Small stones in the gallbladder: Gallstones – Symptoms and causes
Gallstones Picture, Causes, Age, & Symptoms
Gallstones are crystal-like deposits that develop in the gallbladder — a small, pear-shaped organ that stores bile, a digestive fluid produced by the liver.
These deposits may be as small as a grain of sand or as large as a golf ball; they may be hard or soft, smooth or jagged. You may have several gallstones or just one.
Some 30 million American adults suffer from gallstones. Yet most of those who have the condition do not realize it. In this case, what you don’t know probably won’t hurt you; gallstones that are simply floating around inside the gallbladder generally cause no symptoms and no harm.
These “silent” stones usually go unnoticed unless they show up in an ultrasound exam conducted for some other reason. However, the longer a stone exists in the gallbladder, the more likely it is to become problematic. People who have gallstones without symptoms have 20% chance of having an episode of pain during their lifetime.
When symptoms do occur, it’s usually because the gallstone has moved and become lodged within a duct that carries bile, such as the cystic duct, a small conduit that connects the gallbladder to another tube called the common bile duct. The typical symptom is abdominal pain, perhaps accompanied by nausea, indigestion, or fever. The pain, caused by the gallbladder’s contraction against the lodged stone, generally occurs within an hour of eating a large meal or in the middle of the night. Stones can also clog the common bile duct, which carries bile into the small intestine, and the hepatic ducts, which take bile out of the liver.
Obstructions in the bile pathway may cause a duct to become inflamed and possibly infected. Blockage of the common bile duct, which merges with the pancreatic duct at the small intestine, can also lead to inflammation of the pancreas (gallstone pancreatitis).
In a rare but dangerous condition that occurs most often in older women, gallstones migrate into the small intestine and block the passageway into the large intestine; symptoms include severe and frequent vomiting. Although gallstones are present in about 80% of people with gallbladder cancer, it is uncertain whether gallstones play a role, except when really large stones (greater than 3 centimeters in diameter) are present.
About a million new cases of gallstones are diagnosed in the U.S. each year. For reasons that are still unclear, women are two times more likely than men to be afflicted. Native Americans have the highest rates of gallstones in the U.S. because they have a genetic disposition to secrete high levels of cholesterol in bile (a contributing factor to gallstones.) Mexican-Americans also have high rates of gallstones.
Gallstones are also more common in people over age 60, in those who are obese or have lost a lot of weight in a short amount of time, in those who have diabetes or sickle cell disease, and in women who have had multiple pregnancies and who take hormone replacement therapy or birth control pills.
What Causes Gallstones?
The primary function of the gallbladder is to store bile, a brown or yellowish fluid that helps the body break down fatty food. When you eat a meal, the gallbladder releases its stored bile into the cystic duct. From there the fluid passes through the common bile duct and into the small intestine to mix with food.
Chief among the ingredients of bile are cholesterol and bile acids. Normally, the concentration of bile acids is high enough to break down the cholesterol in the mixture and keep it in liquid form. However, a diet high in fat can tip this delicate balance, causing the liver to produce more cholesterol than the bile acids are able to handle. As a result, some of this excess cholesterol begins to solidify into crystals, which we call gallstones. About 80% of all gallstones are called cholesterol stones and are created this way. The remaining 20% consist of calcium mixed with the bile pigment bilirubin and are called pigment stones. 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.
Gallstones Diagnosis, Tests, & Treatments
How Do I Know if I Have Gallstones?
If your symptoms suggest a gallstone problem, your doctor might first examine your skin for jaundice, and then feel your abdomen to check for tenderness. A blood test may reveal evidence of an obstruction.
Because other digestive problems, such as an infection of the duct, can produce symptoms similar to those of a gallstone attack, the doctor may also run other tests to determine if gallstones are in fact the culprit.
The most common technique is an ultrasound exam. This quick, painless procedure uses high-frequency sound waves to create pictures of the gallbladder, bile duct, and their contents. CT scans are also sometimes done to look at the anatomy of your internal organs.
A more complicated test may be used if the doctor suspects that a gallstone is lodged in a bile duct. Commonly known by the acronym ERCP, this test allows the doctor to look at the bile duct through a small flexible tube called an endoscope. The doctor sprays the back of the patient’s throat with an anesthetic drug to prevent gagging, sedates the patient, and passes the endoscope into the mouth, through the stomach, and into the area of the small intestine where the bile duct enters. Dye is injected through the tube and into the bile duct, and then the doctor takes X-rays. Stone removal can be done during this procedure as well. The procedure takes about an hour.
What Are the Treatments for Gallstones?
In most cases, treatment of gallstones is considered necessary only if you are having symptoms. Of the various conventional treatments that are available, surgical removal of the gallbladder is the most widely used. Some alternative treatments have also been found to be effective in alleviating the symptoms of troublesome gallstones.
Conventional Medicine for Gallstones
When deciding what course of action to take for symptomatic gallstones, doctors usually choose from among three main treatment options: Watchful waiting, nonsurgical therapy, and surgical removal of the gallbladder.
Gallstones and Watchful Waiting
Though a gallstone episode can be extremely painful or frightening, almost a third to half of all people who experience an attack never have a recurrence. In some cases, the stone dissolves or becomes dislodged and thereby resumes its “silence.” Because the problem may solve itself without intervention, many doctors take a wait-and-see approach following the initial episode.
Even when the patient has had repeated gallstone episodes, the doctor may postpone treatment or surgery because of other health concerns. If your surgery has been delayed, you should remain under a doctor’s care and report any recurrences of gallstone symptoms immediately.
Nonsurgical Therapy for Gallstones
If you are unable or unwilling to go through surgery for a gallstone problem that requires treatment, your doctor may recommend one of several noninvasive techniques. Note that though these methods may destroy symptom-causing gallstones, they can do nothing to prevent others from forming, and recurrence is common.
Some gallstones can be dissolved through the use of a bile salt, although the procedure can be used only with stones formed from cholesterol and not from bile pigments. The drug Actigall (ursodiol) is taken as a tablet; depending on its size, the gallstone may take months or even years to go away. Because some stones are calcified, this treatment often doesn’t work.
Another nonsurgical technique, shock wave therapy, uses high-frequency sound waves to fragment the stones. Bile salt is administered afterward to dissolve small pieces. This therapy is rarely used.
Doctors can also attempt to remove gallstones during an ERCP. During the procedure an instrument is inserted through the endoscope to attempt removal of the stone.
While these therapies may work for some, all of the above nonsurgical therapies are usually unsuccessful long term (since recurrence is common) and are rarely advised in clinical practice.
Surgery to Remove the Gallbladder
While the gallbladder serves an important function, it is not essential for a normal, healthy life. When gallstones are persistently troublesome, doctors often recommend removing the organ entirely. This operation is considered among the safest of all surgical procedures. Each year approximately 750,000 Americans have their gallbladder removed. It is also the only treatment method that eliminates the possibility that other gallstones will develop in the future.
When the gallbladder has been removed, bile flows directly from the liver into the small intestine, and this sometimes leads to diarrhea. Because bile no longer accumulates in the gallbladder, quantities of the digestive fluid cannot be stored up and used to break down an especially fatty meal. This condition is not considered serious, however, and can be corrected by simply limiting fat in the diet.
In the past, removal of the gallbladder was done through traditional “open” surgery, which requires surgeons to make a large incision in the abdomen. Patients faced a two- or three-day hospital stay plus several weeks of recovery at home.
Today, however, the most commonly used surgical technique is a much simpler approach known as laparoscopic cholecystectomy. The doctor makes several small incisions in the abdomen, then uses special pencil-thin instruments to remove the gallbladder. A tiny microscope and video camera, snaked through the incision to the site, allow the surgeon to view the operation.
Laparoscopic surgery is highly effective and very safe. It has reduced the hospital stay to a day or two. Patients report less pain and are generally able to resume a normal lifestyle in a short period of time. However, people who are obese or who have a severe infection or inflammation in the gallbladder may still be considered candidates for traditional open surgery.
Approach Considerations, Treatment of Asymptomatic Gallstones, Treatment of Patients with Symptomatic Gallstones
Douglas M Heuman, MD, FACP, FACG, AGAF Chief of Hepatology, Hunter Holmes McGuire Department of Veterans Affairs Medical Center; Professor, Department of Internal Medicine, Division of Gastroenterology, Virginia Commonwealth University School of Medicine
Douglas M Heuman, MD, FACP, FACG, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Physicians, American Gastroenterological Association
Disclosure: Received grant/research funds from Novartis for other; Received grant/research funds from Bayer for other; Received grant/research funds from Otsuka for none; Received grant/research funds from Bristol Myers Squibb for other; Received none from Scynexis for none; Received grant/research funds from Salix for other; Received grant/research funds from MannKind for other.
Anastasios A Mihas, MD, DMSc, FACP, FACG Professor, Department of Medicine, Division of Gastroenterology, Virginia Commonwealth University School of Medicine; Consulting Staff, Virginia Commonwealth University Hospitals and Clinics; Chief of GI Clinical Research, Director of GI Outpatient Service, Associate Director of Hepatology, Hunter Holmes McGuire Veterans Affairs Medical Center
Anastasios A Mihas, MD, DMSc, FACP, FACG is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, Sigma Xi, The Scientific Research Honor Society, Southern Society for Clinical Investigation, American Federation for Clinical Research, Gastroenterology Research Group
Disclosure: Nothing to disclose.
Jeff Allen, MD Assistant Professor, Department of Surgery, University of Louisville
Disclosure: Nothing to disclose.
BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine
BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.
Firass Abiad, MD Head of Division, General and Laparoscopic Surgery, Specialized Medical Center Hospital, Saudi Arabia
Disclosure: Nothing to disclose.
BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine
Disclosure: Nothing to disclose.
David Eric Bernstein, MD Director of Hepatology, North Shore University Hospital; Professor of Clinical Medicine, Albert Einstein College of Medicine
David Eric Bernstein, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.
Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.
David FM Brown, MD Associate Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital
Disclosure: Nothing to disclose.
William K Chiang, MD Associate Professor, Department of Emergency Medicine, New York University School of Medicine; Chief of Service, Department of Emergency Medicine, Bellevue Hospital Center
William K Chiang, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Medical Toxicology, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.
Alfred Cuschieri, MD, ChM, FRSE, FRCS, Head, Professor, Department of Surgery and Molecular Oncology, University of Dundee, UK
Imad S Dandan, MD Consulting Surgeon, Department of Surgery, Trauma Section, Scripps Memorial Hospital
Imad S Dandan, MD is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, American Medical Association, American Trauma Society, California Medical Association, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.
David Greenwald, MD Associate Professor of Clinical Medicine, Fellowship Program Director, Department of Medicine, Division of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine
David Greenwald, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, and New York Society for Gastrointestinal Endoscopy
Eugene Hardin, MD, FAAEM, FACEP Former Chair and Associate Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science; Former Chair, Department of Emergency Medicine, Martin Luther King Jr/Drew Medical Center
Disclosure: Nothing to disclose.
Faye Maryann Lee, MD Staff Physician, Department of Emergency Medicine, New York University/Bellevue Hospital Center
Faye Maryann Lee, MD is a member of the following medical societies: Phi Beta Kappa
Disclosure: Nothing to disclose.
Sally Santen, MD Program Director, Assistant Professor, Department of Emergency Medicine, Vanderbilt University
Disclosure: Nothing to disclose.
Assaad M Soweid, MD, FASGE, FACG Associate Professor of Clinical Medicine, Endosonography and Advanced Therapeutic Endoscopy, Director, Endoscopy-Bronchoscopy Unit, Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Lebanon
Assaad M Soweid, MD, FASGE, FACG is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Gynecological and Obstetrical Society, and American Medical Association
Disclosure: Nothing to disclose.
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Medscape Salary Employment
General Surgery – Gallstones
What are gallstones?
Gallstones are hard particles that develop in the gallbladder. The gallbladder is a small, pear-shaped organ located in the upper right abdomen—the area between the chest and hips—below the liver.
Gallstones can range in size from a grain of sand to a golf ball. The gallbladder can develop a single large gallstone, hundreds of tiny stones, or both small and large stones. Gallstones can cause sudden pain in the upper right abdomen. This pain, called a gallbladder attack or biliary colic, occurs when gallstones block the ducts of the biliary tract.
By BruceBlaus (Own work) [CC BY-SA 4. 0 (http://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons
What is the biliary tract?
The biliary tract consists of the gallbladder and the bile ducts. The bile ducts carry bile and other digestive enzymes from the liver and pancreas to the duodenum—the first part of the small intestine.
The liver produces bile—a fluid that carries toxins and waste products out of the body and helps the body digest fats and the fat-soluble vitamins A, D, E, and K. Bile mostly consists of cholesterol, bile salts, and bilirubin. Bilirubin, a reddish-yellow substance, forms when hemoglobin from red blood cells breaks down. Most bilirubin is excreted through bile.
The bile ducts of the biliary tract include the hepatic ducts, the common bile duct, the pancreatic duct, and the cystic duct. The gallbladder stores bile. Eating signals the gallbladder to contract and empty bile through the cystic duct and common bile duct into the duodenum to mix with food.
What causes gallstones?
Imbalances in the substances that make up bile cause gallstones. Gallstones may form if bile contains too much cholesterol, too much bilirubin, or not enough bile salts. Scientists do not fully understand why these imbalances occur. Gallstones also may form if the gallbladder does not empty completely or often enough.
The two types of gallstones are cholesterol and pigment stones:
- Cholesterol stones, usually yellow-green in color, consist primarily of hardened cholesterol. In the United States, more than 80 percent of gallstones are cholesterol stones.1
- Pigment stones, dark in color, are made of bilirubin.
Who is at risk for gallstones?
Certain people have a higher risk of developing gallstones than others:2
- Women are more likely to develop gallstones than men. Extra estrogen can increase cholesterol levels in bile and decrease gallbladder contractions, which may cause gallstones to form. Women may have extra estrogen due to pregnancy, hormone replacement therapy, or birth control pills.
- People over age 40 are more likely to develop gallstones than younger people.
- People with a family history of gallstones have a higher risk.
- American Indians have genetic factors that increase the amount of cholesterol in their bile. In fact, American Indians have the highest rate of gallstones in the United States—almost 65 percent of women and 30 percent of men have gallstones.
- Mexican Americans are at higher risk of developing gallstones.
Other factors that affect a person’s risk of gallstones include2
- Obesity. People who are obese, especially women, have increased risk of developing gallstones. Obesity increases the amount of cholesterol in bile, which can cause stone formation.
- Rapid weight loss. As the body breaks down fat during prolonged fasting and rapid weight loss, the liver secretes extra cholesterol into bile. Rapid weight loss can also prevent the gallbladder from emptying properly. Low-calorie diets and bariatric surgery—surgery that limits the amount of food a person can eat or digest—lead to rapid weight loss and increased risk of gallstones.
- Diet. Research suggests diets high in calories and refined carbohydrates and low in fiber increase the risk of gallstones. Refined carbohydrates are grains processed to remove bran and germ, which contain nutrients and fiber. Examples of refined carbohydrates include white bread and white rice.
- Certain intestinal diseases. Diseases that affect normal absorption of nutrients, such as Crohn’s disease, are associated with gallstones.
- Metabolic syndrome, diabetes, and insulin resistance. These conditions increase the risk of gallstones. Metabolic syndrome also increases the risk of gallstone complications. Metabolic syndrome is a group of traits and medical conditions linked to being overweight or obese that puts people at risk for heart disease and type 2 diabetes.
More information about these conditions is provided in the NIDDK health topic, Insulin Resistance and Prediabetes.
Pigment stones tend to develop in people who have
- cirrhosis—a condition in which the liver slowly deteriorates and malfunctions due to chronic, or long lasting, injury
- infections in the bile ducts
- severe hemolytic anemias—conditions in which red blood cells are continuously broken down, such as sickle cell anemia
What are the symptoms and complications of gallstones?
Many people with gallstones do not have symptoms. Gallstones that do not cause symptoms are called asymptomatic, or silent, gallstones. Silent gallstones do not interfere with the function of the gallbladder, liver, or pancreas.
If gallstones block the bile ducts, pressure increases in the gallbladder, causing a gallbladder attack. The pain usually lasts from 1 to several hours.1 Gallbladder attacks often follow heavy meals, and they usually occur in the evening or during the night.
Gallbladder attacks usually stop when gallstones move and no longer block the bile ducts. However, if any of the bile ducts remain blocked for more than a few hours, complications can occur. Complications include inflammation, or swelling, of the gallbladder and severe damage or infection of the gallbladder, bile ducts, or liver.
A gallstone that becomes lodged in the common bile duct near the duodenum and blocks the pancreatic duct can cause gallstone pancreatitis—inflammation of the pancreas.
Left untreated, blockages of the bile ducts or pancreatic duct can be fatal.
When should a person talk with a health care provider about gallstones?
People who think they have had a gallbladder attack should notify their health care provider. Although these attacks usually resolve as gallstones move, complications can develop if the bile ducts remain blocked.
People with any of the following symptoms during or after a gallbladder attack should see a health care provider immediately:
- abdominal pain lasting more than 5 hours
- nausea and vomiting
- fever—even a low-grade fever—or chills
- yellowish color of the skin or whites of the eyes, called jaundice
- tea-colored urine and light-colored stools
These symptoms may be signs of serious infection or inflammation of the gallbladder, liver, or pancreas.
How are gallstones diagnosed?
A health care provider will usually order an ultrasound exam to diagnose gallstones. Other imaging tests may also be used.
- Ultrasound exam. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. A specially trained technician performs the procedure in a health care provider’s office, outpatient center, or hospital, and a radiologist—a doctor who specializes in medical imaging—interprets the images. Anesthesia is not needed. If gallstones are present, they will be visible in the image. Ultrasound is the most accurate method to detect gallstones.
- Computerized tomography (CT) scan. A CT scan is an x ray that produces pictures of the body. A CT scan may include the injection of a special dye, called contrast medium. CT scans use a combination of x rays and computer technology to create three-dimensional (3-D) images. CT scans require the person to lie on a table that slides into a tunnel-shaped device where the x rays are taken. An x-ray technician performs the procedure in an outpatient center or hospital, and a radiologist interprets the images. Anesthesia is not needed. CT scans can show gallstones or complications, such as infection and blockage of the gallbladder or bile ducts. However, CT scans can miss gallstones that are present.
- Magnetic resonance imaging (MRI). MRI machines use radio waves and magnets to produce detailed pictures of the body’s internal organs and soft tissues without using x rays. A specially trained technician performs the procedure in an outpatient center or hospital, and a radiologist interprets the images. Anesthesia is not needed, though people with a fear of confined spaces may receive light sedation. An MRI may include the injection of contrast medium. With most MRI machines, the person lies on a table that slides into a tunnel-shaped device that may be open ended or closed at one end; some newer machines allow the person to lie in a more open space. MRIs can show gallstones in the ducts of the biliary system.
- Cholescintigraphy. Cholescintigraphy—also called a hydroxyl iminodiacetic acid scan, HIDA scan, or hepatobiliary scan—uses an unharmful radioactive material to produce pictures of the biliary system. In cholescintigraphy, the person lies on an exam table and a health care provider injects a small amount of unharmful radioactive material into a vein in the person’s arm. The health care provider may also inject a substance that causes the gallbladder to contract. A special camera takes pictures of the radioactive material as it moves through the biliary system. A specially trained technician performs the procedure in an outpatient center or hospital, and a radiologist interprets the images. Anesthesia is not needed. Cholescintigraphy is used to diagnose abnormal contractions of the gallbladder or obstruction of the bile ducts.
- Endoscopic retrograde cholangiopancreatography (ERCP). ERCP uses an x ray to look into the bile and pancreatic ducts. After lightly sedating the person, the health care provider inserts an endoscope—a small, flexible tube with a light and a camera on the end—through the mouth into the duodenum and bile ducts. The endoscope is connected to a computer and video monitor. The health care provider injects contrast medium through the tube into the bile ducts, which makes the ducts show up on the monitor. The health care provider performs the procedure in an outpatient center or hospital. ERCP helps the health care provider locate the affected bile duct and the gallstone. The stone is captured in a tiny basket attached to the endoscope and removed. This test is more invasive than other tests and is used selectively.
Health care providers also use blood tests to look for signs of infection or inflammation of the bile ducts, gallbladder, pancreas, or liver. A blood test involves drawing blood at a health care provider’s office or commercial facility and sending the sample to a lab for analysis.
Gallstone symptoms may be similar to those of other conditions, such as appendicitis, ulcers, pancreatitis, and gastroesophageal reflux disease.
Sometimes, silent gallstones are found when a person does not have any symptoms. For example, a health care provider may notice gallstones when performing ultrasound for a different reason.
How are gallstones treated?
If gallstones are not causing symptoms, treatment is usually not needed. However, if a person has a gallbladder attack or other symptoms, a health care provider will usually recommend treatment. A person may be referred to a gastroenterologist—a doctor who specializes in digestive diseases—for treatment. If a person has had one gallbladder attack, more episodes will likely follow.
The usual treatment for gallstones is surgery to remove the gallbladder. If a person cannot undergo surgery, nonsurgical treatments may be used to dissolve cholesterol gallstones. A health care provider may use ERCP to remove stones in people who cannot undergo surgery or to remove stones from the common bile duct in people who are about to have gallbladder removal surgery.
Surgery to remove the gallbladder, called cholecystectomy, is one of the most common operations performed on adults in the United States.
The gallbladder is not an essential organ, which means a person can live normally without a gallbladder. Once the gallbladder is removed, bile flows out of the liver through the hepatic and common bile ducts and directly into the duodenum, instead of being stored in the gallbladder.
Surgeons perform two types of cholecystectomy:
Laparoscopic cholecystectomy. In a laparoscopic cholecystectomy, the surgeon makes several tiny incisions in the abdomen and inserts a laparoscope—a thin tube with a tiny video camera attached. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close-up view of organs and tissues. While watching the monitor, the surgeon uses instruments to carefully separate the gallbladder from the liver, bile ducts, and other structures. Then the surgeon removes the gallbladder through one of the small incisions. Patients usually receive general anesthesia.
Most cholecystectomies are performed with laparoscopy. Many laparoscopic cholecystectomies are performed on an outpatient basis, meaning the person is able to go home the same day. Normal physical activity can usually be resumed in about a week.3
Open cholecystectomy. An open cholecystectomy is performed when the gallbladder is severely inflamed, infected, or scarred from other operations. In most of these cases, open cholecystectomy is planned from the start. However, a surgeon may perform an open cholecystectomy when problems occur during a laparoscopic cholecystectomy. In these cases, the surgeon must switch to open cholecystectomy as a safety measure for the patient.
To perform an open cholecystectomy, the surgeon creates an incision about 4 to 6 inches long in the abdomen to remove the gallbladder. 4 Patients usually receive general anesthesia. Recovery from open cholecystectomy may require some people to stay in the hospital for up to a week. Normal physical activity can usually be resumed after about a month.3
A small number of people have softer and more frequent stools after gallbladder removal because bile flows into the duodenum more often. Changes in bowel habits are usually temporary; however, they should be discussed with a health care provider.
Though complications from gallbladder surgery are rare, the most common complication is injury to the bile ducts. An injured common bile duct can leak bile and cause a painful and possibly dangerous infection. One or more additional operations may be needed to repair the bile ducts. Bile duct injuries occur in less than 1 percent of cholecystectomies.5
Nonsurgical Treatments for Cholesterol Gallstones
Nonsurgical treatments are used only in special situations, such as when a person with cholesterol stones has a serious medical condition that prevents surgery. Gallstones often recur within 5 years after nonsurgical treatment.6
Two types of nonsurgical treatments can be used to dissolve cholesterol gallstones:
- Oral dissolution therapy. Ursodiol (Actigall) and chenodiol (Chenix) are medications that contain bile acids that can dissolve gallstones. These medications are most effective in dissolving small cholesterol stones. Months or years of treatment may be needed to dissolve all stones.
- Shock wave lithotripsy. A machine called a lithotripter is used to crush the gallstone. The lithotripter generates shock waves that pass through the person’s body to break the gallstone into smaller pieces. This procedure is used only rarely and may be used along with ursodiol.
Eating, Diet, and Nutrition
Factors related to eating, diet, and nutrition that increase the risk of gallstones include
- rapid weight loss
- diets high in calories and refined carbohydrates and low in fiber
People can decrease their risk of gallstones by maintaining a healthy weight through proper diet and nutrition.
Ursodiol can help prevent gallstones in people who rapidly lose weight through low-calorie diets or bariatric surgery. People should talk with their health care provider or dietitian about what diet is right for them.
Points to Remember
- Gallstones are hard particles that develop in the gallbladder.
- Imbalances in the substances that make up bile cause gallstones. Gallstones may form if bile contains too much cholesterol, too much bilirubin, or not enough bile salts. Scientists do not fully understand why these imbalances occur.
- Women, people over age 40, people with a family history of gallstones, American Indians, and Mexican Americans have a higher risk of developing gallstones.
- Many people with gallstones do not have symptoms. Gallstones that do not cause symptoms are called asymptomatic, or silent, gallstones.
- If gallstones block the bile ducts, pressure increases in the gallbladder, causing a gallbladder attack.
- Gallbladder attacks often follow heavy meals, and they usually occur in the evening or during the night.
- Gallstone symptoms may be similar to those of other conditions.
- If gallstones are not causing symptoms, treatment is usually not needed. However, if a person has a gallbladder attack or other symptoms, a health care provider will usually recommend treatment.
- The usual treatment for gallstones is surgery to remove the gallbladder. If a person cannot undergo surgery, nonsurgical treatments may be used to dissolve cholesterol gallstones. A health care provider may use endoscopic retrograde cholangiopancreatography (ERCP) to remove stones in people who cannot undergo surgery or to remove stones from the common bile duct in people who are about to have gallbladder removal surgery.
- The gallbladder is not an essential organ, which means a person can live normally without a gallbladder. Once the gallbladder is removed, bile flows out of the liver through the hepatic and common bile ducts and directly into the duodenum, instead of being stored in the gallbladder.
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Gallstones top to toe: what the radiologist needs to know | Insights into Imaging
The broad spectrum of gallstone-related disease can be broken down based on the anatomical locations in which they occur (Fig. 8).
Illustration outlines the multitude of locations within the digestive tract where gallstones can manifest and lists the pathological processes that occur in these locations
Unsurprisingly, the most common location for gallstones and thus gallstone-related disease is the gallbladder.
Biliary colic is caused when a stone temporarily obstructs the drainage from the cystic duct, resulting in severe cramping abdominal and right upper quadrant pain that can radiate to the back and right shoulder tip as the gallbladder contracts (typically, these symptoms are temporary and subside with resolution of the cystic duct obstruction). Ultrasonography will often demonstrate cholelithiasis without associated complications in patients with simple biliary colic.
Calculous cholecystitis refers to infection and inflammation of the gallbladder wall caused by irritation from gallstones, and this can be an acute or chronic process. The typical clinical presentation of acute cholecystitis is of right upper quadrant pain, with or without radiation to the right shoulder, which is more constant compared to the intermittent pain seen in biliary colic. There is usually associated pyrexia and other infective symptoms such as nausea and vomiting. The typical imaging features of acute cholecystitis are as follows: gallbladder wall thickening, pericholecystic fluid and a distended gallbladder  (Figs. 9 and 10). Chronic cholecystitis is caused by repeated episodes of biliary colic and acute cholecystitis over time, and in contrast to acute cholecystitis, the gallbladder is usually shrunken down and the wall is thickened and scarred.
Sagittal ultrasound image of the gallbladder which contains hyperechoic gallstones. There is gallbladder wall thickening (black arrow) and pericholecystic fluid (white arrow) consistent with acute calculous cholecystitis
Coronal (a) and axial (b) contrast-enhanced CT of the abdomen. There is gallbladder wall thickening (black arrow) and pericholecystic fluid (white arrows) consistent with acute cholecystitis
Emphysematous cholecystitis (EC) is a particular entity in which the gallbladder wall becomes necrotic, and this typically occurs with bacterial organisms such as the gas forming organisms such as clostridium, or with E. coli infections. Although rare, EC is associated with high mortality secondary to gallbladder perforation and gangrene, and EC is seen more commonly in patients with diabetes mellitus, coronary artery disease and SIRS (systemic inflammatory response syndrome) . On plain films and CT, gas can be seen within the gallbladder wall (Fig. 11).
Coronal contrast-enhanced CT of the abdomen demonstrating a markedly distended gallbladder. There are multiple locules of gas within the anti-dependent gallbladder wall (arrow). Findings are consistent with emphysematous cholecystitis
If an episode of acute cholecystitis is particularly severe or left untreated, it can progress to a gallbladder perforation. This can be appreciated on US or on CT and MRI with pericholecystic abscesses or a defect in the gallbladder wall and a rim of bilious fluid outside of the gallbladder (Fig. 12). There may be an associated intrahepatic abscess which may require radiological or surgical drainage. Other rare complications of severe cholecystitis include cholecysto-cutaneous fistula and thrombophlebitis of a recanalised umbilical vein (Figs. 13 and 14).
Axial contrast-enhanced CT of the abdomen. There is gallbladder wall thickening and pericholecystic fluid consistent with acute cholecystitis. There is a defect in the medial gallbladder wall with a hypoattenuating collection within segment 5 of the liver (arrow). Appearances are consistent with gallbladder perforation and hepatic abscess
Axial (a) and coronal (b) contrast-enhanced CT of the abdomen. There is extensive gallbladder wall thickening and stranding with the inflammatory process extending through the peritoneum to the right anterolateral abdominal wall with fistulation to the skin (arrows)
Axial (a), coronal (b) and sagittal (c) contrast-enhanced CT of the abdomen. There is gallbladder wall thickening and pericholecystic fluid consistent with acute cholecystitis. There is marked expansion and oedema surrounding the falciform ligament (arrows). Appearances are due to thrombophlebitis of a recanalised umbilical vein
Along the spectrum of chronic cholecystitis is the porcelain gallbladder, where calcification of the gallbladder wall is caused by repeated episodes of cholecystitis (Fig. 15). There is evidence of a causal relationship between gallstones, chronic cholecystitis and gallbladder carcinoma (Fig. 16), and malignancy often presents at an advancedstage; however, definitive proof is lacking .
Axial (a) and sagittal (b) contrast-enhanced CT of the abdomen demonstrating peripheral calcification of the gallbladder wall (arrows) consistent with porcelain gallbladder
Sagittal ultrasound of the gallbladder demonstrating a soft tissue mass within the gallbladder with internal vascularity consistent with a gallbladder carcinoma
A gallbladder mucocoele results when a stone obstructs the cystic duct causing the gallbladder to become distended with bile. When the bile within the mucocoele becomes infected, this is known as a gallbladder empyema (Fig. 17).
a Sagittal ultrasound of a distended gallbladder with an impacted stone in the gallbladder neck. Mild associated gallbladder wall thickening. b Axial contrast-enhanced CT of the abdomen in the same patient, again demonstrating a distended gallbladder with an impacted hyperattenuating stone in the gallbladder neck. There is subtle associated fat stranding. Findings are consistent with a gallbladder mucocoele. The gallbladder wall thickening and fat stranding are suggestive of possible empyema
Mirizzi syndrome refers to a gallstone that is impacted in the cystic duct or neck of gallbladder which causes extrinsic compression on the common bile duct resulting in obstructive jaundice (Fig. 18).
a Maximum intensity projection (MIP). b Axial T2-weighted MRCP image of the biliary tree. The gallbladder is distended with extensive intrahepatic biliary duct dilatation. The common bile duct is normal in calibre. Appearances are consistent with Mirizzi syndrome, with a stone in Hartmann’s pouch of the gallbladder causing extrinsic compression of the common hepatic duct
Both biliary dilatation and the offending gallstone can be seen on ultrasound; however, cross-sectional imaging with MRI or CT, or ERCP, may be needed to confirm that biliary dilatation is secondary to compression from a gallbladder/cystic duct stone rather than secondary to a CBD calculus.
The next anatomical location where gallstones can be found is outside the gallbladder but within the pancreaticobiliary system. When gallstones exit the gallbladder into the common bile duct (choledocholithiasis), they can often obstruct the normal drainage of bile which can lead to jaundice. This is typically associated with pain, unlike malignant biliary obstruction which is characteristically painless (Fig. 19).
(a) Sagittal ultrasound, (b) fluoroscopic ERCP cholangiogram, (c) T2-weighted axial MRI and (d) coronal MIP MRI of the biliary tree. These images demonstrate multiple filling defects (arrows) within the common bile duct with associated biliary duct dilatation consistent with obstructing choledocholithiasis
The obstruction of biliary drainage and stasis of bile may result in infection in the form of ascending cholangitis and associated sepsis. The clinical picture associated with this is described in Reynolds’ pentad consisting of fever, right upper quadrant pain, jaundice, hypotension and altered mental status. These patients may require urgent decompression of the biliary system.
In rare cases, there can be retrograde passage of gallstones into the common hepatic duct or the right or left main hepatic ducts, or stones can form in intrahepatic ducts due to biliary stasis.
If a gallstone passes down the common bile duct and comes to rest at the ampulla of Vater, it may block the drainage of the pancreatic duct causing back pressure on the pancreatic cells and resulting in gallstone pancreatitis. These patients present with epigastric pain radiating to the back and the severity ranges from mild to severe. There is a significant mortality associated with severe pancreatitis, and critically ill patients should be managed in a high dependency or intensive care monitored environment. While imaging is not usually required or indicated to confirm the diagnosis of acute pancreatitis, an ultrasound of the gallbladder can confirm or rule out the presence of gallstones. CT abdomen/pelvis is best performed 48 h after the onset of symptoms to assess for complications of pancreatitis such as peripancreatic collections or pancreatic necrosis (Fig. 20).
Axial contrast-enhanced CT of the abdomen (a) and axial fat-suppressed T2-weighted MRI of the abdomen (b) in the same patient demonstrating extensive inflammation and oedema of the pancreas secondary to gallstone pancreatitis with a peripancreatic collection (arrow)
In general, larger gallstones are more likely to obstruct higher in the common bile duct, and as such are more likely to cause obstructive jaundice or cholangitis. Smaller gallstones are more likely to cause pancreatitis as they more freely pass down to the level of the ampulla of Vater [4, 5].
Gallstones can also cause pathology outside of the biliary system. The most common cause, although rare, is a cholecystoenteric fistula. Chronic irritation from a large gallstone can erode through the gallbladder wall with fistulisation into small bowel. This can be seen on imaging with air seen within the gallbladder or biliary tree (pneumobilia).
When a gallstone passes through the fistula into the small bowel, this can result in intestinal obstruction, either proximal or more commonly distal. The most common place for distal small bowel obstruction and gallstone ileum is at the level of ileocecal valve as this is the narrowest point; however, gallstone ileus can occur anywhere in the gastrointestinal tract. The diagnosis is suggested on abdominal X-ray by the presence of pneumobilia in the right upper quadrant with dilated loops of bowel consistent with bowel obstruction. Gallstone ileus is more accurately diagnosed with CT which may show pneumobilia or may directly demonstrate the presence of a cholecystoenteric fistula and associated bowel obstruction (Fig. 21).
Coronal (a) and axial (b) contrast-enhanced CT of the abdomen demonstrating multiple dilated loops of small bowel. There is a 3-cm peripherally hyperattenuating obstructing gallstone in the left flank (arrow 1). There is an extensive inflammatory process in the gallbladder bed with air in the gallbladder (arrow 2) consistent with a cholecystoenteric fistula. Appearances are consistent with a bowel obstruction secondary to a gallstone ileus
Bouveret’s syndrome is a particular eponymous syndrome in which a stone obstructs the upper GI tract proximally at the level of duodenum or gastric outlet. Patients typically present with copious vomiting owing to the proximal level of obstruction. There may be little or no small bowel dilatation; in particular, the X-ray abdomen may be completely normal which can falsely reassure. Imaging will demonstrate evidence of gastric outlet or duodenal obstruction related to a gallstone in the upper GI tract (Fig. 22).
Ultrasound (a), CT (b, c), MRI (d) and endoscopic images (e). Demonstrating a large calcified gallstone in the proximal duodenum with a massively dilated stomach. Findings are consistent with a proximal bowel obstruction consistent with Bouveret’s syndrome
Finally, there are a number of imaging features post-cholecystectomy that the radiologist should be aware of. Immediate complications can include post-operative bleeding or an injury to the common bile duct resulting in a bile leak and subsequent biloma. CT is the optimal imaging modality for the initial imaging of post-operative complications, where these complications and fluid collections are well appreciated. It can be difficult to differentiate between blood and bile on CT, and measuring a region of interest to obtain the Hounsfield attenuation value of the fluid can help differentiate between the two. The typical Hounsfield unit of blood is 25–75 and that of bile is usually < 20; however, there can be some overlap. Other factors should be considered to ascertain the aetiology of any visualised collection, for example, a layering haemotocritl level with altered attenuation values can be a feature seen with haemorrhagic collections where the inferior denser (haemorrhagic) component is seen dependently  (Fig. 23).
Axial and coronal contrast enhanced CT of the abdomen in a patient several hours post-cholecystectomy. There is large volume perihepatic fluid with an average Hounsfield unit of 55 consistent with post-cholecystectomy bleeding
Dropped gallstones at time of laparoscopy can have a delayed presentation with post-operative complications such as intrabdominal abscess formation and CT demonstrating a radio-opaque gallstone surrounded by abscess (Fig. 24). Gallstone abscesses without radiopaque gallstones can pose a particular diagnostic challenge as the nidus for infection is not definitely confirmed on imaging. Abscesses related to dropped gallstones can be complex and may extend through abdominal planes and extend extra-peritoneally into adjacent subcutaneous and soft tissue plains. The clinical history will often include a history of prior or difficult cholecystectomy. Gallbladder clips or an absent gallbladder can be seen on cross-sectional imaging as clues.
Axial and sagittal images of a contrast-enhanced CT abdomen in a patient several days post-laparoscopic cholecystectomy. There is a rim-enhancing fluid collection compatible with an abscess which contains multiple (dropped) gallstones
Patients with occult choledocholithiasis that proceed to cholecystectomy can present with obstructive jaundice and cholangitis in the post-operative period. It is important that any patient in whom choledocholithiasis is suspected undergo MRCP prior to surgery. Alternatively, an intra-operative cholangiogram or choledochoscope can be performed intra-operatively to ensure the common bile duct is clear of stones. Late post-cholecystectomy complications can include stump cholecystitis or a retained cystic duct stump or common bile duct stone. These findings result from incomplete cholecystectomy and can be identified on imaging  (Fig. 25).
Coronal magnetic resonance MIP image of the biliary tree. The gallbladder is absent consistent with a prior cholecystectomy. There is a filling defect in the distal common bile duct (arrow) with associated biliary duct dilatation consistent with an obstructing gallstone
What Does the Size of Your Gallstone Mean?: Matthew Lublin, MD, FACS: Advanced Laparoscopic Surgeon
Gallstones are very common in the general population and gallbladder surgery is one of the most frequently performed general surgical procedures in the United States. When gallstones become symptomatic, causing what is often referred to as a gallstone “attack,” the most reliable form of treatment is removal of the entire gallbladder.
When patients first start experiencing gallstone pain, they are usually referred to an imaging center for a comprehensive abdominal ultrasound, both to confirm the presence of a gallstone or gallbladder disease and rule out any other abdominal conditions. The report we receive from the imaging typically states the size of the gallstone. So, what exactly does the size of the stone tell us?
- First, the larger the gallstone, the lower the likelihood that it can be passed out of the gallbladder into the common bile duct. A large sized stone simply cannot pass through the small cystic duct and therefore not cause the complications of jaundice or pancreatitis associated with gallstones.
- Second, studies have shown a possible correlation between the size of a gallstone and gallbladder cancer. There are many factors that affect gallbladder cancer and it remains a relatively uncommon disease in the United States. However, most patients with gallbladder cancer also have gallstones. This may be, in part, related to the organ’s inflammatory response to the stone.
- Lastly, the size of the gallstone is somewhat less important than whether the gallstone is symptomatic or asymptomatic. We tend to remove the gallbladder only when gallstones become symptomatic, regardless of the size of the stone (unless it is extremely large).
What Is a Normal Size Gallstone?
The answer is that there is no normal size when it comes to gallstones. Some patients have anywhere from a few to hundreds of tiny gallstones. Other patients will have a single gallstone as large as 5 cm, although a gallstone of this size is rare.
When We Treat Gallstones
Not everyone with gallstones will become symptomatic. Approximately 10 to 20% of those with gallstones ever experience symptoms. Others may experience a single attack, typically mistaking it for food poisoning or other digestive issues, and never have another. However, typically, after the first attack, the chances of a subsequent attack increase dramatically. These subsequent attacks may come frequently or infrequently.
Ultimately, no matter what the size of the stone, it is important that symptomatic stones are treated early because they can lead to more serious complications of gallbladder disease. Patients who have their gallbladder removed electively, tend to have fewer complications and a shorter recovery.
Gallstones | Boston Children’s Hospital
What are gallstones?
Gallstones are solid deposits of digestive fluid in the gallbladder, a small organ that sits just below the liver. Although the condition is more common in adults, about 2 percent of children of children are diagnosed with gallstones. Another word for gallstones is cholelithiasis.
Many people have gallstones without realizing it. Sometimes, however, the gallbladder becomes inflamed or a gallstone moves into a duct or passageway, creating a blockage. When this happens, a child may have abdominal pain and nausea, vomiting and/or fever.
How do gallstones form?
Normally, bile drains from the liver into the small intestine where it helps digest food. Between meals, bile is stored in the gallbladder. Sometimes bile hardens and forms gallstones. Gallstones range in size from small like a grain of sand to the size of a golf ball.
There are different types of gallstones:
- Pigment gallstones are the most common type of gallstone in children. They form when bile contains too much bilirubin, a byproduct of the body’s natural breakdown of red blood cells.
- Cholesterol gallstones are the most common form of gallstone in adults. They form when bile mixes with cholesterol and hardens.
What causes gallstones?
Girls are at higher risk than boys of developing gallstones. Other than gender, a number of factors can cause gallstones to form. The most common causes in children include:
- abnormalities in the production of red blood cells
- prolonged fasting due to illness
- use of contraceptives
- long-term parenteral nutrition
What are the symptoms of gallstones
Often, people have gallstones but no symptoms. If gallstones become symptomatic, the gallbladder typically needs to be removed. Symptoms often flare up after meals, especially meals high in fat or grease.
- pain in the upper right abdomen
When to seek emergency medical care
If a child with gallstones experiences any of the following symptoms, they need immediate medical care:
- abdominal pain that is so intense, the child can not get comfortable
- jaundice (a yellowish tint in the eyes and skin)
- fever with chills
How we care for gallstones
The Division of Gastroenterology, Hepatology and Nutrition at Boston Children’s Hospital will assess your child’s symptoms and order appropriate tests to determine the severity of the gallstones. Depending on the test results, we will determine the best course of treatment for your child with a team of physicians.
If your child has symptomatic gallstones that require surgery, surgeons in our will use a minimally invasive procedure called a laparoscopic cholecystectomy to remove the blocked gallbladder.
Medical Center Axon
Cholelithiasis (GSD) This is the formation of stones (calculi) in the gallbladder, bile ducts.
Causes of occurrence
- unbalanced diet with a predominance of animal fats (pork, lamb, beef) in the diet to the detriment of vegetable fats
- Hormonal Disorders
- disorders of fat metabolism with an increase in body weight
- liver damage
- inflammation in the gallbladder
- violation of outflow, stagnation of bile
- hereditary predisposition
It should start with the fact that gallstones may not manifest themselves at all for a long time. The absence of clinical manifestations occurs mainly in the initial period of cholelithiasis. Usually, gallstones begin to manifest themselves 5-10 years after their onset. Sometimes very small single stones give a vivid clinical picture, and at the same time, large stones can exist for a long time without causing any symptoms. In most cases, the manifestations of gallstone disease are rather indistinct. Periodically, there may be vague moderate pain in the right hypochondrium.More often, these pains are associated with food, especially with the intake of fatty foods. Sometimes these pains radiate to the back on the right. However, in the case when complications of gallstone disease develop, the clinical picture becomes much brighter and more definite.
- hepatic colic
- acute cholecystitis
- obstructive jaundice
With hepatic colic, sharp pain, as a rule, occurs suddenly, often at night, localized in the right hypochondrium (sometimes in the epigastric region). Hepatic colic may be the beginning of the development of acute cholecystitis. The main signs of acute cholecystitis: paroxysmal pain in the right half of the abdomen, radiating to the right shoulder, scapula; nausea and vomiting; chills and fever. Obstructive jaundice with gallstone disease occurs due to the developed obstruction of the bile ducts. Accompanied by yellow staining of the skin, mucous membranes.
Treatment of gallstone disease
Currently existing drugs for dissolving gallstones are very expensive and require many years of continuous use.After its end, calculi will form again, since the causes of stone formation have not been eliminated.
Surgical treatment HCL is recognized as the main method. Removal of the gallbladder in 99% of cases removes the problem of cholecystitis. As a rule, this does not have a noticeable effect on vital functions.
Operations are performed by open and endoscopic methods.
When performing an open operation (cholecystectomy), an incision of the anterior abdominal wall is made.Removal of the gallbladder from a standard open access belongs to the category of traumatic interventions with an increased risk of complications. Despite this drawback, the need for the use of such operations remains in the complicated course of gallstone disease.
The method of endoscopic removal of the gallbladder (laparoscopic cholecystectomy) is based on the use of modern medical technology, which can significantly reduce the trauma of the patient’s tissues, facilitate his condition in the postoperative period.The operation is performed with special instruments inserted into the abdominal cavity through small incisions. Patients stand up on their own already on the second (and sometimes on the first) day after the operation. Intestinal function is restored faster. On the second day, meals are allowed. Compared with traditional intervention through a wide access, the risk of formation of cicatricial adhesions inside the abdominal cavity after surgery (the so-called adhesions), incisional hernias, suppuration and other complications is reduced. An important factor is the absence of large postoperative scars on the anterior abdominal wall after endoscopic surgery.
Ivanova Lyubov Nikolaevna
What is it?
Gallstone disease (GSD) is a disease in which stones form in the gallbladder or bile ducts.
ZhKB occurs quite often. Ultrasound examination of practically healthy adults in 10-15% of them reveals stones in the gallbladder. More often women are ill.
Two main factors are to blame for the formation of stones: stagnation of bile in the gallbladder and an increase in the concentration of salts in bile due to metabolic disorders.
Stones can be provoked by:
- overeating, starvation, irregular nutrition, lack of dietary fiber;
- sedentary lifestyle, sedentary work;
- taking hormonal contraceptives;
- diseases of the gastrointestinal tract.
What’s going on?
The formation of stones in the gallbladder occurs as a result of the deposition of crystals in oversaturated bile.The stones are composed of cholesterol, bilirubin and calcium salts. Gallstones interfere with the normal functioning of the gallbladder, and sometimes, moving to the mouth of the bile duct, clog it. As a result, the outflow of bile from the bladder is disrupted, its walls are overstretched and the person feels severe pain. In addition, the gallbladder can become inflamed. Over time, the gallbladder cannot fulfill its function – the accumulation of bile.
How to recognize?
While the stones are small and calmly lie in the gallbladder, a person may not be aware of his illness.
Signs by which one can suspect gallstone disease: heaviness in the right hypochondrium, bitterness in the mouth, nausea, belching. When the process has gone far, patients have attacks of biliary colic: in the right hypochondrium or in the upper abdomen there is a sharp pain. It may be accompanied by nausea and vomiting that does not bring relief. The pains may not be very severe, go away on their own, but still this is a serious reason to consult a gastroenterologist.
The diagnosis is made after examination and a series of examinations.
First of all, it is an ultrasound of the abdominal cavity organs.
In the most difficult cases, X-ray examination methods (cholangiography and cholecystography), computed tomography may be required.
Therapeutic treatment consists in adhering to a diet (excluding fatty, spicy, fried, that is, all choleretic products), taking antispasmodic drugs.
It is possible to dissolve small cholesterol stones with ursodeoxycholic acid preparations.The course of treatment is a year or more. Relapses are possible.
Surgical treatment is the most expedient. It is ideal to carry out a planned operation before recurrent seizures, in the absence of complications. It consists in removing the gallbladder, which can be done in two ways: classical cholecystectomy and laparoscopic cholecystectomy. The type of operation is chosen by the surgeon.
Cholecystectomy (removal of the gallbladder) | Removal of stones from the gallbladder in Krasnodar
Bitterness in the mouth, yellowness of the skin and stabbing pain under the right rib most likely indicates problems with the gallbladder.For years, stones grow in it, not giving themselves out for a long time, but at one point making life painful.
Cholelithiasis is characterized by the formation of hard calculi (stones) in the gallbladder and its ducts. One of the main reasons for the development of the disease is a diet with an excessive amount of animal fats. This food culture leads to the development of atherosclerotic plaques in the vessels of the gallbladder mucosa. When plaque comes in contact with bile acid, stones form.If this happens, then the gallbladder has already lost its properties and does not work for the good of the body.
STONES IN GALLBLADDER – THIS IS NOT A CAUSE, BUT A CONSEQUENCE
Bitterness in the mouth, yellowness of the skin, and stabbing pain under the right rib most likely indicates a problem with the gallbladder. For years, stones grow in it, without giving themselves out for a long time, but at one point they make life painful. There is an opinion that to solve the problem it is enough to remove the stones, however, modern surgical practice shows that this approach does not bring long-term results and may even worsen the situation.
Removal of stones from the gallbladder leads to the growth of new
Practice has shown that when the stones are eliminated with the preservation of the gallbladder, after a while they are formed again. This happens for one reason: the part of the gallbladder, cut to remove stones, after suturing becomes the main factor of crystal formation, and the process of calculus growth becomes faster. Removing only a stone is possible, but there is no logic in this: they will reappear, and the patient must endure the risks of surgery every time.
The risk of developing oncology increases
A stone in the gallbladder is an irritating factor that provokes cancer. Long-term persistent inflammation actively affects the development of cancer of the gallbladder, cancer of the bile ducts.
ENDOSCOPIC GALL BLADDER REMOVAL
The main way to improve the quality of life and eliminate the formation of stones permanently is to remove the gallbladder along with them.
The operation (cholecystectomy) lasts on average only 40-60 minutes.It is performed using modern endoscopic equipment, when small incisions of 0.5-1 cm are made on the body. Rehabilitation is quick, the patient can walk comfortably the next day. The quality of life improves, pains and seizures go away, it becomes possible to eat without strict diets.
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When patience bursts in the gallbladder
Why does someone have to remove the gallbladder, while others have no problems with it? There are many reasons, and they are different.It has been proved, for example, that it is mainly a female problem – representatives of of the fair sex suffer from gallstone disease 2-3 times more often than men. Usually it overtakes women who have given birth and are prone to overweight, explains the deputy chief physician of the 6th clinic in Minsk, gastroenterologist Tatyana Malaya. The female hormones estrogens make a special contribution to the formation of gallstones. Pregnancy, taking contraceptives, hormone therapy sometimes add fuel to the fire.But among men, those who are thin and over 60 are more likely to have gallstones.
But if you think that gallstones are a problem only for adults, you are wrong. Gallstone disease has ceased to be casuistry in childhood. There are even cases when the gallbladder is clogged with stones in very young children, which suggests a hereditary predisposition. If, say, a woman had cholelithiasis, there is a very high probability that her daughter will develop the same pathology.
Stones grow in the gallbladder rather slowly. They are the size of a grain of sand or as large as a golf ball. There can be many or just one. And about 80 percent of it comes from cholesterol.
It has been proven that a deficiency of vitamin C in the body contributes to the appearance of stones, and vitamin E reduces the risk of their formation. By the way, people who neglect breakfast or drink only coffee in the morning are more likely to suffer from this disease. Although a sedentary lifestyle can also provoke its occurrence, in which metabolic processes in the body, as a rule, slow down.
When there are stones in the gallbladder, the disease may not manifest itself for years. But often such sufferers are plagued by discomfort in the right hypochondrium, severe pain and nausea.
Hearing about their diagnosis, many patients dream of one thing: getting rid of gallstones, avoiding surgery. However, only small, up to 5 mm in diameter, pebbles come out on their own. And although it was previously believed that people with this disease can be made a tyubage, or blind probing, to free the gallbladder from stones, now it has been proven that this procedure is dangerous.Stones that have been in the gallbladder for many years and were “silent” can budge. And if they get stuck in the bile duct, the patient will experience severe pain, obstructive jaundice may occur.
However, sometimes it is still possible to do without the operation. But this can be mainly counted on by very elderly people who cannot undergo a standard operation. Surgeons open the gallbladder and remove large stones from it. But, notes Tatyana Malaya, this will not save the patient from problems with the formation of stones in the future, because the conditions for their occurrence still remain.Gastroenterologists adhere to a different tactic: if stones less than 1 cm in size appear and they do not disrupt the process of outflow of bile, they try to dissolve them with the help of drugs created on the basis of substances similar in composition to bile acids. These medicines not only dissolve existing stones, but also prevent the formation of new ones, and also improve the quality of bile, thereby making it easier to digest food and relieving people with similar problems from unpleasant symptoms.
However, not all stones and not every person can dissolve.Basically, drugs act only on cholesterol stones with a diameter of up to 1.5-2 cm, and those of them that occupy no more than half of the gallbladder. But there is one drawback: it will take years to take such funds.
The rest of the patients cannot avoid the most gentle method of removing the gallbladder – laparoscopic cholecystectomy. The operation is performed using an endoscope. Through small (5-10 mm) punctures, instruments are introduced into the abdominal cavity, and bile and stones are removed from the diseased organ.After that, the “empty” gallbladder decreases sharply in volume and can be removed through a puncture.
So, delete – period? And then what? How does a person who underwent such an operation feel? Where, after removal of the bladder, will bile accumulate, which directly flows from the liver into the small intestine? Now the patient will have to take care not to allow a large accumulation of it. Excess bile looks for a way out and finds it, getting into the stomach. Because of this, at first, irritation of the gastric mucosa may appear, then erosion or ulcers.That is why those who do not have a gallbladder need to eat fractionally and often – from 5 to 7 times a day, and the breaks between meals should not exceed 2-3 hours. Then bile will not act on the walls of the intestines or stomach, but on the food eaten.
Therefore, if something bothers you, your stomach hurts, you don’t have to hope at random, put a heating pad on your right side and wait for it to pass by itself. This usually ends in failure: surgeons have to resort to emergency surgery.
The second most common mistake in a pain attack is taking all kinds of medications. Remember: if the bladder is inflamed and sore, and you start taking choleretic drugs that reduce it, there is an additional load on the unhealthy organ. With an exacerbation of gallstone disease, it is also not recommended to use pain relievers. But drugs that relieve spasms (such as no-shpa) can relieve pain.
Six months after the removal of the gallbladder, any significant restrictions on food are no longer required, explains Tatyana Malaya.If you really want something, be sure to “respect” your desire. Just let it not be a whole portion of, say, not a very healthy kebab, but just a couple of slices. If you are stressed about the inability to taste the dish, there will be nothing good from such abstinence. Food should be varied and complete, with the presence of proteins, fats and carbohydrates in the diet.
90,000 Gallstone disease – causes, symptoms, diagnosis, complications, treatment of gallstones
Published: 02.07.2021 12:45:00 Updated: 02.07.2021 Views: 20873 90 007
Gallstone disease is a chronic disease of the organs of the hepatobiliary system, characterized by impaired synthesis and circulation of bile, the formation of stones in the gallbladder or bile ducts. Most often, the pathology is manifested by paroxysmal pain in the right hypochondrium – biliary colic, jaundice.A complete cure is possible only by surgery. Without removing calculi, it is possible to develop severe, including life-threatening, complications – cholecystitis, peritonitis and others.
According to the clinical guidelines of the Russian Federation, the prevalence of gallstone disease in developed countries reaches 10-15%, which is explained by the nature of the diet of their inhabitants. In Africa and Asia, this figure is much lower and amounts to about 3.5-5%. Mostly people aged 40 to 69 are ill.In women, the risk of developing gallstone disease is 2-3 times higher than in men.
The main cause of stone formation in the gallbladder and ducts is an increased concentration of bile. When it is oversaturated with cholesterol, large yellowish-white calculi are formed. If there is an inflammatory process in the biliary tract, as well as with hemolysis and cirrhosis of the liver, pigmented brown or black stones are formed.
The following factors contribute to the development of gallstone disease:
- genetic predisposition;
- high-calorie food with excessive consumption of fatty foods and simple carbohydrates;
- sedentary lifestyle;
- taking hormonal contraceptives;
- fast weight loss, low-calorie diet;
- alcohol abuse;
- chronic liver pathologies, diabetes mellitus, Crohn’s disease, anemia, cystic fibrosis, infectious process in the biliary tract;
- taking certain medications, for example, octreotide, clofibrate.
Pathology may not have clinical manifestations for a long time. Symptoms of gallstone disease appear with inflammation or obstruction in the biliary tract, when stones from the gallbladder cavity move into its neck or ducts and clog them. This process may be accompanied by an attack of biliary colic, symptoms of acute calculous cholecystitis, as well as chronic cholecystitis, cholangitis, biliary pancreatitis.
Biliary colic has the following symptoms:
- Severe pain in the projection of the gallbladder.It begins in the right hypochondrium, suddenly and can give in the back, under the right shoulder blade, in the neck, in the right shoulder. In rare cases, its migration to the heart region causes angina pectoris. The duration of such an attack with gallstone disease is from a couple of minutes to several days. The nature of the pain is first acute, then constant, aching.
- Bitter taste in the mouth, impaired appetite.
- Dyspeptic manifestations. Nausea, vomiting with an admixture of bile, not leading to relief, frequent and loud belching of air or food eaten.
- Increased body temperature. With purulent cholecystitis, fever can reach 39 ° C and above.
- Indigestion. Often the patient has bloating, atonic constipation.
Exacerbation of gallstone disease can be triggered by a violation of the diet. The movement of calculi can also be caused by shaking riding, tilting of the body. With the development of choledocholithiasis – stones entering the bile ducts and blocking them – obstructive jaundice develops.With it, the skin, sclera of the eyes and mucous membranes acquire an icteric tint, itching of the skin, darkening of urine and discoloration of feces are present.
Often, gallstone disease appears together with a hiatal hernia, gastric ulcer or duodenal ulcer, colon diverticulosis. This is due to the common innervation of the affected organs and similar predisposing factors for these pathologies. In such a situation, the clinical picture of the disease may not be entirely typical.
Gastroenterologist, surgeon, general practitioner and therapist are involved in the diagnosis of gallstone disease. In a conversation with a patient, he finds out the duration and nature of the symptoms, the presence of predisposing factors. An important place in the examination is occupied by palpation of the right upper quadrant of the abdomen, during which soreness and other characteristic signs of acute cholecystitis are determined: the symptom of Zakharyin, Ortner, Murphy.
Further examination includes the use of laboratory and instrumental methods:
1.General blood analysis. Neutrophilic leukocytosis and accelerated ESR indicate inflammation in the gallbladder – acute cholecystitis.
2. Biochemical blood test. Allows to reveal the increase in cholesterol and bilirubin, activity of alkaline phosphatase, typical for gallstone disease. Overlapping of the biliary tract and stagnation of bile often lead to liver damage, therefore, in gallstone disease, indicators such as alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transpeptidase, total and C-reactive protein are also important.
3. Tumor markers in serum blood. Their definition is aimed at identifying signs of cancer of the organs of the hepatobiliary system.
4. General analysis of urine. Particular attention is paid to the level of bilirubin metabolic products.
5. Ultrasound of the liver and biliary tract. Method of choice in the diagnosis of gallstone disease. During the examination, the so-called “non-functioning” gallbladder can be determined, containing a small amount of bile, or, on the contrary, an organ that is stretched and does not contract in response to choleretic food.There is also severe soreness in the right hypochondrium when pressed with a transducer (“ultrasonic Murphy’s symptom”), the presence of fluid around the gallbladder, thickening of its wall more than 4 mm. Despite the high sensitivity of ultrasound, with choledocholithiasis, it is not informative enough.
6. Plain radiography of the abdominal cavity. EFFECT: method allows to detect gallstones with sufficient calcium content and complications of gallstone disease. The method is also used to recognize emphysematous cholecystitis, porcelain gallbladder, calcareous bile.
7. X-ray studies with contrast. In the course of execution, a “disabled” gallbladder that does not lend itself to staining can be determined. Endoscopic retrograde cholangiography is an invasive method involving cannulation of the large papilla with the introduction of contrast through the common bile duct. Percutaneous transhepatic cholangiography is performed if it is impossible to perform other methods of contrasting. Oral contrast cholecystography and intravenous dye cholangiography are rare.
8. Esophagastric duodenoscopy. Method of visualization of the duodenum with mandatory examination of the large duodenal papilla.
9. Magnetic resonance cholangiopancreatography. It has high accuracy in detecting small calculi with a size of 2 mm or more, including in the area of the bile ducts (situations when the capabilities of ultrasound are insufficient).
10. Endoscopic ultrasound examination of the pancreato-biliary zone. This study makes it possible to recognize even very small stones, sludge, strictures of the terminal part of the common bile duct.However, the invasiveness of the procedure and the ability to assess the ductal system only in the area of confluence with the duodenum impose restrictions on its implementation.
11. Bilioscintigraphy. This is a radioisotope assay with 99mTc labeled iminodiacetic acids. Cholelithiasis is indicated by the absence of visualization of the gallbladder, accompanying not only the obstruction of the cystic duct, but also acute or chronic cholecystitis or underwent cholecystectomy.
With gallstone disease, the stone traumatizes the walls of the organs with the development of inflammation in them, therefore, the pathology can be complicated by cholangitis, cicatricial fusion of the large duodenal papilla, the formation of fistulous passages between the biliary tract and adjacent organs or the abdominal cavity.
Untimely detection and treatment of acute cholecystitis is dangerous by the development of such fatal complications of gallstone disease as empyema, gangrene and perforation of the gallbladder, peritonitis.
With an established gallstone disease, the patient must be prescribed a diet, and he is also recommended to correct his lifestyle and reduce weight. Meals should be frequent and small portions, with the exception of fried and fatty, every 3-4 hours, balanced, contain proteins, carbohydrates, dietary fiber.
Drug therapy is effective only at the initial stage of gallstone disease, before the formation of calculi. In this case, treatment is aimed at normalizing the composition of bile and preventing its stagnation. Ursodeoxycholic acid preparations are used, which reduces the saturation of bile with cholesterol and partially extracts it from stones. To relieve the symptoms of acute calculous cholecystitis, patients are prescribed antispasmodics. The manifestations of chronic cholecystitis, dyspeptic disorders and indigestion are eliminated with the help of defoamers, prokinetics, probiotics, choleretic, enzyme preparations.According to indications, antibacterial agents are also prescribed.
If stones are found in the gallbladder, as well as signs of obstructive jaundice, surgical treatment of gallstone disease is indicated. The most often performed removal of the gallbladder together with calculi is cholecystectomy. Such an operation not only prevents complications of acute cholecystitis, but also malignant degeneration of the inflamed organ in the long term.
Treatment of gallstones in Germany
Thomas W.Kraus, visceral surgeon-oncologist
Since 2005, Professor Kraus has been working as the chief physician of the Department of General and Visceral Surgery at the Nordwest Clinic in Frankfurt am Main.
More about the specialist →
The gallbladder is a digestive organ that accumulates and excretes bile and bile acids, which are formed in the liver, are involved in the digestion of fats and activating the movement of food through the intestines.
As a result of internal ( endogenous ) and external ( exogenous ) factors, the balance of bile formation is often disturbed, and stones are formed from bile acids, the size of which can vary from the smallest grain of sand to a chicken egg.This is how the development of gallstone disease begins, , the treatment of which is carried out at the highest level by the surgeons of the clinic “Nordwest” in Germany. Many years of experience working with patients at different stages of the complexity of the course of this pathology, today helps our doctors to most effectively deal with stones both in the gallbladder itself and in its ducts.
Symptoms of gallstones
Typical signs of gallstone disease are:
- inflammation of the gallbladder;
- paroxysmal pain ( colic ) in the right hypochondrium, sometimes radiating to the back or right shoulder;
- temperature rise;
- stool staining;
- obstructive jaundice.
In 20% of patients, the disease may be asymptomatic. In such cases, timely detection of pathology is important in order to prevent the development of possible complications and exacerbation of gallstone disease . For this purpose, routine diagnostics are carried out in Germany, and a preventive examination system is used as part of a check-up program for men and women developed for patients of the Nordwest clinic.
Diagnosis of gallstone disease
The causes of colic in the right hypochondrium must certainly be clarified.For this, modern diagnostic methods are used:
For an accurate diagnosis, the degree of development of the disease and the choice of the method of therapy, the doctor interviews the patient to identify possible causes of the formation of stones in the gallbladder, which may include the following factors:
- inflammatory processes in the gallbladder;
- stagnation of bile;
- An excess of calcium, cholesterol, bile pigment in bile;
- taking hormonal drugs, in particular estrogen;
- long-term drug therapy;
- improper diet and diet;
- diabetes mellitus;
- alcohol dependence;
- cirrhosis of the liver;
- hemolytic anemia;
- Caroli syndrome.
Cost of removing gallstones
Prices for surgical treatment in Germany are formed, depending on the patient’s condition at the time of contacting the clinic, as well as on the size of the formed calculus. The larger and denser it is, the more difficult it is to get rid of it. The main treatment for gallstone disease is surgery. Today, in most cases, laparoscopic cholecystectomy is performed – removal of the gallbladder through small punctures.It is also worth noting the possibility of dissolving and crushing stones in the gallbladder without surgery, however, the effectiveness of these methods in each case should be considered by the doctor after a thorough diagnosis. If surgery is not required, in addition to diet, drug therapy will be prescribed to prevent the development of gallstone disease. As a rule, if the presence of calculi does not cause discomfort and danger to the patient’s health, if the diet is followed, the operation can be avoided.
Clinic “Nordwest” is a qualified center in Germany for surgical treatment of the gallbladder. The highest level of the doctors of the clinic is confirmed by various specialized bodies and companies. The excellence of healthcare professionals is reflected in the current list of FOCUS clinics: Nordwest Hospital ranks among the best clinics in Germany for the treatment of gallbladder diseases.
90,000 Stones in our body – Medical and Diagnostic Center Neuron (Taganrog)
- Author: LDC Neuron
- Published: 10 November 2015
Did you know that our body can be a whole museum of various stones.Only, unlike the museum exposition, they do not admire these stones, but try to get rid of them as quickly as possible. Where in the body can stones form?
One of the main places prone to stone formation is gall bladder .
Gallstones, or, as doctors call them, calculi, are hard, dense formations ranging in size from a grain of sand to a chicken egg: smooth black, easily crumbling – cholesterol and green, soft – pigmented.Mostly women after 40 years of age suffer from gallstone disease. For a long time, stones may not remind of themselves in any way, but can lead to quite unpleasant symptoms: pain, heaviness in the stomach, belching, nausea. A characteristic manifestation of the disease is a severe pain attack, biliary colic. As a rule, to get rid of stones, you have to remove the gallbladder.
Interesting fact: the largest stone was removed from the gallbladder of an 80-year-old patient in London in 1952, and it weighed 6.29 kg.As for the number of stones, in 2002 in Romania 831 stones were found in a patient’s gallbladder – this is also a medical record.
Kidney stones , on the contrary, are more often found in men. Kidney stones can be of different colors, brown and yellow stones are more common. They are also very different in size: from a grain of sand to 15 cm in diameter, but on average they are 2–4 mm. And the largest stone described in the Guinness Book of Records, the size of a coconut, weighed 1125 g.Its “owner” was 48-year-old Hungarian Sandor Sarkadi.
Kidney stones are dangerous because they may not manifest themselves for years, and a person does not even know about their existence. But if the stone begins to move and blocks the urinary tract, the outflow of urine is impaired and renal colic occurs – a severe pain attack.
As a rule, small stones and sand leave the body on their own, while large ones are either crushed by ultrasound or (most often) removed surgically. Some calculi can be dissolved with drugs.
From the kidney, the stone can enter the ureter . Most of the calculi pass further, bladder , but some remain in the ureter and continue to grow there. Then they have to be removed surgically.
In the bladder, there are stones both from the kidney and those formed in the organ itself when urine outflow is impaired. As a rule, these stones are dangerous for men, since in women they easily come out on their own due to the peculiarities of the female genitourinary system.
But stones are found not only in the gallbladder, bladder and kidneys. So in large intestine “live” fecal stones – coprolites. They are formed with constipation and can reach 10-15 cm in diameter. Coprolites are dangerous because they can cause intestinal obstruction. That is why it is very important to monitor the correct functioning of the gastrointestinal tract and prevent constipation.
The well-known cholesterol plaques deposited on the walls of blood vessels are also stones formed by calcium salts of fatty acids.These are dense, yellowish-white deposits ranging in size from 0.1 to 5 cm. Cholesterol plaques impede blood flow through the vessels. This disease is called atherosclerosis. And if such a stone completely blocks the vessel, then the blood supply to the organ fed by it stops and its necrosis occurs – a heart attack.
Stones can form in of the prostate gland due to stagnation of prostate secretion in it. Their size is small – 0.1-1 cm.
Few people know that small stones (0.1–0.5 cm) are also found in the ducts of the salivary glands .The reasons are a violation of the outflow of saliva, stagnation of saliva, inflammation, trauma. These stones are removed surgically.