What are the main causes of gallstones. How can gallstones be diagnosed and treated effectively. What are the potential complications of untreated gallstones. Can gallstones be prevented through lifestyle changes.

Understanding Gallstones: Formation and Risk Factors

Gallstones are small, hard deposits that form in the gallbladder, a small organ located beneath the liver. These stones typically develop due to an imbalance in the chemical composition of bile, a digestive fluid produced by the liver and stored in the gallbladder. In most cases, gallstones form when cholesterol levels in the bile become too high, causing excess cholesterol to crystallize and form stones.

Several factors can increase the risk of developing gallstones:

• Being overweight or obese
• Being female, especially if you’ve had children
• Being 40 years or older (risk increases with age)
• Genetic predisposition
• Rapid weight loss or prolonged fasting
• Certain medical conditions, such as diabetes or liver disease

Do all gallstones cause symptoms. While gallstones are common, affecting more than 1 in 10 adults in the UK, only a minority of people experience symptoms. Many individuals have what are known as “silent” gallstones, which don’t cause any noticeable problems and may not require treatment.

Recognizing the Symptoms of Gallstone Disease

When gallstones do cause symptoms, the condition is referred to as gallstone disease or cholelithiasis. The most common symptom is biliary colic, characterized by sudden, intense abdominal pain that typically lasts between 1 and 5 hours. This pain occurs when a gallstone becomes trapped in a duct within the gallbladder.

Other symptoms of gallstone disease may include:

• Pain in the center of the abdomen or under the ribs on the right side
• Pain that may radiate to the side or shoulder blade
• Nausea and vomiting
• Jaundice (yellowing of the skin and eyes)
• Fever and chills
• Persistent abdominal discomfort

Can gallstone symptoms be mistaken for other conditions. Yes, the symptoms of gallstones can sometimes be confused with other digestive issues or even heart problems. It’s essential to consult a healthcare provider for an accurate diagnosis if you experience persistent or severe abdominal pain.

Diagnosing Gallstones: Medical Imaging and Tests

Diagnosing gallstones typically involves a combination of medical history, physical examination, and imaging tests. The most common diagnostic tools include:

1. Ultrasound: This non-invasive imaging technique is often the first choice for detecting gallstones.
2. CT scan: Provides detailed images of the gallbladder and surrounding organs.
3. HIDA scan: A nuclear medicine test that evaluates gallbladder function and detects blockages.
4. Blood tests: Can help identify signs of infection or inflammation.
5. MRI: May be used to visualize the bile ducts and detect any obstructions.

How accurate are these diagnostic methods. Ultrasound is highly effective in detecting gallstones, with an accuracy rate of around 95%. However, combining multiple diagnostic approaches can provide a more comprehensive understanding of the condition and guide treatment decisions.

Treatment Options for Gallstone Disease

Treatment for gallstones is typically only necessary when they cause symptoms or complications. The most common treatment approaches include:

1. Watchful Waiting

For asymptomatic gallstones, a “wait and see” approach may be recommended. Regular monitoring can help detect any changes or development of symptoms.

2. Surgical Removal (Cholecystectomy)

Laparoscopic cholecystectomy, a minimally invasive surgery to remove the gallbladder, is the gold standard treatment for symptomatic gallstones. This procedure is relatively simple and has a low risk of complications.

3. Medications

In some cases, medications like ursodeoxycholic acid may be prescribed to dissolve small gallstones. However, this approach is less effective and takes longer than surgery.

4. Lithotripsy

This non-invasive technique uses shock waves to break up gallstones. It’s less commonly used and may be combined with medication to dissolve the fragments.

Is gallbladder removal always necessary for gallstones. No, not all cases of gallstones require gallbladder removal. The decision to perform surgery depends on the severity of symptoms, the frequency of attacks, and the overall health of the patient.

Living Without a Gallbladder: What to Expect

Many people worry about the consequences of gallbladder removal, but it’s important to understand that you can lead a normal life without this organ. After cholecystectomy:

• The liver continues to produce bile for fat digestion
• Bile flows directly into the small intestine instead of being stored in the gallbladder
• Most people don’t experience significant digestive changes
• Some individuals may need to make minor dietary adjustments

Are there any long-term effects of gallbladder removal. While most people adapt well to life without a gallbladder, some may experience occasional diarrhea or digestive discomfort. These symptoms usually improve over time and can be managed with dietary modifications.

Preventing Gallstones: Lifestyle Modifications and Risk Reduction

While not all gallstones can be prevented, certain lifestyle changes may help reduce your risk:

1. Maintain a healthy weight: Obesity increases the risk of gallstones, so achieving and maintaining a healthy BMI is crucial.
2. Eat a balanced diet: Include plenty of fruits, vegetables, whole grains, and lean proteins in your diet.
3. Stay hydrated: Drinking adequate water can help prevent bile from becoming too concentrated.
4. Exercise regularly: Physical activity may help reduce the risk of gallstone formation.
5. Avoid rapid weight loss: Gradual, steady weight loss is preferable to extreme dieting, which can increase gallstone risk.

Can dietary changes alone prevent gallstones. While a healthy diet can reduce the risk of gallstone formation, it’s not a guarantee. Genetic factors and other non-modifiable risks still play a role in gallstone development.

Complications of Untreated Gallstones: When to Seek Medical Attention

If left untreated, gallstones can lead to several serious complications:

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

When should you seek immediate medical care for gallstone symptoms. If you experience severe abdominal pain lasting more than a few hours, fever and chills, or yellowing of the skin and eyes, seek medical attention promptly. These symptoms may indicate a serious gallstone complication requiring urgent treatment.

Alternative Therapies and Natural Remedies for Gallstones

While conventional medical treatments are the most effective for gallstones, some people explore alternative or complementary approaches. These may include:

• Herbal remedies: Such as milk thistle, peppermint, or turmeric
• Acupuncture: To manage pain and promote overall wellness
• Gallbladder flushes or cleanses: Controversial methods claiming to remove gallstones naturally
• Apple cider vinegar: Believed by some to help dissolve gallstones

Are natural remedies effective for treating gallstones. While some alternative therapies may offer symptom relief, there is limited scientific evidence supporting their effectiveness in treating or preventing gallstones. It’s crucial to consult with a healthcare provider before trying any alternative treatments, as some may interact with medications or cause adverse effects.

In conclusion, understanding gallstones, their causes, symptoms, and treatment options is essential for managing this common condition effectively. While many cases of gallstones remain asymptomatic, those experiencing symptoms should seek medical advice to prevent potential complications. With proper diagnosis and treatment, most cases of gallstone disease can be successfully managed, allowing individuals to maintain a high quality of life. Remember that prevention through healthy lifestyle choices plays a crucial role in reducing the risk of gallstone formation and promoting overall digestive health.

Gallstones – Illnesses & conditions

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1. 1.

   About gallstones

2. 2.

   Symptoms of gallstones

3. 3.

   Causes of gallstones

4. 4.

   Diagnosing gallstones

5. 5.

   Treating gallstones

6. 6.

   Complications of gallstones

7. 7.

   Preventing gallstones

About gallstones

Gallstones are small stones, usually made of cholesterol, that form in the gallbladder. In most cases they don’t cause any symptoms and don’t need to be treated.

However, if a gallstone becomes trapped in a duct (opening) inside the gallbladder it can trigger a sudden intense abdominal pain that usually lasts between 1 and 5 hours. This type of abdominal pain is known as biliary colic.

Some people with gallstones can also develop complications, such as inflammation of the gallbladder (cholecystitis), which can cause:

• persistent pain
• jaundice 
• a fever

When gallstones cause symptoms or complications, it’s known as gallstone disease or cholelithiasis. Read more about:

• symptoms of gallstones
• complications of gallstones

The gallbladder

The gallbladder is a small, pouch-like organ found underneath the liver. Its main purpose is to store and concentrate bile.

Bile is a liquid produced by the liver to help digest fats. It’s passed from the liver through a series of channels, known as bile ducts, into the gallbladder.

The bile is stored in the gallbladder and over time it becomes more concentrated, which makes it better at digesting fats. The gallbladder releases bile into the digestive system when it’s needed.

What causes gallstones?

Gallstones are thought to develop because of an imbalance in the chemical make-up of bile inside the gallbladder. In most cases the levels of cholesterol in bile become too high and the excess cholesterol forms into stones.

Gallstones are very common. It’s estimated that more than 1 in every 10 adults in the UK has gallstones, although only a minority of people develop symptoms.

You’re more at risk of developing gallstones if you’re:

• overweight or obese 
• female, particularly if you’ve had children
• 40 or over (the risk increases as you get older)

Read more about:

• causes of gallstones 
• preventing gallstones

Treating gallstones

Treatment is usually only necessary if gallstones are causing:

• symptoms – such as abdominal pain
• complications – such as jaundice or acute pancreatitis

In these cases, keyhole surgery to remove the gallbladder may be recommended. This procedure, known as a laparoscopic cholecystectomy, is relatively simple to perform and has a low risk of complications.

You can lead a perfectly normal life without a gallbladder. Your liver will still produce bile to digest food, but the bile will just drip continuously into the small intestine, rather than build up in the gallbladder.

Read more about:

• treating gallstones
• diagnosing gallstones

Outlook

Most cases of gallstone disease are easily treated with surgery.  Very severe cases can be life-threatening, especially in people who are already in poor health. However, deaths from gallstone disease are rare in the UK.

Symptoms of gallstones

Most cases of gallstones don’t cause any symptoms. But if a gallstone blocks one of the bile ducts, it can cause sudden, severe abdominal pain, known as biliary colic.

Other symptoms may develop if the blockage is more severe or develops in another part of the digestive system.

Abdominal pain (biliary colic)

Gallstones can cause sudden, severe abdominal pain that usually lasts 1 to 5 hours (although it can sometimes last just a few minutes).

The pain can be felt:

• in the centre of your abdomen (tummy)
• just under the ribs on your right-hand side – it may spread from here to your side or shoulder blade

The pain is constant and isn’t relieved when you go to the toilet, pass wind or are sick. It’s sometimes triggered by eating fatty foods, but may occur at any time of day and it may wake you up during the night.

Biliary colic doesn’t happen often. After an episode of pain, it may be several weeks or months before you experience another episode.

Some people also have periods where they sweat excessively and feel sick or vomit.

When gallstones cause episodes of biliary colic, it is known as ‘uncomplicated gallstone disease’.

Other symptoms

In a small number of people, gallstones can cause more serious problems if they obstruct the flow of bile for longer periods or move into other organs (such as the pancreas or small bowel).

If this happens, you may develop:

• a high temperature of 38C (100.4F) or above
• more persistent pain
• a rapid heartbeat
• yellowing of the skin and whites of the eyes (jaundice)
• itchy skin
• diarrhoea
• chills or shivering attacks
• confusion
• a loss of appetite

Doctors refer to this more severe condition as ‘complicated gallstone disease’.

Read more about the complications of gallstones.

When to seek medical advice

If you think you may be experiencing biliary colic, you should make an appointment with your GP.

Contact your GP immediately for advice if you develop:

• jaundice
• abdominal pain lasting longer than eight hours
• a high temperature and chills
• abdominal pain so intense that you can’t find a position to relieve it

If it’s not possible to contact your GP immediately, phone your local out-of-hours NHS 24 111 service.

Causes of gallstones

Gallstones are thought to be caused by an imbalance in the chemical make-up of bile inside the gallbladder. Bile is a liquid produced by the liver to aid digestion.

It’s still unclear exactly what leads to this imbalance, but gallstones can form if:

• there are unusually high levels of cholesterol inside the gallbladder (about 4 in every 5 gallstones are made up of cholesterol)
• there are unusually high levels of a waste product called bilirubin inside the gallbladder (about 1 in every 5 gallstones is made up of bilirubin)

These chemical imbalances cause tiny crystals to develop in the bile. These can gradually grow (often over many years) into solid stones that can be as small as a grain of sand or as large as a pebble.

Sometimes only 1 stone will form, but there are often several at the same time.

Who’s at risk?

Gallstones are more common if you:

• are female, particularly if you’ve had children, are taking the combined Pill, or are undergoing high-dose oestrogen therapy
• are overweight or obese
• are aged 40 years or older (the older you are, the more likely you are to develop gallstones)
• have a condition that affects the flow of bile – such as cirrhosis (scarring of the liver), primary sclerosing cholangitis, or obstetric cholestasis 
• have Crohn’s disease or irritable bowel syndrome (IBS)
• have a close family member who’s also had gallstones
• have recently lost weight (from either dieting or weight-loss surgery)
• are taking an antibiotic called ceftriaxone

Diagnosing gallstones

Gallstones may be discovered during tests for a different condition, as they often don’t cause any symptoms.

If you do have symptoms of gallstones, make an appointment with your GP so they can try to identify the problem.

Seeing your GP

Your GP will ask about your symptoms in detail and may carry out the Murphy’s sign test to help determine if your gallbladder is inflamed.

During this test, your GP places their hand or fingers on the upper-right area of your tummy and asks you to breathe in. If you find this painful, it usually means your gallbladder is inflamed and you may need urgent treatment.

Your GP may also recommend having blood tests to look for signs of infection, or to check if your liver is working normally. If gallstones have moved into your bile duct, the liver may not be able to function properly.

Further tests

If your symptoms and test results suggest you may have gallstones, you’ll usually be referred for further tests. You may be admitted to hospital for tests the same day if your symptoms suggest you have a more severe form of gallbladder disease.

Ultrasound scan

Gallstones can usually be confirmed using an ultrasound scan, which uses high frequency sound waves to create an image of the inside of the body.

The type of ultrasound scan used for gallstones is similar to the scan used during pregnancy, where a small handheld device called a transducer is placed onto your skin and moved over your upper abdomen.

Sound waves are sent from the transducer, through your skin and into your body. They bounce back off the body tissues, forming an image on a monitor. This is a painless procedure that usually takes about 10-15 minutes to complete.

When gallstones are diagnosed, there may be some uncertainty about whether any stones have passed into the bile duct.

Gallstones in the bile duct are sometimes seen during an ultrasound scan. If they’re not visible but your tests suggest the bile duct may be affected, you may need an MRI scan or a cholangiography.

MRI scan

A magnetic resonance imaging (MRI) scan may be carried out to look for gallstones in the bile ducts. This type of scan uses strong magnetic fields and radio waves to produce detailed images of the inside of the body.

Cholangiography

A procedure called a cholangiography can give further information about the condition of your gallbladder.

A cholangiography uses a dye that shows up on X-rays. The dye may be injected into your bloodstream or injected directly into your bile ducts during surgery or using an endoscope passed through your mouth.

After the dye has been introduced, X-ray images are taken. They’ll reveal any abnormality in your bile or pancreatic systems. If your gallbladder and bile systems are working normally, the dye will be absorbed in the places it’s meant to go (your liver, bile ducts, intestines and gallbladder).

If a blockage is detected during this test, your doctor may try to remove it at this point using an endoscope. This is known as an endoscopic retrograde cholangio-pancreatography (ERCP). See treating gallstones for more information about ERCP.

CT scan

A computerised tomography (CT) scan may be carried out to look for any complications of gallstones, such as acute pancreatitis. This type of scan involves taking a series of X-rays from many different angles.

CT scans are often done in an emergency to diagnose severe abdominal pain.

Treating gallstones

Your treatment plan for gallstones depends on how the symptoms are affecting your daily life.

If you don’t have any symptoms, a policy of ‘active monitoring’ is often recommended. This means you won’t receive immediate treatment, but you should let your GP know if you notice any symptoms.

As a general rule, the longer you go without symptoms, the less likely it is that your condition will get worse.

You may need treatment if you have a condition that increases your risk of developing complications, such as:

• scarring of the liver (cirrhosis)
• high blood pressure inside the liver – this is known as portal hypertension and is often a complication of alcohol-related liver disease
• diabetes

Treatment may also be recommended if a scan shows high levels of calcium inside your gallbladder, as this can lead to gallbladder cancer in later life.

If you have episodes of abdominal pain (biliary colic), treatment depends on how the pain affects your daily activities. If the episodes are mild and infrequent, you may be prescribed painkillers to control further episodes and given advice about eating a healthy diet to help control the pain.

If your symptoms are more severe and occur frequently, surgery to remove the gallbladder is usually recommended.

The gallbladder isn’t an essential organ and you can lead a perfectly normal life without one. Some people may experience symptoms of bloating and diarrhoea after eating fatty or spicy food. If certain foods do trigger symptoms, you may wish to avoid them in the future.

Keyhole surgery to remove the gallbladder

If surgery is recommended, you’ll usually have keyhole surgery to remove your gallbladder. This is known as a laparoscopic cholecystectomy.

During a laparoscopic cholecystectomy, 3 or 4 small cuts are made in your abdomen. One larger cut (about 2-3cm) will be by the belly button and the others (each 1cm or less) will be on the right side of your abdomen.

Your abdomen is temporarily inflated using carbon dioxide gas. This is harmless and makes it easier for the surgeon to see your organs.

A laparoscope (long thin telescope with a tiny light and video camera at the end) is inserted through one of the cuts in your abdomen. This allows your surgeon to view the operation on a video monitor. Your surgeon will then remove your gallbladder using special surgical instruments.

If it’s thought there may be gallstones in the bile duct, an X-ray or ultrasound scan of the bile duct is also taken during the operation. If gallstones are found, they may be removed during keyhole surgery. If the operation can’t be done this way or an unexpected complication occurs, it may have to be converted to open surgery (see below).

After the gallbladder has been removed, the gas in your abdomen escapes through the laparoscope and the cuts are closed with dissolvable stitches and covered with dressings.

Laparoscopic cholecystectomies are usually performed under a general anaesthetic, which means you’ll be asleep during the procedure and won’t feel any pain while it’s carried out. The operation takes 60-90 minutes and you can usually go home the same day. Full recovery typically takes around 10 days.

Single-incision keyhole surgery

Single-incision laparoscopic cholecystectomy is a newer type of keyhole surgery used to remove the gallbladder. During this type of surgery, only one small cut is made, which means you’ll only have one barely visible scar.

However, single-incision laparoscopic cholecystectomies haven’t been carried out as often as conventional laparoscopic cholecystectomies, so there are still some uncertainties about it. Access to this type of surgery is also limited because it needs an experienced surgeon with specialist training.

The National Institute for Health and Care Excellence (NICE) has more information on single-incision laparoscopic cholecystectomy.

Open surgery

A laparoscopic cholecystectomy may not always be recommended, for example if you:

• are in the third trimester (the last three months) of pregnancy
• are extremely overweight
• have an unusual gallbladder or bile duct structure that makes a keyhole procedure difficult and potentially dangerous

In these circumstances, an open cholecystectomy may be recommended. During this procedure, a 10-15cm (4-6in) incision is made in your abdomen underneath the ribs so the gallbladder can be removed. This is done under general anaesthetic, so you’ll be asleep and won’t feel any pain.

Open surgery is just as effective as laparoscopic surgery, but it does have a longer recovery time and causes more visible scarring. Most people have to stay in hospital for up to 5 days and it typically takes 6 weeks to fully recover.

Endoscopic retrograde cholangio-pancreatography (ERCP)

An endoscopic retrograde cholangio-pancreatography (ERCP) is a procedure that can be used to remove gallstones from the bile duct. The gallbladder isn’t removed during this procedure, so any stones in the gallbladder will remain unless removed using the surgical techniques mentioned above.

ERCP is similar to a diagnostic cholangiography (see diagnosing gallstones for more information), where an endoscope (long, thin flexible tube with a camera at the end) is passed through your mouth down to where the bile duct opens into the small intestine.

However, during ERCP the opening of the bile duct is widened with a small incision or an electrically heated wire. The bile duct stones are then removed or left to pass into your intestine and out of your body.

Sometimes a small tube called a stent is permanently placed in the bile duct to help the bile and stones pass.

An ERCP is usually carried out under sedation, which means you’ll be awake throughout the procedure but won’t experience any pain.

The ERCP procedure lasts about 30 minutes on average, but can take from 15 minutes to over an hour. You may need to stay overnight in hospital after the procedure so you can be monitored.

Medication to dissolve gallstones

If your gallstones are small and don’t contain calcium, it may be possible to take ursodeoxycholic acid tablets to dissolve them.

However, these aren’t prescribed very often because:

• they’re rarely very effective
• they need to be taken for a long time (up to 2 years)
• gallstones can recur once treatment is stopped

Side effects of ursodeoxycholic acid are uncommon and are usually mild. The most commonly reported side effects are feeling sick, being sick and itchy skin.

The use of ursodeoxycholic acid isn’t usually recommended for pregnant or breastfeeding women. Sexually active women should use either a barrier method of contraception, such as a condom, or a low-dose oestrogen contraceptive pill while taking ursodeoxycholic acid, as it may affect other types of oral contraceptive pills.

Ursodeoxycholic acid tablets are occasionally also prescribed as a precaution against gallstones if it’s thought you’re at risk of developing them. For example, you may be prescribed ursodeoxycholic acid if you’ve recently had weight loss surgery, as rapid weight loss can cause gallstones to grow.

Complications of gallstones

A small number of people with gallstones may develop serious problems if the gallstones cause a severe blockage or move into another part of the digestive system.

Inflammation of the gallbladder (acute cholecystitis)

In some cases of gallstone disease a bile duct can become permanently blocked, which can lead to a build-up of bile inside the gallbladder. This can cause the gallbladder to become infected and inflamed.

The medical term for inflammation of the gallbladder is acute cholecystitis. Symptoms include:

• pain in your upper abdomen that travels towards your shoulder blade (unlike biliary colic, the pain usually lasts longer than five hours)
• a high temperature (fever) of 38C (100.4F) or above
• a rapid heartbeat

An estimated 1 in 7 people with acute cholecystitis also experience jaundice (see below).

Acute cholecystitis is usually treated first with antibiotics to settle the infection and then keyhole surgery to remove the gallbladder. This operation can be more difficult when performed as an emergency and there’s a higher risk of it being converted to an open procedure.

Sometimes a severe infection can lead to a gallbladder abscess (empyema of the gallbladder). Antibiotics alone don’t always treat these and they may need to be drained.

Occasionally a severely inflamed gallbladder can tear, leading to peritonitis (inflammation of the inside lining of the abdomen).  If this happens, you may need to have antibiotics given directly into a vein (intravenous antibiotics) and surgery may be required to remove a section of the lining if part of it becomes severely damaged.

Read more about acute cholecystitis.

Jaundice

If a gallstone passes out of the gallbladder into the bile duct and blocks the flow of bile, jaundice occurs.

Symptoms of jaundice include:

• yellowing of the skin and eyes
• dark brown urine
• pale stools
• itching

Sometimes the stone passes from the bile duct on its own. If it doesn’t, the stone needs to be removed. See treating gallstones.

Infection of the bile ducts (acute cholangitis)

If the bile ducts become blocked, they’re vulnerable to infection by bacteria. The medical term for a bile duct infection is acute cholangitis.

Symptoms of acute cholangitis include:

• pain in your upper abdomen that travels towards your shoulder blade
• a high temperature
• jaundice
• chills
• confusion
• itchy skin
• generally feeling unwell

Antibiotics will help treat the infection, but it’s also important to help the bile from the liver to drain with an endoscopic retrograde cholangio-pancreatography (ERCP). See treating gallstones for more information.

Acute pancreatitis

Acute pancreatitis may develop when a gallstone moves out of the gallbladder and blocks the opening (duct) of the pancreas, causing it to become inflamed.

The most common symptom of acute pancreatitis is a sudden severe dull pain in the centre of your upper abdomen, around the top of your stomach.

The pain of acute pancreatitis often gets steadily worse until it reaches a constant ache. The ache may travel from your abdomen and along your back and may feel worse after you have eaten. Leaning forward or curling into a ball may help to relieve the pain.

Other symptoms of acute pancreatitis can include:

• feeling sick
• being sick
• diarrhoea 
• loss of appetite
• a high temperature (fever) of 38C (100.4F) or above
• tenderness of the abdomen
• less commonly, jaundice

There’s currently no cure for acute pancreatitis, so treatment focuses on supporting the functions of the body until the inflammation has passed.

This usually involves admission to hospital so you can be given:

• fluids into a vein (intravenous fluids)
• pain relief
• nutritional support
• oxygen through tubes into your nose

With treatment, most people with acute pancreatitis improve within a week and are well enough to leave hospital after 5-10 days.

Read more about acute pancreatitis.

Cancer of the gallbladder

Gallbladder cancer is a rare but serious complication of gallstones. An estimated 660 cases of gallbladder cancer are diagnosed in the UK each year.

Having a history of gallstones increases your risk of developing gallbladder cancer. Approximately 4 out of every 5 people who have cancer of the gallbladder also have a history of gallstones.

However, people with a history of gallstones have a less than one in 10,000 chance of developing gallbladder cancer.

If you have additional risk factors, such as a family history of gallbladder cancer or high levels of calcium inside your gallbladder, it may be recommended that your gallbladder be removed as a precaution, even if your gallstones aren’t causing any symptoms.

The symptoms of gallbladder cancer are similar to those of complicated gallstone disease, including:

• abdominal pain
• high temperature (fever) of 38C (100.4F) or above
• jaundice

Gallbladder cancer can be treated with a combination of surgery, chemotherapy and radiotherapy.

Gallstone ileus

Another rare but serious complication of gallstones is known as gallstone ileus. This is where the bowel becomes obstructed by a gallstone.

Gallstone ileus can occur when an abnormal channel, known as a fistula, opens up near the gallbladder. Gallstones are then able to travel through the fistula and can block the bowel.

Symptoms of gallstone ileus include:

• abdominal pain
• being sick
• swelling of the abdomen 
• constipation

A bowel obstruction requires immediate medical treatment. If it’s not treated, there’s a risk that the bowel could split open (rupture). This could cause internal bleeding and widespread infection.

If you suspect you have an obstructed bowel, contact your GP as soon as possible. If this isn’t possible, phone the NHS 24 111 service.

Surgery is usually required to remove the gallstone and unblock the bowel. The type of surgery you receive depends on where in the bowel the obstruction has occurred.

Preventing gallstones

From the limited evidence available, changes to your diet and losing weight (if you’re overweight) may help prevent gallstones.

Diet

Because of the role cholesterol appears to play in the formation of gallstones, it is advisable to avoid eating too many foods with a high saturated fat content.

Foods high in saturated fat include:

• meat pies
• sausages and fatty cuts of meat
• butter, ghee and lard
• cream
• hard cheeses 
• cakes and biscuits
• food containing coconut or palm oil

A healthy, balanced diet is recommended. This includes plenty of fresh fruit and vegetables (at least 5 portions a day) and wholegrains.

There’s also evidence that regularly eating nuts, such as peanuts or cashews, can help reduce your risk of developing gallstones. 

Drinking small amounts of alcohol may also help reduce your risk of gallstones. However, you shouldn’t regularly drink more than 14 units of alcohol a week as this can lead to liver problems and other health conditions. Regularly drinking any amount of alcohol can increase the risk to your health.

Read more about: 

• high cholesterol
• how to lower your cholesterol
• healthy eating

Losing weight

Being overweight, particularly being obese, increases the amount of cholesterol in your bile, which increases your risk of developing gallstones. You should control your weight by eating a healthy diet and taking plenty of regular exercise.

However, avoid low-calorie, rapid-weight-loss diets. There’s evidence they can disrupt your bile chemistry and increase your risk of developing gallstones. A more gradual weight loss plan is recommended.

Read more about losing weight and getting started with exercise.

Symptoms, Causes, Treatment, and More

Gallstones are deposits of digestive fluid made of solidified substances found in bile, like cholesterol. They are common and may or may not produce symptoms. People with symptoms usually need to have their gallbladders taken out.

Read on to learn more about gallstones, the symptoms they can cause, and how to treat them.

Your gallbladder is a small organ in your upper right abdomen, right below your liver. It’s a pouch that stores bile, a green-yellow liquid that helps digestion. Issues with your gallbladder typically occur when something is blocking its bile duct—like a gallstone.

Most gallstones are created when substances found in bile, like cholesterol, harden. Gallstones are very common and routinely asymptomatic.

However, about 10 percent of people who are diagnosed with gallstones will develop noticeable symptoms within 5 years.

Photo: Bruce Blaus | Wikimedia Commons | https://commons. wikimedia.org/wiki/File:Gallstones.png

Gallstones can lead to pain in the upper right abdomen or the center of your stomach. You may experience gallbladder pain from time to time after you eat foods that are high in fat, such as fried foods, but the pain can occur at almost any time.

Pain caused by gallstone issues usually lasts for only a few hours, but it can feel severe.

If gallstones are left untreated or unidentified, the symptoms may increase to include:

• a high temperature
• rapid heartbeat
• yellowing of the skin and whites of the eyes (jaundice)
• itchy skin
• diarrhea
• chills
• confusion
• a loss of appetite

These symptoms can be signs of a gallbladder infection, or inflammation of the gallbladder, liver, or pancreas.

Because gallstone symptoms may mimic the symptoms of other serious issues like appendicitis and pancreatitis, no matter what, if you’re dealing with one or more of these issues — it’s time to see a doctor or get yourself to the ER.

If you need help finding a urologist, then check out our FindCare tool here.

Asymptomatic gallstones

Gallstones themselves don’t cause pain. Rather, pain occurs when gallstones block the movement of bile from the gallbladder.

According to the American College of Gastroenterology, about 80 percent of people who have gallstones have “silent gallstones.” This means they don’t experience pain or have symptoms. In these cases, your doctor may discover the gallstones from X-rays or during abdominal surgery.

The actual cause of gallstones is thought to be due to a chemical imbalance of bile inside of the gallbladder. While researchers still aren’t clear about what exactly causes that imbalance to happen, there are a few possible reasons:

Too much cholesterol in your bile

Having too much cholesterol in your bile can lead to yellow cholesterol stones. These hard stones may develop if your liver makes more cholesterol than your bile can dissolve.

Too much bilirubin in your bile

Bilirubin is a chemical produced during the normal breakdown of red blood cells. After it’s created, it passes through the liver and is eventually excreted out of the body.

Some conditions, such as liver damage and certain blood disorders, cause your liver to produce more bilirubin than it should. Pigment gallstones form when your gallbladder can’t break down the excess bilirubin. These hard stones are often dark brown or black.

Concentrated bile due to a full gallbladder

Your gallbladder needs to be able to empty its bile to function properly. If it fails to empty its bile content, the bile becomes overly concentrated, which can cause stones to form.

Most of the time, you won’t need treatment for gallstones unless they cause you pain. Sometimes you can pass gallstones without even noticing. If you’re in pain, your doctor will likely recommend surgery. In rare cases, medication may be used.

If you’re at high risk for surgery complications, there are a few nonsurgical ways to attempt to treat gallstones. However, if surgery isn’t performed, your gallstones may come back — even with additional treatment. This means you may need to keep an eye on your condition for the majority of your life.

Surgery

Cholecystectomy, which is surgery to remove the gallbladder, is one of the most common operations performed on adults in the United States. Because the gallbladder isn’t an essential organ, it’s possible to live a healthy life without it.

There are two types of cholecystectomy:

• Laparoscopic cholecystectomy. This is a common surgery that requires general anesthesia. The surgeon will usually make three or four incisions in your abdomen. They’ll then insert a small, lighted device into one of the incisions, check for stones, and carefully remove your gallbladder. You can usually go home on the day of the procedure or the day after if you have no complications.
• Open cholecystectomy.This surgery is typically performed when the gallbladder is inflamed, infected, or scarred. This surgery may also happen if problems occur during a laparoscopic cholecystectomy.

You may experience loose or watery stools after gallbladder removal. Removing a gallbladder involves rerouting the bile from the liver to the small intestine. Bile no longer goes through the gallbladder and it becomes less concentrated. The immediate result is a laxative effect that can cause diarrhea, but this issue should resolve on its own for most people.

Nonsurgical treatments

If surgery can’t be performed, such as if the patient is a much older individual, there are a few other ways doctors can try to get rid of your gallstones.

• Oral dissolution therapy typically includes using the medications ursodiol (Actigall) and chenodiol (Chenix) to break up gallstones. These medications contain bile acids, which work to break up the stones. This treatment is best suited for breaking up cholesterol stones and can take many months or years to work completely.
• Shock wave lithotripsy is another option. A lithotripter is a machine that generates shock waves that pass through a person. These shock waves can break gallstones into smaller pieces.
• Percutaneous drainage of the gallbladder involves placing a sterile needle into the gallbladder to aspirate (draw out) bile. A tube is then inserted to help with additional drainage. This procedure isn’t typically a first line of defense and tends to be an option for individuals who may not be suited for other procedures.

Some risk factors for gallstones are related to diet, while other factors are not as controllable. Uncontrollable risk factors are things like age, race, sex, and family history.

Lifestyle risk factors

• living with obesity
• a diet high in fat or cholesterol and low in fiber
• undergoing rapid weight loss
• living with type 2 diabetes

Genetic risk factors

• being born female
• being of Native American or Mexican descent
• having a family history of gallstones
• being 60 years or older

Medical risk factors

• living with cirrhosis
• being pregnant
• taking certain medications to lower cholesterol
• taking medications with a high estrogen content (like certain birth controls)

While some medications may increase your risk of gallstones, don’t stop taking them unless you have discussed it with your doctor and have their approval.

Your doctor will perform a physical examination that includes checking your eyes and skin for visible changes in color. A yellowish tint may be a sign of jaundice, the result of too much bilirubin in your body.

The exam may involve using diagnostic tests that help your doctor see inside your body. These tests include:

• Ultrasound. An ultrasound produces images of your abdomen. It’s the preferred imaging method to confirm that you have gallstone disease. It can also show abnormalities associated with acute cholecystitis.
• Abdominal CT scan. This imaging test takes pictures of your liver and abdominal region.
• Gallbladder radionuclide scan. This important scan takes about one hour to complete. A specialist injects a radioactive substance into your veins. The substance travels through your blood to the liver and gallbladder. On a scan, it can reveal evidence to suggest infection or blockage of the bile ducts from stones.
• Blood tests. Your doctor may order blood tests that measure the amount of bilirubin in your blood. The tests also help determine how well your liver is functioning.

To help improve your condition and reduce your risk of gallstones, try these tips:

• Eat fewer refined carbs (like cookies and white bread) and less sugar.
• Increase your intake of healthy fats, like fish oil and olive oil, which may help your gallbladder contract and empty on a regular basis.
• Eat the proper amount of fiber per day (women need about 25 grams a day, men need about 38 grams a day).
• Get some sort of physical activity every day.
• Keep yourself properly hydrated.

If you plan to lose weight, do it slowly. Rapid weight loss may increase your risk of gallstones and other health problems.

While there is no foolproof way to completely prevent gallstones, cholesterol seems to play a major role in their formation. If you have a family history of gallstones, your doctor may advise you to limit foods with a high saturated fat content. Some of these foods include:

• fatty meat, like sausage and bacon
• cakes and cookies
• lard and cream
• certain cheeses

Because people living with obesity are more predisposed to gallstones, keeping your weight within a moderate range is another way to limit the possibility of their formation.

If your doctor has diagnosed you with gallstones and decides you need surgery to remove them or your gallbladder, the outlook is often positive. In most cases of stone removal, stones don’t return.

If you aren’t able to have surgery and decide to take medication to dissolve the stones, the gallstones can return, so you and your doctor will need to monitor your progress.

If your gallstones aren’t causing symptoms, you will most likely not need to do anything. Still, you may want to make lifestyle changes to prevent them from getting bigger and causing problems.

Gallbladder Stones: Causes, Symptoms, Diagnosis and Diet

Contents

• 1 Gallbladder Stones: How to Determine Causes, Recognize Symptoms, Properly Diagnose and Which Diet Can Help You Completely Get Rid of the Problem
  • 1. 1 Gallbladder Stones: symptoms and diagnosis
    • 1.1.1 Symptoms
    • 1.1.2 Diagnosis
    • 1.1.3 Diet
  • 1.2 Related videos:
  • 1.3 Gallstones : description, causes and symptoms
  • 1.4 Why do gallstones occur?
  • 1.5 What are the symptoms of gallstones?
  • 1.6 Diagnosing gallstones
  • 1.7 Treatments for gallstones
  • 1.8 Medicines for gallstones
    • 1.8.1 How can medicines help gallstones?
  • 1.9 Role of diet in the treatment of gallstones
  • 1.10 Food avoidance for gallstones
  • 1.11 What foods are good for gallstones?
  • 1.12 What exercises and massages help with gallstones?
  • 1.13 Preventive measures to help prevent gallstones
  • 1.14 Q&A:
    • • 1.14.0.1 What are gallstones?
      • 1.14.0.2 What are the causes of gallstones?
      • 1.14.0.3 What symptoms may indicate the presence of gallstones?
      • 1.14.0. 4 What diagnosis should be done if gallstones are suspected?
      • 1.14.0.5 Which diet will help with gallstones?
      • 1.14.0.6 How are gallstones treated?

Find out the causes, symptoms, diagnosis and effective diet to treat gallstones. Our article will help you deal with this problem and restore health to your gallbladder.

The gallbladder is an important organ responsible for storing and secreting bile needed for the digestion of fats. However, sometimes gallstones can form in the gallbladder, which can lead to painful and dangerous consequences.

The reason for the formation of stones in the gallbladder can be a violation of the metabolism of bile acids and cholesterol, unbalanced diet, heredity and other factors. Symptoms of gallstones may include pain in the right hypochondrium, nausea, vomiting, fever, and other signs.

Diagnosis of gallstones includes ultrasound, exercise therapy, general clinical and biochemical blood tests and other methods. Treatment of gallstones may include conservative therapy, laparoscopic cholecystectomy, and other methods.

To prevent the formation of gallstones, it is recommended to follow a diet, drink enough water, lead a healthy lifestyle and consult a doctor at the first symptoms. In addition, there is a diet for gallstones that helps reduce the burden on the organ and prevent the formation of new stones.

Gallstones: symptoms and diagnosis

Symptoms

Gallstones can present with different symptoms. One of the most common symptoms is pain in the right hypochondrium, which can be severe or mild. This pain can be felt after eating fatty foods, as well as during physical exertion. Some patients may also experience nausea, vomiting, shoulder and back pain, fatigue, and jaundice.

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Diagnosis

Diagnosis of gallstones may include various methods such as ultrasound, x-ray, computed tomography and magnetic resonance imaging. The doctor may prescribe one or more of these methods to determine the presence of stones and their size.

Diet

Nutrition for gallstones plays an important role in the treatment and prevention of new gallstones. The main recommendation is to limit fatty and spicy foods, as well as to eat plenty of vegetables, fruits and green vegetables. You should also avoid snacking between meals and drinking large amounts of alcohol.

Related videos:

Gallstones: description, causes and symptoms

Gallstones are small hard formations that can form from bile inside the gallbladder. They can be of different sizes and shapes and can be found both in the gallbladder and in the bile duct.

The main reason for the formation of stones in the gallbladder is a violation of the normal bile process. For example, if there are too many salts or fatty acids in the bile duct, they can harden and turn into small stones. Other causes include heredity, reduced bile secretion, increased levels of cholesterol in the blood and bile, and diabetes mellitus.

Symptoms of gallstones can range from mild to severe. Many people with gallstones do not experience any symptoms, however, if the stones begin to block the bile ducts, there may be sharp pain in the right side, nausea, vomiting, fever, jaundice, and other problems.

• Diagnosis: Gallbladder stones are diagnosed using ultrasound or X-ray with contrast of the bile ducts. Your doctor may also order blood and urine tests to evaluate liver and biliary function.
• Diet: There are a number of foods that contribute to the formation of gallstones. Therefore, it is important to watch your diet. Avoid fatty, fried and spicy foods, alcohol, and foods high in cholesterol. Try to eat more fruits, vegetables, grains and protein foods.

Why do gallstones occur?

Although the exact cause of gallstones is not known, they are often thought to be due to irregular excretion of bile from the gallbladder. One of the main reasons associated with this phenomenon is an imbalance of cholesterol in the body. A high concentration of cholesterol in bile can lead to the formation of stones.

In addition, various metabolic disorders can also influence the formation of stones, especially if a person is obese. Genetic factors and increased levels of stress can also lead to the formation of gallstones.

Another reason is some diseases, such as cirrhosis of the liver, diseases of the bile ducts. People with high blood sugar levels are also generally at risk.

What symptoms indicate the presence of gallstones?

Gallstones are a common disease that occurs due to the crystallization of bile inside the gallbladder. For most people, stones stay in the gallbladder for a long time without causing discomfort. However, in some cases, stones can entrap the bile ducts, causing severe pain and other symptoms.

The main symptoms of gallstones are acute pain in the right hypochondrium, nausea and vomiting. Pain can lead to heartburn and a feeling of fullness in the stomach. Often after eating there is a feeling of heaviness in the abdomen and increased gas formation. In some people, changes in skin color and bile ducts are possible, which is associated with possible problems with the excretion of bile.

Symptoms of gallstones can come and go and are often unrelated. In many cases, symptoms may be vague or absent entirely. However, for most people with gallstones, the symptoms of gallstones can be significant and negatively affect their quality of life and well-being.

Diagnosing the presence of gallstones

1. Laboratory tests:

1. Blood tests: bilirubin and alkaline phosphatase levels may be elevated in the presence of gallstones;
2. Ultrasound diagnosis: non-invasive method to determine the number and size of stones in the gallbladder;
3. Cholangiopancreatography: A convertographic study in which a thin catheter is inserted into the bile duct through which a contrast agent is injected to show the ducts and the presence of stones in them.

2. Clinical signs:

• Pain in the right hypochondrium;
• Nausea and vomiting;
• Belching;
• Increased body temperature;
• Jaundice.

3. Instrumental examinations:

• Endoscopic ultrasonic cholangiopancreatography (EUS-CPG): more accurate method of examination, which allows to determine the presence of stones smaller than 3 mm;
• Magnetic resonance cholangiopancreatography (MRCP): is considered the safest and most effective diagnostic method used when there are contraindications to x-ray studies.

The complex use of various diagnostic methods allows you to more accurately determine the presence of stones in the gallbladder and conduct more effective treatment. If stones are found, it is necessary to consult a gastroenterologist for treatment, which includes a diet and, if necessary, surgery.

Treatments for gallstones

Pharmacotherapy: Some types of gallstones can be resolved with certain medications. The area of ​​the gallbladder where the stone is located will be relaxed, allowing the stone to pass out of the bile ducts. This method is most effective in the presence of cholesterol stones.

Surgical method: Surgery may be used when pharmacotherapy fails or stones are too large to dissolve. Laparoscopic cholecystectomy is usually used – removal of the gallbladder through small incisions in the abdominal cavity. In rare cases, open cholecystectomy may be required.

Emergency Procedure: If a stone obstructs the bile ducts, emergency medical attention is needed to prevent complications. This may be biliary stenting or endoscopic stone removal.

Diet: Limiting fatty and fried foods and increasing your intake of fruits, vegetables, and whole grains are general dietary guidelines for preventing gallstones. In addition, a specialist may recommend a fluid diet to reduce pressure on the gallbladder and prevent new gallstones from forming.

Control: After treatment, it is important to monitor your health and monitor for any changes in symptoms such as abdominal pain. Regular check-ups and ultrasounds can also help control future gallstones.

Medicines for gallstones

How can medicines help with gallstones?

For gallstones, drug treatment can help improve the patient’s general condition and reduce symptoms. Medications can help break down stones and promote their removal from the body.

Ursodeoxycholic acid is a popular drug used to treat gallstones. It reduces the amount of cholesterol in bile, which helps dissolve stones.

Chenodexcholic acid is another drug that can help with gallstones. This drug improves the patient’s condition, destroys gallstones and promotes their removal from the body.

Simethicone is a drug used to reduce gas in the intestines. With stones in the gallbladder, not only pain can occur, but also heartburn and bloating. Simethicone helps to reduce the amount of gas in the intestines and reduce uncomfortable symptoms.

Drotaverine is a drug that is widely used to reduce pain symptoms. It helps relieve spasms of smooth muscles, thereby reducing pain in the gallbladder.

In addition to these drugs, other drugs may be used to treat gallstones. However, do not forget that drugs should be prescribed only by a doctor and after diagnosis and determination of the cause of the disease.

The role of diet in the treatment of gallstones

Gallbladder stones are a serious disease that can lead to many complications and even surgery.

One of the important aspects of the treatment of gallstones is proper diet.

What should be excluded from the diet in case of gallstones?

• Fatty and fried foods that can promote the formation of new stones and worsen existing ones.
• Spicy and sour foods that can cause pain attacks and worsen the functioning of the gallbladder.
• Alcohol and strong coffee – these drinks can cause severe pain in the gallbladder area.

What should be included in the diet for gallstones?

• Fibre-rich foods: fresh vegetables, fruits and grains will help improve digestion and facilitate the removal of gallstones.
• Protein foods: Meat, fish and eggs are essential to keep the body healthy.
• Dairy products: These help lower blood cholesterol levels and reduce the risk of new stones.

Proper diet can significantly reduce the risk of new gallstones and improve the overall condition of the patient.

Food avoidance for gallstones

For those with gallstones, it is important to watch your diet. Some foods can worsen the condition of the gallbladder and cause increased pain. In addition, a violation of the diet can lead to the formation of new stones.

Remove from your diet:

• Fatty food. It causes a high production of bile, which can easily cause new stones to form and exacerbate the disease.
• Hot spices, marinades, ketchup, mayonnaise. They can irritate the walls of the gallbladder and cause pain.
• Fast carbohydrates, confectionery, sweets. They contribute to the formation of stones and disrupt the gallbladder.
• Alcohol, carbonated drinks. These drinks cause stomach acid to rise, which can cause pain in the liver and gallbladder.

It is important to remember that with stones in the gallbladder, you should not starve and refuse food. The diet should include healthy foods such as vegetables, fruits, greens, lean meats and fish. When in doubt about your diet, you should always consult a doctor or an experienced nutritionist.

What foods are good for gallstones?

In the presence of gallstones, it is very important to watch your diet and eat only those foods that will not harm your health. There is a certain list of products that are useful for this disease:

• Low fat dairy products. They can provide tremendous health and digestive benefits as they contain calcium, which helps dissolve gallstones.
• Vegetables and fruits. They should be the basis of daily nutrition. Fresh vegetables and fruits should be consumed as they contain fiber, which helps improve digestion and remove toxins from the body.
• Poultry, fish and fatty meats. Their consumption should be minimized or completely eliminated from the diet due to their high fat content, which can cause new stones to form.
• Green tea. It contains antioxidants that cleanse the body of waste and toxins.
• Sunflower and olive oils. They contain healthy fats that aid in the digestion of food and prevent the formation of new gallstones.

But not only is it important to know what foods are good for gallstones, but you also need to follow a diet and give up bad habits in order to avoid possible complications and reduce the consequences of the disease.

What exercises and massages help with gallstones?

Gallstones can cause severe pain and discomfort. However, some exercises and massages can help alleviate the symptoms associated with this disease:

• Breathing exercises – Deep breathing can help relieve pain and relax the abdominal muscles. You need to take a deep breath, hold your breath for a few seconds and then slowly exhale.
• Squats – This exercise can improve blood circulation in the gallbladder and prevent the formation of new stones. You need to stand shoulder-width apart, sit down, keeping your back straight and breathe deeply.
• Abdominal Massage – Abdominal massage can help soften gallstones and relieve pain. It is necessary to lie on your back, place your hands on your stomach and slowly make circular movements in a clockwise direction.

However, no exercise should cause pain or discomfort. If you have gallstones, you should consult your doctor before starting any exercise or massage activities.

Preventive measures to help prevent gallstones

Everyone knows that prevention is better than cure. Gallstones can lead to serious health problems, so it’s important to take steps to prevent them from forming.

• Proper nutrition: Eat healthy, high-fiber, low-calorie foods. Avoid greasy and fatty foods, as well as foods rich in cholesterol.
• Water: Drink enough water to avoid dehydration, which can lead to the formation of stones.
• Moderate exercise: Regular exercise helps keep you active and prevents gallstones.
• Weight control: Avoid being overweight, as more weight increases the risk of developing gallstones.

Remember, if you are experiencing symptoms of gallstones, do not attempt to self-diagnose your condition. Visit a doctor to get proper diagnosis and treatment.

Q&A:

What are gallstones?

Gallstones are solid growths, usually made up of cholesterol or bilirubin, that can form in the gallbladder.

What are the causes of gallstones?

The occurrence of gallstones can be caused by several factors, including hereditary predisposition, prolonged fasting, excess weight, consumption of foods rich in fat.

What symptoms may indicate the presence of gallstones?

Some of the most common symptoms of gallstones include right upper quadrant pain, nausea, vomiting, jaundice, and fever. However, in many people, gallstones may not cause symptoms and are discovered incidentally during diagnostic tests for other reasons.

What diagnosis should be done if gallstones are suspected?

Experts may recommend several diagnostic tests to detect gallstones, including ultrasound, gastroduodenoscopy, x-rays, and CT scans. Ultrasound is often used as it is the most accurate and safest procedure performed.

Which diet will help with gallstones?

Experts may have different opinions on which diet will help gallstones, but some of the most recommended foods include vegetables, fruits, lean fish and meat, oatmeal, rice, and oatmeal. Avoid fatty, fried and heavy foods, alcohol and foods containing cholesterol.

How are gallstones treated?

If gallstones cause severe pain or serious health problems, surgery may be required. Surgical treatment can be carried out both by removing stones and by removing the gallbladder. Other treatments include drug therapy and lithotripsy. A very effective way of prevention is regular body care, maintaining a healthy lifestyle and proper nutrition.

Gallstone disease – causes, symptoms, diagnosis, complications, treatment of stones in the gallbladder

Gallstone disease is a chronic disease of the organs of the hepatobiliary system, characterized by a violation of the 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 removal of calculi, the development of severe, including life-threatening, complications is possible – cholecystitis, peritonitis and others.

According to the clinical recommendations 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 is 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.

Causes

The main cause of stone formation in the gallbladder and ducts is an increased concentration of bile. When it is oversaturated with cholesterol, large calculi of a yellowish-white color are formed. If there is an inflammatory process in the bile ducts, 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 diet with excessive consumption of fatty foods and simple carbohydrates;
• sedentary lifestyle;
• obesity;
• taking hormonal contraceptives;
• pregnancy;
• rapid weight loss, low-calorie diet;
• helminthiasis;
• alcohol abuse;
• chronic liver pathology, diabetes mellitus, Crohn’s disease, anemia, cystic fibrosis, infectious process in the biliary tract;
• certain medications, eg octreotide, clofibrate.

Symptoms

Pathology for a long time may not have clinical manifestations. Symptoms of gallstone disease appear with inflammation or obstruction in the biliary tract, when stones from the cavity of the gallbladder 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 starts 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 region of the heart causes angina pectoris. The duration of such an attack in cholelithiasis is from a couple of minutes to several days. The nature of pain is first acute, then constant, aching.
• Bitter taste in the mouth, loss of 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, constipation of the atonic type.

An exacerbation of gallstone disease can be triggered by a violation of the diet. The movement of calculi can also be caused by shaking riding, torso tilts. With the development of choledocholithiasis – the entry of stones into the bile ducts and their blockage – mechanical jaundice develops. With it, the skin, sclera of the eyes and mucous membranes become icteric, there is itching of the skin, darkening of the urine and discoloration of the feces.

Often cholelithiasis appears together with hiatal hernia, peptic ulcer of the stomach or duodenum, diverticulosis of the colon. 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 characteristic.

Diagnosis

The diagnosis of gallstone disease is handled by a gastroenterologist, a surgeon, a general practitioner and a general practitioner. In a conversation with the 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 pain and other characteristic signs of acute cholecystitis are determined: a symptom of Zakharyin, Ortner, Murphy.

Further examination includes the use of laboratory and instrumental methods:
1. Complete blood count. Neutrophilic leukocytosis and accelerated ESR indicate inflammation in the gallbladder – acute cholecystitis.
2. Biochemical blood test. Allows you to identify a typical for cholelithiasis increase in cholesterol and bilirubin, alkaline phosphatase activity. Blockage of the bile ducts and bile stasis often lead to liver damage, so indicators such as alanine aminotransferase, aspartate aminotransferase, gamma-glutamyltranspeptidase, total and C-reactive protein are also important in cholelithiasis.
3. Tumor markers in serum. Their determination is aimed at identifying signs of cancer 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 stretched and not contracting in response to choleretic food. There is also severe pain in the right hypochondrium when pressed by the probe (“Murphy’s ultrasound 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 sufficiently informative.
6. Plain radiography of the abdominal cavity. The method allows to detect gallstones with a sufficient content of calcium in them and complications of cholelithiasis. The method is also used to recognize emphysematous cholecystitis, porcelain gallbladder, lime bile.
7. X-ray studies with contrast. During execution, a “disabled”, non-staining gallbladder can be determined. Endoscopic retrograde cholangiography is an invasive method that includes cannulation of the major papilla with the introduction of contrast through the choledochus. Percutaneous transhepatic cholangiography is performed if other contrast methods cannot be performed. Oral contrast-enhanced cholecystography and intravenous dye cholangiography are rarely performed.
8. Esophagastroduodenoscopy. A method of visualization of the duodenum with a mandatory examination of the major duodenal papilla.
9. Magnetic resonance cholangiopancreatography. It has high accuracy in detecting small calculi with a size of 2 mm, including those in the area of ​​the bile ducts (situations where the capabilities of ultrasound are insufficient).
10. Endoscopic ultrasound examination of the pancreato-biliary zone. This study allows you 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 where it enters the duodenum impose restrictions on its implementation.
11. Bilioscintigraphy. This is a radioisotope study with 99mTc labeled iminodiacetic acids. Gallstone disease 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 previous cholecystectomy.

Complications

In cholelithiasis, the walls of organs are traumatized by a stone with the development of inflammation in them, so the pathology can be complicated by cholangitis, cicatricial fusion of the major duodenal papilla, the formation of fistulous tracts between the biliary tract and neighboring organs or the abdominal cavity.

Untimely detection and treatment of acute cholecystitis is dangerous for the development of such fatal complications of cholelithiasis as empyema, gangrene and perforation of the gallbladder, peritonitis.

Treatment

When cholelithiasis is established, the patient is prescribed a diet, he is also recommended lifestyle correction and weight loss. Meals should be frequent and in small portions, with the exception of fried and fatty foods, every 3-4 hours, balanced, contain proteins, carbohydrates, and dietary fiber.

Drug therapy is effective only at the initial stage of gallstone disease, before the formation of calculi. In this case, the 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 alleviate the symptoms of acute calculous cholecystitis, patients are prescribed antispasmodics.