What are the primary factors contributing to gallstone formation in women. How does pregnancy influence the development of gallstones. Why are women at a higher risk for gallbladder stones compared to men. What steps can be taken to reduce the risk of gallstone formation.

Understanding Gallstones: A Predominant Issue for Women

Gallstones, small, hardened deposits that form in the gallbladder, disproportionately affect women. In fact, studies indicate that 65-75% of gallstone sufferers in the United States are female. This striking gender disparity raises questions about the underlying causes and risk factors specific to women.

The Role of Hormones in Gallstone Formation

The primary reason for the increased prevalence of gallstones in women lies in hormonal differences. Two key hormones play significant roles:

• Estrogen: Increases cholesterol levels in bile, a major component of gallstones
• Progesterone: Slows down gallbladder emptying, potentially leading to stone formation

Due to these hormonal factors, women under 40 are approximately three times more likely to develop gallstones than men of the same age. While the risk equalizes somewhat by age 60, women continue to have a higher overall risk throughout their lives.

Pregnancy and Gallstone Risk: A Closer Look

Pregnancy significantly increases a woman’s risk of developing gallstones. The hormonal changes during this period can lead to higher cholesterol levels and delayed gallbladder emptying, creating an environment conducive to stone formation.

Gallstone Statistics During Pregnancy

How common are gallstones during pregnancy? By the third trimester, nearly 8% of pregnant women develop new gallstones. However, only about 1% experience symptoms, and less than 10% of those with symptoms develop complications.

Recognizing Gallstone Symptoms During Pregnancy

Pregnant women with gallstones typically experience symptoms similar to non-pregnant individuals, including:

• Pain in the right upper area or center of the abdomen (biliary colic)
• Nausea and vomiting
• Indigestion

More severe symptoms may indicate complications and require immediate medical attention:

• Continuous and severe pain
• Persistent vomiting
• Fever
• Light-colored stools
• Dark urine
• Yellowing of the skin and eyes (jaundice)

Gallstone Complications: When to Seek Urgent Care

While many gallstones remain asymptomatic, some can lead to serious complications. These may include:

• Cholecystitis: Inflammation of the gallbladder
• Choledocholithiasis: Blockage of the bile ducts
• Cholangitis: Infection of the biliary tree
• Pancreatitis: Inflammation of the pancreas

If you experience any of the severe symptoms mentioned earlier, particularly during pregnancy, it’s crucial to seek immediate medical attention.

The Impact of Hormonal Therapies on Gallstone Risk

Beyond natural hormonal fluctuations, certain medical treatments can also increase a woman’s risk of developing gallstones. Estrogen therapy and oral contraceptive pills have been linked to a higher incidence of gallstone formation.

Evaluating the Risk-Benefit Ratio

For women considering or currently using these treatments, it’s essential to discuss the potential risks with a healthcare provider. In many cases, the benefits of these therapies may outweigh the increased gallstone risk, but individual factors should be carefully considered.

Preventive Measures: Reducing Gallstone Risk in Women

While some risk factors for gallstones, such as hormonal influences, are not modifiable, there are several steps women can take to reduce their risk:

Dietary Modifications

A balanced diet can play a significant role in preventing gallstone formation:

• Incorporate cholesterol-lowering foods: Whole grains, fruits, vegetables, nuts, beans, and fatty fish
• Limit high-cholesterol foods: Reduce intake of saturated fats and processed foods
• Maintain adequate fiber intake: Helps regulate cholesterol levels

Weight Management

Obesity is a significant risk factor for gallstone development. Maintaining a healthy weight through a balanced diet and regular exercise can help reduce this risk.

Regular Physical Activity

Exercise not only aids in weight management but also helps regulate cholesterol levels and promotes healthy gallbladder function.

Staying Hydrated

Adequate water intake can help prevent bile from becoming too concentrated, reducing the risk of stone formation.

When to Consult a Gallbladder Specialist

If you experience persistent pain in your upper right abdomen or other symptoms suggestive of gallstones, it’s important to consult a healthcare provider. Early detection and treatment can prevent more serious complications.

Diagnostic Procedures

A gallbladder specialist may recommend various tests to confirm the presence of gallstones:

• Ultrasound: The most common and non-invasive method for detecting gallstones
• CT scan: Provides detailed images of the gallbladder and surrounding structures
• HIDA scan: Assesses gallbladder function and bile flow
• Blood tests: Can help identify signs of infection or inflammation

Treatment Options for Gallstones in Women

The appropriate treatment for gallstones depends on the severity of symptoms and individual factors. Options may include:

Watchful Waiting

For asymptomatic gallstones, a healthcare provider may recommend monitoring the condition without immediate intervention.

Medication

In some cases, medications to dissolve small gallstones may be prescribed. However, this approach is less common and typically reserved for patients who cannot undergo surgery.

Surgical Intervention

For symptomatic gallstones or those causing complications, surgical removal of the gallbladder (cholecystectomy) is often recommended. This procedure is typically performed laparoscopically, resulting in shorter recovery times and minimal scarring.

Living Without a Gallbladder: Post-Surgery Considerations

After gallbladder removal, most women can lead normal, healthy lives with minimal dietary restrictions. However, some may experience changes in digestion and may benefit from certain lifestyle modifications:

• Gradual reintroduction of fatty foods
• Eating smaller, more frequent meals
• Increasing fiber intake
• Staying hydrated

It’s important to follow post-operative instructions and maintain regular check-ups with your healthcare provider to ensure optimal recovery and long-term health.

The Future of Gallstone Prevention and Treatment

As research into gallstone formation and prevention continues, new strategies for reducing risk and improving treatment outcomes are emerging. Some areas of ongoing investigation include:

Genetic Factors

Scientists are exploring genetic markers that may predispose individuals to gallstone formation. This research could lead to more personalized prevention strategies and treatments.

Novel Medications

Researchers are working on developing new medications that may more effectively dissolve gallstones or prevent their formation, potentially offering alternatives to surgery for some patients.

Improved Surgical Techniques

Advancements in minimally invasive surgery continue to refine gallbladder removal procedures, potentially leading to even faster recovery times and reduced complications.

As our understanding of gallstone formation and its gender-specific risk factors deepens, women can take proactive steps to reduce their risk and maintain optimal gallbladder health. By staying informed about the latest research and recommendations, and working closely with healthcare providers, women can navigate the challenges of gallstone prevention and treatment with confidence.

Why Women Are At An Increased Risk For Gallstones

Author: Ahsan Bhatti, MD

Gallstones affect men and women alike, and if these stones become large enough and impede the healthy flow of bile out of the gallbladder, it can lead to the need for surgical removal. And while the condition affects both sexes, you may be surprised to learn that women are much more likely to be affected by gallstone formation. Below, we take a closer look at why gallstones tend to disproportionately affect women, and what you can do to lower your gallstone risk.

Gallstone Development In Women

Your diet plays an important role in the development or prevention of gallstones, and in general, women tend to be more conscious about their diets than men, which makes the fact that anywhere from 65%-75% of gallstone sufferers in the US are women all that more strange. So why are gallstones more likely to develop in women?

The main reason why women tend to be more affected by gallstones is due to the differences in hormone production between the sexes. There are two main hormones at play that factor into this difference, and they are estrogen and progesterone, two hormones that are more readily produced by women.

The presence of estrogen increases the amount of cholesterol in bile, and cholesterol is a key component in gallstone formation. In fact, many gallstones are actually solidified cholesterol, so if there is more of it in your bile, there’s a greater likelihood that it could clump together and form a stone that cannot be successfully passed. Progesteron is a hormone that is involved in the menstrual cycle, and it can slow down the process of emptying the bladder. If your gallbladder cannot release bile as quickly as normal, it’s possible that gallstones can get stuck in a bile duct instead of being passed.

Because of these two hormones, women under the age of 40 are roughly three times more likely to develop a gallstone than similar-aged men. By the age of 60, other factors have nearly evened the likelihood, but women still tend to have a higher risk of gallstone formation. Estrogen therapy and oral contraceptive pills have also been linked to a higher risk of gallstone formation.

Tips for Reducing Gallstone Risk

So regardless of sex, what can you do to reduce your risk of develop a gallstone? Since there’s not much to be done about hormone production, we have to look at other modifiable risk factors. Obesity and diabetes are two other health conditions that increase your risk of gallstone formation, so eat a healthy diet and work to lower your diabetes risk. High cholesterol diets also obviously put you at risk as this cholesterol needs to be safely removed from the body, so eat plenty of cholesterol-lowering foods like whole grains, fruits, vegetables, nuts, beans and fatty fish.

If you’ve been bothered by pain in your upper right abdomen and believe you may be dealing with gallstones, it’s important to set up a consultation with a gallbladder specialist sooner rather than later. Bile impediments can cause significant health problems, so set up an appointment and learn about your treatment options if it turns out that there is a gallstone blockage. For more information, or to set up your first appointment, give Dr. Bhatti and the team at Bhatti GI Consultants a call today at (952) 368-3800.

Gallbladder gallbladder,  gallstone

Gallstones in Pregnancy | Patient Information | JAMA

The risk of developing gallstones can increase during pregnancy.

The main purpose of the gallbladder is to store bile, which is released into the small intestine after meals to help with digestion. Bile is made up of cholesterol, bilirubin (a product of red blood cells), and bile salts. Gallstones are formed when these components are not well balanced.

Women are at higher risk of gallstones, and that risk increases during pregnancy. Increased hormones during pregnancy can cause higher cholesterol levels and delayed gallbladder emptying, which can lead to formation of gallstones. Nearly 8% of pregnant women form new gallstones by the third trimester, but only about 1% have symptoms. Of those with symptoms, less than 10% develop complications.

Symptoms and Complications

People with gallstones during pregnancy have the same symptoms as those who are not pregnant, such as pain in the right upper area or center of the abdomen (biliary colic). More serious complications can cause more severe symptoms: continuous and severe pain, ongoing vomiting, fever, light-colored stools, dark urine, or yellowing of the skin and eyes. These symptoms can indicate an infection of the gallbladder (cholecystitis) or blockage of the bile ducts (choledocholithiasis), which can lead to infection of the biliary tree (cholangitis) or inflammation of the pancreas (pancreatitis). If any of these symptoms occur, patients should seek urgent medical attention.

Diagnosis and Treatment

Diagnosis of gallstones is made by abdominal imaging, most commonly ultrasound, which is safe during pregnancy. Although medications can help prevent gallstones, they are not as effective in dissolving already formed stones. Surgical removal of the gallbladder (cholecystectomy) is the definitive treatment for gallstones. Removing the gallbladder does not pose serious long-term consequences; the liver will continue to make bile without the gallbladder present.

Pregnant women with biliary colic should avoid eating or drinking until the attack subsides. Pain medications and intravenous fluids may be given in the hospital to help with symptoms. If biliary colic does not resolve with these measures, cholecystectomy should be considered. The minimally invasive surgery typically is done in the second or early third trimester. However, for serious complications, surgery is recommended regardless of trimester. If gallstones are obstructing bile flow or causing pancreas inflammation, a procedure called endoscopic retrograde cholangiopancreatography (ERCP) can be performed to retrieve gallstones and alleviate duct obstruction, delaying the need for surgery. In such cases, early treatment in pregnant women is preferred to postponing the procedure until after delivery.

Pregnant women should make a shared decision with their doctors weighing the risk of surgical complications (damage of structures near the gallbladder, bleeding, infection) against the risks to both mother and fetus of delaying surgery. Patients with cholecystitis who do not undergo cholecystectomy are at a higher risk of adverse outcomes such as preterm delivery, longer hospital stay, and being readmitted to the hospital. Recurring biliary colic symptoms in pregnant women can be more severe than the initial episodes.

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JAMA Patient Pages on gallstones and biliary colic, laparoscopic cholecystectomy, and endoscopic retrograde cholangiopancreatography were published in the October 16, 2018; May 1, 2018; and November 20, 2018 issues of JAMA, respectively.

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Conflict of Interest Disclosures: None reported.

Source: Schwulst SJ, Son M. Management of gallstone disease during pregnancy. JAMA Surg. 2020;155(12):1162-1163. doi:10.1001/jamasurg.2020.3683

Cholelithiasis – Medcor

Treatment of cholelithiasis

In order for the treatment of cholelithiasis to have the most tangible effect, it is important to approach the principles of therapy differently in patients of different ages, at different stages of the disease. The presence or absence of complications should also be taken into account. For all patients who have been found to have gallstones, proper nutrition is important for gallstone disease.

If the patient has an exacerbation of the disease, an attack of biliary colic, he should not eat at all for one or two days to ensure a sparing regimen for the pancreas. Next, you should eat only boiled, pureed, low-fat foods.

In case of an acute attack of the disease, the patient is prescribed drugs with an analgesic effect. In especially severe cases, it is possible to prescribe narcotic analgesics, as well as the introduction of antispasmodic drugs intravenously. If the development of inflammation in the biliary tract was detected during the diagnostic process, antibiotics are included in the course of complex therapy. If gallstone disease is accompanied by pancreatitis, it is advisable to take enzyme preparations – mezim, festal, creon.

It is also possible to prescribe drugs that improve the functioning of the liver – Essentiale, Hepatil, Karsil. If only solitary, floating gallstones are found, treatment may consist of trying to dissolve them. Chenodeoxycholic or ursodeoxycholic acid preparations are used as drugs that contribute to the dissolution of stones.

For successful dissolution of stones, it is important that normal functions of the gallbladder are preserved, there is no inflammation in the biliary tract and gallbladder. These drugs help to reduce the synthesis of cholesterol, reduce its excretion with bile, promote the separation of cholesterol crystals from stones and their excretion with bile.

This treatment can last more than half a year. For the period of treatment, it is important for the patient to follow a diet that will include a minimum of cholesterol and plenty of fluids. However, such treatment is contraindicated for pregnant women, since the drugs can have a negative effect on the fetus.

Shock wave cholelithotripsy is a modern technique for the treatment of cholelithiasis, which consists in crushing stones. For this, a sound wave is used. For crushing to be successful, the size of the stone should not be more than 3 cm in diameter.

Surgery for cholelithiasis involves the complete removal of the gallbladder. Today, laparoscopic cholecystectomy is predominantly used for this. This method of removing the gallbladder is much less traumatic, the postoperative period lasts a much shorter period of time. Such an operation can be done if the goal is to remove stones from the gallbladder.

For stones in the bile duct, a combined operation is performed: the gallbladder is removed using the laparoscopic method, and stones are removed from the bile ducts using an endoscope and sphincterotomy.

Diet for cholelithiasis

Treatment of this disease is impossible without strict adherence to certain nutritional principles. A diet for gallstones can effectively relieve the frequent occurrence of unpleasant symptoms of gallstone disease.

Its main principle is to limit food that contains cholesterol. People with gallstones should not eat cheese, brains, egg yolk, liver, sausages, pork, fatty dairy products, duck and goose meat.

If a patient is overweight, he should exclude easily digestible carbohydrates from the menu.

It is important to eat protein-rich foods regularly. The diet for cholelithiasis involves the use of fish, poultry, rabbit, low-fat cottage cheese. To reduce the cholesterol content in foods, they should be boiled, but do not drink the broth. Food should be consumed in baked, boiled, stewed form. If the meat is baked, then the skin must be removed before eating it.

Vegetable salads dressed with kefir and olive oil. You can’t eat fresh bread: it’s better to take a slightly stale piece of bread or a cracker. It is important to increase your regular fiber intake by introducing as many vegetables as possible into your diet. You should not limit the daily consumption of liquid drinks, as they contribute to the release of toxins from the body, and also support normal metabolic processes.

Diet for gallstones eliminates the inclusion of soda, ice cream, chocolate in the diet. Fatty meals significantly load the gallbladder. You should eat in relatively small portions, dividing the total daily ration into 6-7 meals.

Prevention of cholelithiasis

In order to prevent the development of cholelithiasis, it is important to quickly eliminate all causes that contribute to metabolic disorders and bile stasis. People who are prone to the formation of gallstones, as well as those who suffer from other diseases of the gastrointestinal tract, should pay special attention to the diet, excluding, if possible, food that is forbidden to be consumed with a special diet. It is necessary to eliminate constipation, do not wear tight belts, ensure an everyday active lifestyle.

Due to the fact that cholesterol is synthesized in the body from glucose, it is important not to abuse sugar, as well as products containing it.

Due to the fact that the intensive growth of stones occurs mainly at night, you should try to empty your gallbladder before going to bed. To do this, about two hours before bedtime, you can use choleretic products – tea or kefir with honey, mineral water.

If a patient is diagnosed with a latent course of the disease, he should visit a gastroenterologist at least once a year.

Gallbladder stones: does size matter

03/21/2023 at 13:05

Society

Subject: Ask the Doctor

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Addiction to spicy and fatty foods can play a trick on gourmets. Mistakes in nutrition can lead to a formidable disease of the gastrointestinal tract – cholelithiasis. How does the disease manifest itself and is it possible to ignore such a typical problem for many as gastric colic? Are there pills for gallstones or is the only chance to regain health is surgery? Is it true that the gallbladder should be removed only if the stones have become large? Svetlana Vlasova, a therapist at the Open Clinic, and Vyacheslav Cheremisin, a surgeon at the CDC on Presnya, spoke about this on the air of MK.

– People have known about stones in the gallbladder since ancient times, – said Svetlana Vlasova. – Information has reached our days that stones were even used in religious ceremonies as decorations. Description of gallstone disease can be found in the writings of Hippocrates and Avicenna. In the middle of the 19th century, scientists identified two theories of the onset of the disease. Some associated the disease with disorders of the biliary system. Others – with the presence of foci of inflammation in the body. It was the second version that the famous Russian doctor Botkin adhered to.

– By what symptoms can a modern person suspect cholelithiasis?

– The patient may experience nausea after eating, pulling pains in the right hypochondrium. This can especially occur after taking fatty and fried foods and after overeating. Such pains can be stopped with antispasmodics and “let go” for a while, explains Svetlana Vlasova.

In addition, a patient with gallstones may experience stool problems, flatulence, and bloating. But the main symptom is pain in the right hypochondrium. There is a much more formidable sign of the disease – yellowing of the skin. In this case, the patient needs emergency medical care.

– Meanwhile, cholelithiasis is shrouded in a mass of myths. For example, some patients believe that in this disease the gallbladder itself can not be removed, but only crushed and removed stones.

– This myth exists because stones in a person in the body are formed not only in the gallbladder, but also in the kidneys. Stones are crushed in them, and they come out on their own. Unfortunately, this is not possible in the gallbladder, since the bile ducts are very small in diameter and have a developed character. Therefore, even if the stones are crushed, their movement can cause blockage of the channels and the disease will be aggravated by complications or jaundice. Crushing stones can lead not to a cure, but, on the contrary, to the progression of the disease, – commented on the failure of the popular myth, surgeon Vyacheslav Cheremisin.

Another popular myth is that “having had an operation means you are healthy”. Unfortunately, this is not the case, doctors say. After the removal of the gallbladder, the body needs time to rebuild and begin to function normally in the new “configuration”. Therefore, after the surgeon, the patient is sent to a gastroenterologist, who leads him for some time after the operation.

– Many patients who have undergone gallbladder surgery have a fear of gallstones. It sounds logical: if the stones accumulated in the bladder, what prevents them from appearing in the conducting channels through which bile flows?

– One of the reasons for the formation of stones is the stagnation of bile, which occurs in the bladder. When constrictions occur, deformations occur when the gallbladder is squeezed by other organs. This often happens in pregnant women. When the bladder is removed, the ducts that carry bile from the liver to the intestine allow the bile to flow freely. The formation of stones in the ducts is extremely rare. This is due to a violation of anatomy, – explains Vyacheslav Cheremisin.

Svetlana Vlasova adds that women who take hormonal contraceptives and people with high cholesterol are at an increased risk for stone formation. It also causes thickening of bile. Therefore, even after removal of the gallbladder, risk factors remain in some patients. Doctors advise such people to monitor the level of cholesterol in the blood and take drugs that will be prescribed by the attending doctor.

– Is it possible to do without surgery and make the stones just dissolve? Indeed, advertising on TV regularly presents to the attention of viewers a variety of drugs that are supposedly able to normalize the functioning of the gallbladder.

Vyacheslav Cheremisin emphasizes that not all stones can be dissolved. It all depends on what stones you are dealing with:

– Stones in the gallbladder are cholesterol and pigment. Cholesterol stones are soft, not so dense, do not give a clear clinical picture. Small cholesterol stones can be tried to dissolve with drugs. True, this happens extremely rarely and only with stones of small sizes. Scientific studies have revealed that only stones with a size of 2-3 mm, single and cholesterol in composition, can be dissolved with drugs.

– If there are stones in the gallbladder, most likely you will have to go to surgery. But can it even be delayed? For example, wait until the “pebbles” grow? And if so, how many “carats” should the stone gain in order not to turn into a threat to the life of the patient? Doctors say that everything is individual here.

– For some, even 0.5 cm is a big stone, and for someone, even 2-3 cm is a small stone, – says Vyacheslav Cheremisin. – I had a patient whose stones grew up to 3 cm. She told me that she had heard in some program that if a stone is larger than 3 cm, then it must be removed. If less, you can live with it. The fact is that the size of the calculus does not matter. And a small pebble that will block the ducts will cause so many problems that you can’t wait for a large calculus that stands still. It also happens that the entire gallbladder is occupied by one stone. Therefore, it is wrong to talk about what should be removed only when the stones are large, and which stones are considered large. A stone of any size can cause a problem.

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