What are gallbladder stones. How do they form. What symptoms do they cause. Who is at risk of developing gallstones. How are they diagnosed and treated. Can gallstones be prevented.

Understanding Gallbladder Stones: Formation and Types

Gallbladder stones, also known as gallstones or cholelithiasis, are solid deposits that form in the gallbladder, a small organ located beneath the liver. These stones can vary in size, ranging from as small as a grain of sand to as large as a golf ball. The gallbladder plays a crucial role in storing and releasing bile, a fluid produced by the liver to aid in digestion and carry waste products.

There are two main types of gallstones:

• Cholesterol stones: These yellow-green stones account for approximately 80% of all gallstones. They form when there’s an excess of cholesterol in the bile that cannot be dissolved.
• Pigment stones: Smaller and darker in color, these stones are composed primarily of bilirubin, a byproduct of red blood cell breakdown.

Do gallstones always cause symptoms? Not necessarily. Many people with gallstones remain asymptomatic, only experiencing problems when a stone blocks a bile duct.

Recognizing the Symptoms of Gallstones

When gallstones cause symptoms, they can be quite uncomfortable and even painful. The most common signs include:

• Intense pain in the upper right abdomen, often described as a “gallbladder attack”
• Pain that radiates to the right shoulder or back
• Nausea and vomiting
• Digestive issues such as indigestion, heartburn, and gas

Are there any severe symptoms that require immediate medical attention? Yes, if you experience the following, seek medical help promptly:

• Severe abdominal pain lasting several hours
• Fever and chills
• Yellowing of the skin or eyes (jaundice)

The Root Causes of Gallstone Formation

While the exact mechanisms of gallstone formation are not fully understood, several factors contribute to their development:

1. Excess cholesterol in bile: When the liver produces more cholesterol than the bile can dissolve, the excess may form into stones.
2. High levels of bilirubin: Conditions such as cirrhosis, infections, or blood disorders can lead to increased bilirubin production, promoting stone formation.
3. Incomplete gallbladder emptying: If the gallbladder doesn’t empty completely, bile can become concentrated, increasing the likelihood of stone formation.

Is diet a contributing factor to gallstone formation? While not the sole cause, a diet high in fat and cholesterol but low in fiber can increase the risk of developing gallstones.

Identifying Risk Factors for Gallstone Development

Certain factors can increase an individual’s likelihood of developing gallstones. These include:

• Family history of gallstones
• Being female, especially if pregnant or using hormonal contraceptives
• Age over 40
• Native American or Mexican descent
• Obesity
• Sedentary lifestyle
• Rapid weight loss or frequent fasting
• Diabetes
• Certain medical conditions, such as Crohn’s disease, hemolytic anemia, or cirrhosis

Can medications influence gallstone formation? Yes, some medications, particularly those used to lower cholesterol, may increase the risk of gallstone development.

Diagnostic Approaches for Gallstones

When gallstones are suspected, doctors employ various diagnostic tools to confirm their presence and assess their impact. These may include:

• Blood tests: To check for signs of infection, blockage, or other related conditions
• Ultrasound: A non-invasive imaging technique to visualize the gallbladder and detect stones
• CT scan: Provides detailed images of the gallbladder and surrounding structures
• Magnetic Resonance Cholangiopancreatography (MRCP): Uses magnetic fields and radio waves to create detailed images of the biliary system
• Cholescintigraphy (HIDA scan): Assesses gallbladder function and can help diagnose inflammation
• Endoscopic Retrograde Cholangiopancreatography (ERCP): Allows visualization of the bile ducts and potential stone removal
• Endoscopic ultrasound: Combines ultrasound and endoscopy for detailed imaging of the biliary system

How accurate are these diagnostic methods? While each test has its strengths, ultrasound is often the first-line diagnostic tool due to its high accuracy in detecting gallstones.

Treatment Options for Gallstones: From Watchful Waiting to Surgery

The treatment approach for gallstones depends on the severity of symptoms and the patient’s overall health. Options include:

Watchful Waiting

For asymptomatic gallstones, doctors may recommend monitoring without active treatment. Many small gallstones can pass through the body naturally without causing problems.

Surgical Intervention

When gallstones cause symptoms or complications, surgical removal of the gallbladder (cholecystectomy) is often recommended. The two main surgical approaches are:

• Laparoscopic cholecystectomy: A minimally invasive procedure using small incisions and a camera
• Open cholecystectomy: Traditional surgery with a larger incision, typically reserved for complex cases

Is it possible to live without a gallbladder? Yes, the body can adapt to the absence of a gallbladder, and most people can digest food normally after its removal.

Non-Surgical Treatments

In some cases, non-surgical options may be considered:

• Oral dissolution therapy: Medications to dissolve small cholesterol stones
• Lithotripsy: Using shock waves to break up stones (rarely used for gallstones)

These treatments are generally less effective than surgery and are typically reserved for patients who cannot undergo surgical procedures.

Preventing Gallstone Formation: Lifestyle and Dietary Considerations

While not all gallstones can be prevented, certain lifestyle changes can reduce the risk of their formation:

• Maintaining a healthy weight through balanced diet and regular exercise
• Avoiding rapid weight loss and crash diets
• Eating a diet rich in fiber and low in saturated fats
• Staying hydrated
• Limiting alcohol consumption
• Managing underlying health conditions, such as diabetes

Can certain foods help prevent gallstones? Some studies suggest that consuming foods high in vitamin C, caffeine, and plant-based proteins may have a protective effect against gallstone formation.

Potential Complications of Untreated Gallstones

While many gallstones remain asymptomatic, untreated symptomatic gallstones can lead to serious complications:

• Cholecystitis: Inflammation of the gallbladder
• Choledocholithiasis: Blockage of the common bile duct
• Cholangitis: Infection of the bile ducts
• Pancreatitis: Inflammation of the pancreas
• Gallbladder cancer: A rare but serious potential complication

How quickly can complications develop? Complications can develop gradually or suddenly, emphasizing the importance of prompt medical attention when symptoms arise.

Understanding gallbladder stones is crucial for recognizing symptoms, assessing risk factors, and making informed decisions about treatment. While gallstones can cause significant discomfort and potential complications, modern medical approaches offer effective solutions for managing this common condition. By adopting healthy lifestyle habits and staying vigilant about symptoms, individuals can take proactive steps to maintain their gallbladder health and overall well-being.

As research in this field continues to evolve, new insights into gallstone formation and innovative treatment approaches may emerge, offering hope for even more effective management strategies in the future. For those concerned about gallstones or experiencing symptoms, consulting with a healthcare professional is the best course of action to receive personalized advice and appropriate care.

Picture, Symptoms, Types, Causes, Risks, Treatments

Written by WebMD Editorial Contributors

• What Are Gallstones?
• Gallstone Types
• Symptoms of Gallstones
• Causes of Gallstones
• Gallstone Risk Factors
• Gallstone Diagnosis
• Can Gallstones Go Away on Their Own?
• Gallstone Treatment
• Complications of Gallstones
• Preventing Gallstones
• More

Gallstones are pieces of solid material that form in your gallbladder, a small organ under your liver. If you have them, you might hear your doctor say you have cholelithiasis.

Your gallbladder stores and releases bile, a fluid made in your liver, to help in digestion. Bile also carries wastes like cholesterol and bilirubin, which your body makes when it breaks down red blood cells. These things can form gallstones.

Gallstones can range in size from a grain of sand to a golf ball. You might not know that you have them until they block a bile duct, causing pain that needs treatment right away.

The two main kinds of gallstones are:

• Cholesterol stones. These are usually yellow-green. They’re the most common, making up 80% of gallstones.
• Pigment stones. These are smaller and darker. They’re made of bilirubin.

Gallstones don’t normally cause symptoms. Symptoms occur only when a gallstone gets stuck and blocks the flow of bile through your system.

If you have symptoms, they may include:

• Pain in your upper belly, often on the right, just under your ribs
• Pain in your right shoulder or back
• An upset stomach
• Vomiting
• Other digestive problems, including indigestion, heartburn, and gas

See your doctor or go to the hospital if you have signs of a serious infection or inflammation:

• Belly pain that lasts several hours or is severe
• Fever and chills
• Yellow skin or eyes

Doctors aren’t sure exactly what causes gallstones, but they might happen when:

• There’s too much cholesterol in your bile. Your body needs bile for digestion. It usually dissolves cholesterol. But when it can’t do that, the extra cholesterol might form stones.
• There’s too much bilirubin in your bile. Conditions like cirrhosis, infections, and blood disorders can cause your liver to make too much bilirubin.
• Your gallbladder doesn’t empty all the way. This can make your bile very concentrated.

You’re more likely to get gallstones if you:

• Have a family history of them
• Are a woman
• Are over age 40
• Are of Native American or Mexican descent
• Are obese
• Have a diet high in fat and cholesterol but low in fiber
• Don’t get much exercise
• Use birth control pills or hormone replacement therapy
• Are pregnant
• Have diabetes
• Have an intestinal disease like Crohn’s
• Have hemolytic anemia or cirrhosis of the liver
• Take medicine to lower your cholesterol
• Lose a lot of weight in a short time
• Are fasting

Your doctor will do a physical exam and might order tests including:

Blood tests.  These check for signs of infection or blockage, and rule out other conditions.

Ultrasound. This makes images of the inside of your body.

CT scan. Specialized X-rays let your doctor see inside your body, including your gallbladder.

Magnetic resonance cholangiopancreatography (MRCP). This test uses a magnetic field and pulses of radio waves to make pictures of the inside of your body, including your liver and gallbladder.

Cholescintigraphy (HIDA scan). This test can check whether your gallbladder squeezes correctly. Your doctor injects a harmless radioactive material that makes its way to the organ. A technician can then watch its movement. This can help diagnose cholecystitis (inflammation of the gallbladder) from gallstones.

Endoscopic retrograde cholangiopancreatography (ERCP). Your doctor runs a tube called an endoscope through your mouth down to your small intestine. They inject a dye so they can see your bile ducts on a camera in the endoscope. They can often take out any gallstones that have moved into the ducts, but that’s only done if treatment is planned as part of the procedure since it’s invasive.

Endoscopic ultrasound. This test combines ultrasound and endoscopy to look for gallstones that may be in places that are hard to see with other imaging, such as in the common bile duct as it passes through the pancreas.

If your gallstones aren’t causing symptoms, there’s usually no need for you to have surgery. You’ll only need it if a stone goes into, or blocks, one of your bile ducts. This causes what doctors call a “gallbladder attack.” It’s an intense, knife-like pain in your belly that can last several hours.

If you have sickle cell or another blood disorder, your doctor may consider doing a cholecystectomy as a precaution, even if you don’t have symptoms. 

You don’t need treatment if you don’t have symptoms. Some small gallstones can pass through your body on their own.

Most people with gallstones have their gallbladders taken out. You can still digest food without it. Your doctor will use one of two procedures.

Laparoscopic cholecystectomy. This is the most common surgery for gallstones. The surgeon works through tiny cuts (incisions). They pass a narrow tube called a laparoscope into your belly through a small cut. The tube contains a tiny light and a camera. The doctor will take out your gallbladder through another small cut using special devices. You’ll usually go home the same day.

Open cholecystectomy. Your doctor makes bigger cuts in your belly to remove your gallbladder. You’ll stay in the hospital for a few days afterward. You’ll need open surgery if you have a bleeding disorder. You may also need it if you have severe gallbladder disease, are very overweight, or are in your last trimester of pregnancy.

For both types of surgery,  you’ll get general anesthesia. This means you won’t be awake during the procedure.

If gallstones are in your bile ducts, your doctor may use ERCP to find and remove them before or during surgery.

Nonsurgical treatment: If you have another medical condition and your doctor thinks you shouldn’t have surgery, they might give you medication instead. Chenodiol (Chenodo l) and ursodiol (Actigall, Urso 250, Urso Forte) dissolve cholesterol stones. They can cause mild diarrhea.

You may have to take the medicine for years to totally dissolve the stones, and they may come back after you stop taking it.

Gallstones can cause serious problems, including:

• Gallbladder inflammation (acute cholecystitis). This happens when a stone blocks your gallbladder so it can’t empty. It causes constant pain and fever. Your gallbladder might burst, or rupture, if you don’t get treatment right away.
• Blocked bile ducts. This can cause fever, chills, and yellowing of your skin and eyes (jaundice). If a stone blocks the duct to your pancreas, that organ may become inflamed (pancreatitis).
• Infected bile ducts (acute cholangitis). A blocked duct is more likely to get infected. If the bacteria spread to your bloodstream, they can cause a dangerous condition called sepsis.
• Gallbladder cancer. It’s rare, but gallstones raise your risk of this kind of cancer.

Some lifestyle changes might lower your risk of gallstones.

• Eat a healthy diet that’s high in fiber and good fats, like fish oil and olive oil. Avoid refined carbs, sugar, and unhealthy fats.
• Get regular exercise. Aim for at least 30 minutes, 5 days a week.
• Although obesity is a risk factor, avoid diets that make you lose a lot of weight in a short time.
• If you’re a woman at high risk of gallstones (for example, because of your family history or another health condition), talk to your doctor about whether you should avoid using hormonal birth control.

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Your gallbladder is a pear-shaped organ under your liver. It stores bile, a fluid made by your liver to digest fat. As your stomach and intestines digest food, your gallbladder releases bile through a tube called the common bile duct. The duct connects your gallbladder and liver to your small intestine.

Your gallbladder is most likely to give you trouble if something blocks the flow of bile through the bile ducts. That is usually a gallstone. Gallstones form when substances in bile harden. Gallstone attacks usually happen after you eat. Signs of a gallstone attack may include nausea, vomiting, or pain in the abdomen, back, or just under the right arm.

Gallstones are most common among older adults, women, overweight people, Native Americans and Mexican Americans.

Gallstones are often found during imaging tests for other health conditions. If you do not have symptoms, you usually do not need treatment. The most common treatment is removal of the gallbladder. Fortunately, you can live without a gallbladder. Bile has other ways to reach your small intestine.

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Gallbladder stones – symptoms, diagnosis and treatment of choledocholithiasis

Gallstone disease (GSD) is the formation of stones in the gallbladder cavity and ducts. The gallbladder is an organ that is a hollow “pouch” with a volume of up to 60 ml, into which bile synthesized by the liver flows. In the bladder, bile is concentrated and becomes a participant in the digestive process. Through the ducts, through the duodenum, viscous black-green bile enters the food mass, where it emulsifies fats and participates in other biochemical processes.
Stones in the bile duct (choledocholithiasis) can form on their own or be thrown from the bladder.

Main types of stones

Gallstones vary in size, shape, color and chemical composition.

Size . In the common bile duct, there are no large single stones, which is due to the diameter of the cystic duct. Smaller, lighter ones leave the bladder with a current of bile. Large ones remain at the bottom under the weight of their own weight.

Form. If stones with “edges” are found in the ducts, it can be argued that they came from a bladder: this form appears from the close fit of the stones to each other. Basically, the shape of the bile formations is round, oval.

The color of depends on the chemical composition:

• cholesterol – predominantly yellow, greenish, golden;

• bilirubin (pigment) – soft and colored black;

• calcium (calcareous) formations – whitish, sometimes their surface is like an egg shell;

• with parasitic or bacterial infection – brown.

The classification is based on the predominance of one of the chemical elements. In this case, the other two are also present. In addition to the main ones, dead cellular elements, protein parts and other components are mixed into the structure.

Mechanism of gallstone formation

In case of metabolic disorders and an increase in the amount of cholesterol in the blood, bile is also oversaturated, and crystals are precipitated, which merge with each other, attach protein, calcium and bilirubin molecules to themselves. A rounded body is formed, similar to a small stone. When the gallbladder contracts, the calculus enters the cystic duct and then into the common duct. The cholesterol type is the most common. Stones appear directly in the ducts most often in patients with an already removed gallbladder.

Bilirubin is formed in cirrhosis of the liver or chronic conditions leading to the breakdown of red blood cells – erythrocytes. Increases the level of the pigment bilirubin in the blood and bile. Reacting with calcium, it forms compounds that crystallize and become the basis of black gallstones. More often seen in children.

In people living in poor hygiene conditions and suffering from helminthic infestations, the parasite (often roundworm or Chinese fluke) enters the common bile duct from the duodenum, where it becomes surrounded by bilirubin and calcium salts.

Causes of stone formation:

• unhealthy diet leading to increased blood cholesterol;

• liver disease;

• metabolic disorders;

• conditions leading to the destruction of red blood cells;

• hereditary factors;

• helminthic infestations;

• removed gallbladder and others.

Women get sick more often than men, and younger people less often than older people.

Symptoms of choledocholithiasis

The disease is asymptomatic until the stones are freely evacuated through the duodenum and intestines. Severe symptoms occur when the lumen of the common bile duct is closed. It is similar to the signs of cholecystitis:

• intense pain in the right hypochondrium, radiating to the back. When the region of Vater’s papilla is blocked (the place where the ducts from the gallbladder and pancreas flow into the duodenum 12) passes into the surrounding. Pulling, aching, dull, sometimes sharp;

• sometimes increasing, sometimes decreasing yellowness of mucous membranes and skin. The first yellowing comes after 10-12 hours from the onset of pain;

• pale yellow or white stools;

• dark brown urine;

• body temperature may increase.

The pain subsides when the stone passes into the duodenum and bile flow is restored. When migrating the next calculus, the whole picture will be repeated. The condition is aggravated if inflammation has begun.

Diagnosis of the disease

Diagnosis is based on a medical examination; anamnesis collected by questioning and studying medical records about previous operations and manipulations; laboratory diagnostics; instrumental research.

According to the results of laboratory diagnostics, one can judge the stage of the disease, the presence or absence of an inflammatory process, damage to the pancreas, and so on.

Instrumental methods include the following:

• Ultrasound examination (ultrasound) of the abdominal organs – performed through the skin of the abdomen;

• MRI cholangiography. On a computer tomograph, all ducts, the location and size of stones are viewed;

• computed tomography (CT) allows you to see neoplasms or other organic external causes of narrowing of the ducts;

• videodoudenoscopy allows you to examine the region of the Vater papilla in detail.

The method of instrumental examination is chosen by the doctor depending on the patient’s condition, symptoms and medical history.

Treatment

The removal of a bile duct stone cannot be done by medical or other non-invasive means. The optimal method for the diagnosis and treatment of choledocholithiasis is ERCP (Endoscopic retrograde pancreatic cholangiography). With the help of an X-ray contrast agent introduced through an endoscope, it is possible to assess the state of the biliary system from a series of images. If the diagnosis is confirmed, the surgeon-endoscopist immediately decides on treatment. Large stones are crushed. When narrowing the area of ​​the Vater papilla, it is dissected. The advantages of the technique are that the patient does not need to be moved between the examination and medical manipulations – everything takes place in one operating room, on the same equipment, by one doctor.

If ERCP is not possible or is not effective, laparoscopic surgery is performed. Stones in the bile ducts are removed mechanically, after dissection of the duct wall. The gallbladder is also removed. In difficult cases, resort to the classic abdominal surgery.

Consequences of choledocholithiasis

After the treatment and following the doctor’s recommendations, the patient quickly returns to his usual life. However, if you do not seek medical help in a timely manner, complications may occur.

1. The presence of stones provokes inflammatory processes that are difficult and painful.

2. Since the bile and pancreas ducts join before entering the duodenum, when a stone obstructs the orifice, the ducts swell and the pancreas may be affected. Acute pancreatitis can result in the death of the patient.

3. Communicating with the liver, the inflamed biliary system disrupts the functional activity of this organ (and the liver is involved in digestion, hematopoiesis, deposits the necessary substances, utilizes and deactivates unnecessary ones, and so on). As a result, there is an imbalance in the work of almost all body systems.

Why it is important to seek medical attention at the first symptoms

Since choledocholithiasis is often asymptomatic, it is possible to miss the onset of the inflammatory process. Trying to get rid of pain or other symptoms on their own, a person loses time, and this is absolutely impossible to do, in order to avoid the development of irreversible processes. This is especially true for patients with a removed gallbladder. Timely diagnosis and treatment ensures a favorable outcome.

The Yusupov hospital has all the conditions for high-quality diagnostics and treatment. Here you can also conduct a preventive examination if there was a cholecystectomy in the past or there are cases of cholelithiasis in the family.

Diagnosis and treatment of gallstones : Armedical

Treatment in Israel
State
hospital
Ichilov-Surasky. Official representative.

The gallbladder can form gallstones, which are pieces of hard material like crystals that form directly in the gallbladder. These pieces can be of different shapes, sizes, and presented in different quantities.

The gallbladder is a pear-shaped organ. It is located in the upper right side of the abdomen under the liver. Its main purpose is the accumulation of bile and its excretion at the right time through the bile ducts into the intestines. As you know, bile plays a supporting role in the process of digestion.

Bile is a liquid produced continuously by the liver and is brownish yellow in color. It contains water, bile salts, bilirubin, bile pigments, which gives bile its characteristic color. The amount of bile that the liver can produce per day is up to 3 cups. In turn, the gallbladder is able to store up to 1 cup of bile.

The presence of stones in the gallbladder usually does not cause serious discomfort or pain, but the danger is that they can travel through the bile ducts and block them. And this leads to violations of the outflow of bile and obstruction of the biliary tract.

In 80% of patients, gallstones are yellow, white or light in color due to their calcium and cholesterol content. The remaining 20% ​​are dark-colored stones, which contain bilirubin, which is insoluble in water. 85% of patients have cholesterol-type stones.

In terms of stone size, gallstones can be as small as a grain of sand. But they can also reach large sizes, comparable to the size of a ping-pong ball. There are times when one large stone can form in the gallbladder, and there are also an incredible number (up to a thousand) of small stones.

Stones in the gallbladder – the causes of occurrence

In the course of practice and study of the problem of gallstone disease, the specialists of the Ichilov hospital made conclusions regarding the main causes of its occurrence:

• hereditary factors;
• overweight and sedentary;
• irrational diet and improper eating habits;
• chemical processes in the liver;
• dysmotility of the gallbladder, etc.

Cholesterol stones are formed when the bile contains an excess amount of cholesterol and there is a lack of bile salts, and also when there are proteins or bile in the liver. Also, another reason for the formation of stones is incomplete emptying of the gallbladder.

Symptoms of gallstone disease

Often, gallstone disease can be asymptomatic. But sometimes there may be pain in the upper abdomen on the right, in the right shoulder blade, chest or back. Nausea or vomiting may also be felt. There can be different intervals between such attacks – both a week and a year.
Even if there are no symptoms of the disease, it still needs to be treated, since blockage of the bile ducts can cause the development of jaundice or cholecystitis.

Methods for diagnosing gallstones in Ichilov Hospital

To diagnose gallstones, Ichilov Hospital (Tel Aviv Sourasky Medical Center) performs an ultrasound (an examination using ultrasound). When difficulties arise in identifying stones, other research methods may be required at the discretion of doctors: nuclear magnetic resonance, endoscopic ultrasound, magnetic resonance imaging, endoscopic retrograde cholangiopancreatography.