics of all stages of cholelithiasis is abdominal ultrasound (ultrasound). Ultrasound of the liver and gallbladder allows you to see stones in the bladder cavity, determine their size, mobility, evaluate the size of the residual cavity of the gallbladder, identify signs of inflammation or deformation of its wall. Also, with ultrasound, the intra- and extrahepatic bile ducts are clearly visible, it is possible to assess their deformation, expansion and the presence of additional inclusions (calculi) in them.
2. 2. A more accurate diagnosis of the condition of the biliary tract is shown by magnetic resonance imaging – MR cholangiography.
   When performing MR – cholangiography, an image of the gallbladder, cystic duct, segmental, lobar ducts, common hepatic duct, choledochus and main pancreatic duct is obtained. You can evaluate their deformation, identify the expansion or narrowing of their lumen in certain areas. It becomes possible to accurately visualize stones not only in the gallbladder, but also in the lumen of the bile ducts. Additional examination methods for cholelithiasis include computed tomography (CT) and videoduodenoscopy.
3. 3. Computed tomography (CT) of the abdominal cavity is performed in case of suspected pathology of neighboring organs (liver, pancreas), in case of suspected oncological pathology in the biliary system.
4. 4. Video gastroduodenoscopy is an endoscopic examination that resembles video gastroscopy, but is performed using a special endoscope with lateral optics, which allows you to clearly see the area of ​​\u200b\u200bthe major duodenal papilla or “papilla of Vater” (the place where the bile ducts enter the duodenum).

Treatment of cholelithiasis and chronic calculous cholecystitis

Conservative treatment of gallstones

In the arsenal of doctors there are preparations of ursodeoxycholic acid, which changes the chemical composition of bile. These are drugs henofalk and ursofalk, they are prescribed for the purpose of drug lithosis (dissolution of stones). Treatment should be carried out against the background of strict adherence to diet and diet, as well as anti-inflammatory therapy. The duration of treatment is up to 2.5-3 years and does not always achieve the desired result. It should be remembered that true “stones”, consisting mainly of calcium, do not dissolve. Therefore, drug treatment can be used only in the initial stages of the disease, when the sediment in the bile is mainly represented by cholesterol stones.

Gallbladder removal surgery with stones

Cholecystectomy – removal of the gallbladder – the main method of surgical treatment. The operation is performed either in an open way through an incision in the abdominal wall, or laparoscopically – endovideosurgical cholecystectomy. The purpose of the operation: removal of the gallbladder with stones. The difference lies only in what instruments the surgeon works with and in what way the gallbladder with stones is removed.

In an open surgical operation, the incision through which the bladder is removed can be made from the xiphoid process to the navel, or the second access is in the right hypochondrium. The laparoscopic method is less traumatic – special instruments and optics are inserted through 4 small incisions on the skin. With the help of these tools, the gallbladder is removed. After such an operation, the scars are hardly noticeable. The length of stay in a hospital bed is 2-3 days. A week later, the patient is well.

Patient essential

In the modern world, cholelithiasis is a well-studied pathology, and laparoscopic surgery is the “gold standard of treatment”. Unfortunately, many people do not pay attention to the initial manifestations of the disease, do not undergo clinical examination or preventive examination to detect stones in the gallbladder. As a result, the disease is detected at late stages, when drug treatment is not only ineffective, but also contraindicated, and the success of a minimally invasive surgical operation also becomes doubtful.

In the presence of the complaints described above, as well as the listed risk factors, it is necessary to contact a surgeon or a gastroenterologist for recommendations on examination and selection of optimal treatment or preventive measures.

Our Clinic performs a full range of diagnostics, surgical and endoscopic treatment of cholelithiasis and its complications. Surgical operations in most cases are performed minimally invasively using laparoscopic and endoscopic technologies.

Gallbladder stones: types, symptoms and treatment

The gallbladder is an important organ that takes part in the digestive process. It is responsible for the accumulation and storage of bile. With violations in his work, a person begins to be disturbed by pain in the right side of the abdominal cavity and other unpleasant symptoms. One of the reasons why the gallbladder ceases to function normally is the formation of gallstones.

Hard formations result from stagnant bile. During stagnant processes, its individual components precipitate and crystallize. These crystallized formations are gallstones. At first, they do not cause discomfort to the patient, but over the years they increase in size and disrupt the functioning of the gallbladder. If you do not see a doctor in time, a number of complications may occur: blockage of the bile ducts, acute cholecystitis, biliary pancreatitis, fistula formation.

Why do gallstones appear?

Causes that cause thickening and stagnation of bile:

• malnutrition: overeating, abuse of fatty, fried, smoked foods, lack of vegetables and fruits in the diet, prolonged starvation;
• high cholesterol;
• diet high in animal fats;
• diabetes mellitus;
• metabolic disorder;
• presence of parasites;
• overweight;
• hormonal changes in the body – pregnancy, menopause, treatment with drugs containing hormones;
• certain diseases: diabetes mellitus, infectious diseases, biliary dyskinesia, Crohn’s disease, hepatitis, cirrhosis and other liver pathologies;
• long-term treatment with certain drugs;
• taking hormonal contraceptives;
• frequent drinking;
• unfavorable heredity.

Patients who have one or more risk factors should be vigilant about their health and have an abdominal ultrasound examination once a year.

Symptoms of gallstones

At first, gallstone disease is asymptomatic. A person may not be aware of the formation of calculi for years until the problem is detected on a routine ultrasound examination. Pathology can be suspected by the following signs:

• discomfort, heaviness, pain in the right hypochondrium, worse after eating;
• bitter taste in the mouth;
• frequent belching;
• dark urine;
• light-colored feces;
• stool disorders;
• intermittent nausea.

If the stone moves along the duct, pain may be felt in the lower abdomen, radiating to the thigh.

Movement of stones may cause blockage of the bile duct or duodenal papilla. In this case, intestinal colic will occur, which is accompanied by:

• severe pain that may radiate to the back;
• yellowing of the skin, mucous membranes, sclera of the eyes;
• bilious vomiting;
• fever – a symptom indicates the development of an acute inflammatory process.

An attack of colic can last from half an hour to 12 hours. After the stone moves into the duodenum and the bile flow is restored, the pain subsides. However, colic will resume as soon as the next element moves. Therefore, gallstones are a problem, the solution of which cannot be postponed until later. Otherwise, the patient will face complications that require urgent surgical intervention.

What types of stones are found in the gallbladder?

Solid masses in the gallbladder vary in color, shape, size and composition. They are usually round in shape. Stones that fit snugly against each other will be uneven, with edges. The range of sizes varies from small, like sand, to large, filling the bubble cavity completely.

According to their composition, calculi are divided into:

• Cholesterol stones are formed as a result of disorders in the metabolism of cholesterol and bile acids. They have a yellowish, golden or greenish tint. More common in people who are overweight. The formation of such stones is rarely accompanied by an inflammatory process, so their presence goes unnoticed for a long time.
• Bilirubin – formed due to changes in the composition of the blood. More often these are rounded single calculi of a dark color, but there are also multiple calculi of small sizes.
• Calcium – formed as a result of inflammatory processes in the gallbladder. They have a whitish tint, in addition to calcium, they contain dead epithelial cells, as well as cholesterol.
• Mixed – most common. They have a layered structure, consist of different elements – cholesterol, glycoprotein, bile acids, etc. Mixed stones often cause biliary colic.

Diagnosis of cholelithiasis

The diagnosis is made on the basis of a medical examination, the results of laboratory tests of urine and blood, as well as instrumental studies.

Instrumental methods that make it possible to examine the ducts, assess the localization, size, shape of calculi, determine their composition:

• ultrasound examination of the abdominal cavity;
• magnetic resonance imaging;
• computed tomography;
• cholecystocholangiography – X-ray examination using contrast. Stones that are not detected by X-ray,
• are called X-ray negative.

Examination methods are determined by the doctor based on the symptoms, clinical picture, and the patient’s condition. Further therapeutic tactics depend on the results obtained.

How to treat gallstones?

There are three types of medical tactics for gallstone disease:

Observation – used for asymptomatic course and absence of inflammatory processes.
Conservative therapy – a tactic aimed at dissolving stones with the help of medications or shock wave lithotripsy – destroying stones with a laser or ultrasound.

As medicines the patient is prescribed:

• antispasmodics – reduce pain caused by contraction of the gallbladder;
• medicines that normalize the composition of bile, such as drugs based on ursodeoxycholic acid, such as Ursaclin.
• digestive enzymes;
• cholagogues

For gallstones, treatment with tablets should be agreed with the doctor. The specialist will prescribe the dosage, regimen and duration of taking the drugs. During therapy, the doctor monitors the dynamics with the help of ultrasound. Drug therapy is more likely to be effective in the presence of X-ray negative stones. For large pigmented and calcified calculi, other methods of treatment are required.

• Shock wave lithotripsy is used infrequently. The method is suitable for patients with mild symptoms, high duct patency and small cholesterol formations.
• Surgical treatment – removal of the gallbladder (cholecystectomy). It is used when conservative methods are ineffective.

Cholecystectomy can be performed in two ways:

• by cavitary – used in advanced form of gallstone disease, accompanied by inflammation of the bladder walls;
• laparoscopic – the procedure is performed through small punctures in the abdominal cavity. This is a safer method, after which the patient recovers faster than after abdominal surgery.

For stones in the gallbladder, the doctor prescribes treatment, focusing on the patient’s condition, the number and size of stones, and the presence of an inflammatory process. If the doctor recommends cholecystectomy, do not be afraid and postpone the procedure. The gallbladder is not a vital organ; patients live without it for many years, practically without changing their habitual lifestyle.

Gallbladder stones: treatment with diet

In case of gallstone disease, the patient must follow a special diet, which includes:

• cereals;
• non-acid fruits and vegetables;
• low-fat dairy and sour-milk products;
• lean meats and fish;
• vegetable broth soups;
• vegetable oils.

Food should be steamed, boiled or stewed.

To be excluded from the diet:

• canned food;
• hot spices and condiments;
• sauces;
• strong tea and coffee;
• sparkling water;
• fatty meats;
• hard-boiled eggs;
• smoked products;
• fresh pastries;
• chocolate.