What are gallstones and how do they form. Why do some people develop gallstones while others don’t. How can gallstones be diagnosed and treated effectively. What are the potential complications of untreated gallstones.

Understanding Gallstones: Formation and Types

Gallstones are solid, pebble-like deposits that form in the gallbladder, a small organ located beneath the liver. These stones can vary in size, ranging from tiny grains of sand to golf ball-sized formations. The gallbladder’s primary function is to store and release bile, a fluid produced by the liver to aid in digestion and carry waste products.

There are two main types of gallstones:

• Cholesterol stones: Yellow-green in color, these account for approximately 80% of all gallstones.
• Pigment stones: Smaller and darker, these are composed primarily of bilirubin.

The exact causes of gallstone formation are not fully understood, but several factors contribute to their development:

1. Excess cholesterol in bile
2. Heightened levels of bilirubin in bile
3. Incomplete emptying of the gallbladder

Recognizing Gallstone Symptoms: When to Seek Medical Attention

Many individuals with gallstones remain asymptomatic, unaware of their presence. However, when a gallstone obstructs a bile duct, it can trigger a “gallbladder attack,” characterized by intense, knife-like pain in the upper abdomen. This pain can persist for several hours and may be accompanied by other symptoms.

Common symptoms of gallstones include:

• Sharp pain in the upper right abdomen
• Pain radiating to the right shoulder or back
• Nausea and vomiting
• Digestive issues such as indigestion and heartburn
• Abdominal discomfort and gas

When should you seek immediate medical attention? If you experience severe abdominal pain lasting several hours, accompanied by fever, chills, or yellowing of the skin or eyes, it’s crucial to consult a healthcare professional promptly.

Risk Factors for Gallstone Development: Are You Susceptible?

While anyone can develop gallstones, certain factors increase the likelihood of their formation. Understanding these risk factors can help individuals take preventive measures and seek early medical intervention if necessary.

Key risk factors for gallstone development include:

• Family history of gallstones
• Female gender
• Age over 40
• Native American or Mexican descent
• Obesity
• High-fat, high-cholesterol diet
• Sedentary lifestyle
• Use of hormone-based medications
• Pregnancy
• Diabetes
• Certain intestinal diseases (e.g., Crohn’s disease)
• Hemolytic anemia or liver cirrhosis
• Rapid weight loss or fasting

How can you mitigate your risk of developing gallstones? Maintaining a healthy weight, following a balanced diet rich in fiber, and engaging in regular physical activity can help reduce the likelihood of gallstone formation.

Diagnostic Approaches for Gallstones: From Blood Tests to Imaging

Accurate diagnosis of gallstones is essential for determining the appropriate course of treatment. Healthcare professionals employ various diagnostic tools and techniques to identify and assess gallstones.

Common diagnostic methods include:

• Blood tests to check for signs of infection or blockage
• Ultrasound imaging to visualize the gallbladder and surrounding structures
• CT scans for detailed cross-sectional images
• Magnetic resonance cholangiopancreatography (MRCP) for high-resolution imaging of the liver and gallbladder
• Cholescintigraphy (HIDA scan) to evaluate gallbladder function
• Endoscopic retrograde cholangiopancreatography (ERCP) for direct visualization and potential removal of gallstones
• Endoscopic ultrasound to detect gallstones in hard-to-see locations

What is the most commonly used diagnostic tool for gallstones? Ultrasound imaging is often the first-line diagnostic method due to its non-invasive nature and ability to detect most gallstones effectively.

Treatment Options for Gallstones: Surgical and Non-Surgical Approaches

The treatment of gallstones depends on the severity of symptoms and the overall health of the patient. In many cases, asymptomatic gallstones may not require immediate treatment. However, when symptoms occur or complications arise, intervention becomes necessary.

Treatment options for gallstones include:

1. Watchful waiting for asymptomatic cases
2. Surgical removal of the gallbladder (cholecystectomy)
3. Medications to dissolve small gallstones (in select cases)
4. Lithotripsy to break up larger stones (less common)

The most common surgical procedure for gallstone treatment is laparoscopic cholecystectomy. This minimally invasive approach involves making small incisions in the abdomen to remove the gallbladder. In some cases, open surgery may be necessary, particularly if complications are present.

Can gallstones be treated without surgery? While surgery is the most effective treatment for symptomatic gallstones, some small stones may pass through the body naturally. Additionally, certain medications can help dissolve cholesterol stones over time, but this approach is generally reserved for patients who cannot undergo surgery.

Potential Complications of Untreated Gallstones: Why Early Intervention Matters

While some gallstones may remain asymptomatic, untreated symptomatic gallstones can lead to serious complications. Understanding these potential risks underscores the importance of timely medical intervention.

Possible complications of untreated gallstones include:

• Cholecystitis (inflammation of the gallbladder)
• Choledocholithiasis (obstruction of the common bile duct)
• Cholangitis (infection of the bile ducts)
• Pancreatitis (inflammation of the pancreas)
• Gallbladder cancer (rare but serious)

How quickly can gallstone complications develop? The progression of gallstone-related complications can vary widely. Some individuals may experience acute symptoms requiring immediate attention, while others may develop chronic issues over time. Regular medical check-ups and prompt attention to symptoms can help prevent severe complications.

Lifestyle Changes and Prevention Strategies for Gallstones

While not all gallstones can be prevented, certain lifestyle modifications can help reduce the risk of their formation and recurrence. Implementing these changes can contribute to overall gallbladder health and potentially avoid the need for surgical intervention.

Effective prevention strategies include:

1. Maintaining a healthy weight through balanced nutrition and regular exercise
2. Consuming a diet rich in fiber and low in saturated fats
3. Staying hydrated by drinking plenty of water
4. Avoiding rapid weight loss and crash diets
5. Managing underlying health conditions such as diabetes
6. Limiting alcohol consumption
7. Considering alternatives to hormone-based medications when possible

What role does diet play in gallstone prevention? A diet high in fiber and low in cholesterol can help reduce the risk of gallstone formation. Incorporating foods such as fruits, vegetables, whole grains, and lean proteins while limiting saturated fats and refined sugars can promote gallbladder health.

Living Without a Gallbladder: Adjusting to Post-Cholecystectomy Life

For many individuals who undergo gallbladder removal surgery, concerns may arise about life without this organ. It’s important to understand that the body can adapt to function without a gallbladder, and most people experience minimal long-term effects.

Key points about life after gallbladder removal:

• The liver continues to produce bile, which flows directly into the small intestine
• Digestion may be slightly altered, but overall function remains intact
• Some individuals may experience temporary digestive changes, such as looser stools
• Dietary adjustments may be necessary, particularly in the weeks following surgery
• Long-term prognosis is generally excellent for most patients

How can you optimize your diet after gallbladder removal? Gradually reintroducing foods and paying attention to how your body responds can help identify any triggers for digestive discomfort. Focusing on smaller, more frequent meals and incorporating lean proteins, fruits, vegetables, and whole grains can support digestive health post-surgery.

Emerging Research and Future Directions in Gallstone Management

As medical science advances, new approaches to gallstone prevention, diagnosis, and treatment continue to emerge. Ongoing research aims to improve our understanding of gallstone formation and develop more targeted interventions.

Areas of current research interest include:

• Genetic factors influencing gallstone susceptibility
• Novel imaging techniques for early detection
• Minimally invasive treatment options
• Pharmacological interventions to prevent stone formation
• Personalized risk assessment and prevention strategies

How might future treatments for gallstones differ from current approaches? Advancements in targeted drug delivery, non-invasive stone dissolution techniques, and personalized medicine may offer alternatives to traditional surgical interventions, potentially reducing recovery times and improving patient outcomes.

The Role of Regular Health Screenings in Gallstone Prevention

Regular health check-ups play a crucial role in the early detection and management of gallstones, particularly for individuals with known risk factors. Routine screenings can help identify asymptomatic gallstones before they cause complications and allow for timely intervention if necessary.

Benefits of regular gallbladder health screenings:

1. Early detection of asymptomatic gallstones
2. Monitoring of known gallstones for changes
3. Identification of other gallbladder or liver issues
4. Opportunity for preventive counseling and lifestyle modifications
5. Reduced risk of emergency surgeries and complications

What should a comprehensive gallbladder health screening include? A thorough evaluation typically involves a review of medical history, physical examination, blood tests to assess liver function, and imaging studies such as ultrasound. These assessments can provide valuable insights into gallbladder health and guide preventive measures or treatment decisions.

Gallstones in Special Populations: Pregnancy, Elderly, and Chronic Conditions

Certain populations may face unique challenges when it comes to gallstone development, diagnosis, and treatment. Understanding these specific considerations is essential for providing appropriate care and management strategies.

Special considerations for gallstones in different populations:

• Pregnancy: Increased risk due to hormonal changes; limited treatment options during gestation
• Elderly: Higher prevalence; potential for atypical symptoms; increased surgical risks
• Chronic conditions: Interactions with other health issues; medication considerations; tailored treatment approaches

How does pregnancy affect gallstone management? During pregnancy, conservative management is often preferred when possible, with surgery typically reserved for severe cases or postponed until after delivery. Close monitoring and collaboration between obstetricians and gastroenterologists are crucial for optimal care.

The Economic Impact of Gallstone Disease: Healthcare Costs and Productivity

Gallstone disease not only affects individual health but also has significant economic implications. Understanding the broader impact of this condition can inform public health policies and resource allocation.

Economic factors related to gallstone disease:

1. Direct healthcare costs for diagnosis and treatment
2. Indirect costs due to lost productivity and work absenteeism
3. Long-term economic burden of complications and recurrent issues
4. Impact on healthcare system resources and wait times
5. Potential for cost savings through preventive measures and early intervention

How can preventive strategies impact the economic burden of gallstone disease? Implementing effective prevention programs and promoting early detection can potentially reduce the overall economic impact by decreasing the need for emergency interventions and minimizing complications. This approach may lead to significant cost savings for both individuals and healthcare systems in the long term.

Integrating Complementary Approaches in Gallstone Management

While conventional medical treatments remain the cornerstone of gallstone management, some individuals may explore complementary approaches to support their overall health and potentially reduce the risk of gallstone formation. It’s important to note that these methods should be used in conjunction with, not as a replacement for, standard medical care.

Complementary approaches that may support gallbladder health:

• Herbal remedies (e.g., milk thistle, peppermint)
• Acupuncture for pain management
• Stress reduction techniques (e.g., meditation, yoga)
• Dietary supplements (e.g., vitamin C, lecithin)
• Traditional Chinese medicine practices

What is the current scientific evidence supporting complementary approaches for gallstone management? While some studies suggest potential benefits of certain complementary therapies, more robust research is needed to establish their efficacy and safety. Patients should always consult with their healthcare providers before incorporating any complementary approaches into their gallstone management plan.

The Psychological Impact of Gallstone Diagnosis and Treatment

The diagnosis and treatment of gallstones can have significant psychological effects on patients, ranging from anxiety about potential complications to concerns about surgical procedures. Addressing these psychological aspects is crucial for comprehensive patient care and optimal outcomes.

Common psychological factors associated with gallstone diagnosis and treatment:

1. Anxiety related to symptoms and potential emergencies
2. Fear of surgical procedures and anesthesia
3. Concerns about lifestyle changes and dietary restrictions
4. Impact on body image and self-esteem
5. Stress related to medical costs and time off work

How can healthcare providers address the psychological aspects of gallstone management? A holistic approach that includes patient education, emotional support, and access to mental health resources can help alleviate anxiety and improve overall patient well-being. Clear communication about treatment options, expected outcomes, and post-treatment adjustments can empower patients and promote a more positive psychological outlook.

Picture, Symptoms, Types, Causes, Risks, Treatments

Written by WebMD Editorial Contributors

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

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

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

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

The two main kinds of gallstones are:

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

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

If you have symptoms, they may include:

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

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

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

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

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

You’re more likely to get gallstones if you:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Gallstones can cause serious problems, including:

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

Some lifestyle changes might lower your risk of gallstones.

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

Top Picks

Picture, Symptoms, Types, Causes, Risks, Treatments

Written by WebMD Editorial Contributors

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

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

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

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

The two main kinds of gallstones are:

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

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

If you have symptoms, they may include:

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

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

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

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

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

You’re more likely to get gallstones if you:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Gallstones can cause serious problems, including:

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

Some lifestyle changes might lower your risk of gallstones.

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

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Cholelithiasis – what to do?

What should a person do if such a thing as gallbladder stones suddenly and insidiously burst into his life?

Gallstone disease is a chronic inflammatory disease of the biliary tract, accompanied by the formation of stones most often in the gallbladder (cholecystolithiasis) or bile ducts (choledocholithiasis).

The disease is based on a change in the viscosity of bile (dyscholia), associated with a violation of the physicochemical properties of bile. Stones are formed as a result of precipitation of bile pigments, cholesterol, certain types of proteins, calcium salts, infection of bile, its stagnation, lipid metabolism disorders.

According to the World Health Organization, gallstones can be found in 10-12% of the world’s population. In countries with developed economies – even more often. Every fifth woman and every tenth man suffers from this disease. Over the past decade, the incidence of this disease has doubled.

Gallstones are cholesterol (the vast majority, about 90% of the variants of gallstones), as well as pigmented and mixed stones. So, due to a supersaturation of bile with cholesterol, the formation of cholesterol stones, its precipitation, and the formation of crystals occur. Violation in the gallbladder of the motility leads to the fact that these crystals do not enter the intestine, which ultimately leads to their gradual growth. Pigment stones (also called bilirubin stones) form when there is an increased breakdown of red blood cells, which occurs with topical hemolytic anemia. As for mixed stones, they are a kind of combination based on the processes of both forms. Such stones contain cholesterol, bilirubin and calcium, the very process of their formation occurs as a result of inflammatory diseases affecting the biliary tract and, in fact, the gallbladder.

Causes contributing to the formation of gallstones

• unbalanced diet – the predominance of animal fats
• hormonal disorders
• sedentary lifestyle
• disorders associated with fat metabolism, weight gain
• inflammation and other abnormalities occurring in the gallbladder
• various kinds of liver damage
• pregnancy
• fasting
• heredity
• diabetes mellitus, etc.

Classification

Based on the features of the disease accepted today, the following classification is distinguished according to the stages that are relevant to it:

1. The physico-chemical (initial) stage – or, as it is also called, the pre-stone stage. It is characterized by changes occurring in the composition of bile. There may be no special clinical manifestations at this stage or they may be minimal. It is detected mainly during ultrasound diagnostics, biliary sludge or thickening of bile in the gallbladder is determined. This stage is most favorable for medical (non-surgical) treatment.
2. Stone formation is a stage that is also defined as latent stone bearing. In this case, there are no symptoms of cholelithiasis, however, the use of instrumental diagnostic methods makes it possible to determine the presence of stones in the gallbladder (ultrasound diagnostics, computed tomography). Depending on the size, density of stones, indications for medical or surgical treatment are determined.
3. Clinical manifestations – a stage whose symptoms indicate the development of an acute or chronic form of calculous cholecystitis. The main treatment of this stage is the surgical removal of the gallbladder with stones.

Operate or not

Only a surgeon or gastroenterologist can answer this question after an individual consultation.

Medical litholysis

Non-surgical treatment of cholesterol stones is currently possible, but it should be timely, at the stage of formation of a soft and small stone (that is, in the first or second stages of cholelithiasis).

To determine the possibility of therapeutic treatment of cholecystitis with stones, it is necessary to examine the gallbladder using computed tomography to determine the density of the stone and bile.

MSCT of the gallbladder is performed at the Lotos Medical Center to determine the density of calculi. This study has many advantages over abdominal ultrasound, because determines the density of the stone, and hence its ability to dissolve. Dense, calcareous stones in Hounsfield units according to CT are more than 100 units and cannot be dissolved by drugs. Soft, cholesterol from 30 to 90 units can be medically dissolved. The size of the stone also matters – stones dissolve up to 10-15 mm, with less than 1/3 filling of the gallbladder.

Special bile acid preparations such as those found in human bile can be used to dissolve small stones. Bile acid preparations are effective not only for dissolving stones, but also for preventing their formation. They are appointed by a specialist gastroenterologist. The course of treatment is at least six months, and only under the supervision of a doctor.

Is it necessary to remove the gallbladder if the stone does not bother

Currently, the vast majority of surgeons agree that patients with asymptomatic cholelithiasis with a first discovered small stone should not immediately undergo prophylactic cholecystectomy (removal of the gallbladder). The risk of developing severe complications with small single stones is estimated to be low, therefore, such patients should undergo regular abdominal ultrasound examinations and follow lifestyle and nutrition recommendations.

In the case of calculous cholecystitis, when the patient is periodically disturbed by bouts of biliary colic, doctors recommend cholecystectomy, which should be performed in a planned manner. Each subsequent attack can cause the development of acute cholecystitis, which can be accompanied by severe complications from the liver and pancreas.

If a picture of acute cholecystitis develops – biliary colic lasts more than 3 hours, pain is localized in the right upper quadrant of the abdomen, is not relieved by antispasmodic drugs, the temperature rises, nausea and vomiting occur – an ambulance should be called.

Radical treatment of disease

Surgery for cholelithiasis is the gold standard for the treatment of this pathology. Its goal is to remove the container for calculi, avoiding the recurrence of biliary colic, as well as preventing the occurrence of obstructive jaundice, cholangiogenic sepsis, and biliary peritonitis. Performed in a planned manner, that is, even before the development of complications, the operation is safe. The chance of complete recovery after surgery is about 95%.

“Off”, that is, a gallbladder clogged with stones, cannot be cured without surgery.

The operation can be performed in two ways – abdominal and laparoscopic.

Open surgery

This is a “big” operation in which an incision is made on the front wall of the abdomen under general anesthesia. As a result of this access, surgeons can clearly examine and feel all the bile ducts, perform local ultrasound or x-rays with contrast to remove any existing stones. The method is indispensable for inflammatory and cicatricial processes in the area under the liver. The disadvantages of this intervention are: a longer recovery period after surgery; greater chance of developing incisional hernias; cosmetic defect; more complications develop after surgery.

Laparoscopic method

The most commonly used method of surgical treatment. The laparoscopy operation performed for cholelithiasis is an intervention under visual control using a fiber optic device connected to a monitor through several small incisions on the abdominal wall.

The laparoscopic method has many advantages over abdominal surgery:

• the wound hurts not so much and not so long
• it does not restrict breathing
• intestinal paresis is not expressed
• less severe cosmetic defect

There are also negative sides to laparoscopic cholecystectomy – more contraindications to surgery. In particular, the laparoscopic method cannot be used not only for severe disorders of the heart, blood vessels and lungs, but also in the following cases: obesity, peritonitis, late pregnancy, acute pancreatitis, obstructive jaundice, fistulas between the internal organs and bile ducts, gallbladder cancer , adhesive process in the upper parts of the abdominal cavity, acute cholecystitis (if more than 2 days have passed since the moment of the disease), cicatricial changes in the hepatobiliary zone.

Regardless of how many stones are found in the gallbladder – one large or many small – the gallbladder is removed completely.

This is how the removal of the gallbladder on the monitor of the laparoscopic unit looks like:

In our medical center, highly qualified surgeons in a high-tech surgical hospital will be able to perform cholecystectomy using the method that is necessary in your particular case.

Is it possible to live without a gallbladder

A pathologically altered gallbladder cannot fully perform its functions, and is the cause of constant pain and a source of chronic infection. Therefore, cholecystectomy, performed in accordance with the indications of a qualified physician, improves the patient’s condition and does not affect the function of digestion.

If you or your loved ones have cholelithiasis, you need to act quickly and correctly, without triggering the disease. Properly selected examination and treatment in our center will help to cope with the problem of gallstones.

Be healthy!

Cholelithiasis

Contents

Questions and Answers

What is gallstone disease?

Cholelithiasis, or cholelithiasis, is a disease characterized by the presence of stones (calculi) in the gallbladder and/or bile ducts. The disease can be asymptomatic, symptomatic and complicated.

Why do gallstones form?

The main cause of cholelithiasis is metabolic disorders. At the same time, the composition of bile changes in such a way that its constituent substances precipitate, from which stones are formed. There are a lot of risk factors for cholelithiasis: heredity, liver disease, gout, urolithiasis, excessive consumption of fatty foods (“excess” cholesterol is excreted in bile), the influence of female sex hormones, etc.

How to diagnose cholelithiasis?

Today, the “gold standard” for the diagnosis of cholelithiasis and its complications is ultrasound. Sometimes, to obtain information about the condition of the bile ducts, you will be asked to undergo an MRI or endoscopic cholangiography

What to do if you find stones in the gallbladder?

If this is an “accidental finding” on ultrasound, you did not have symptoms of cholelithiasis – attacks of pain or discomfort in the upper abdomen after eating, any complications (for example, pancreatitis) – according to current clinical guidelines, diet and observation are sufficient. The risk of complications in such a situation is about 2% annually.

If you have had at least one attack of pain, the risk of complications of the disease increases significantly, in which case you need surgery

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Media

her – big or small?

For some reason, most people believe that small stones are much better than large ones.
In fact, the opposite is true , small stones can migrate into the common bile duct, causing complications such as choledocholithiasis, obstructive jaundice, cholangitis, acute pancreatitis, which are life-threatening conditions that require emergency treatment

Basic principles of diet
for cholelithiasis

9 0126 How to remove gallstones without surgery?

To date, there are no other methods comparable in effectiveness with surgery, ways of treating cholelithiasis

But what about the dissolution or crushing of stones?

Unfortunately, “dissolution” under the influence of ursodeoxycholic acid preparations (Ursofalk, Ursosan) is in most cases ineffective.
To improve efficiency, strict criteria for the use of this method have been developed: strictly cholesterol calculi (occur in no more than 25% of patients), size no more than 20 mm, passable bile ducts, preserved gallbladder function, absence of other diseases of the digestive system. However, even under these conditions, the effectiveness of the technique does not exceed 25%.

And even if successfully dissolved, stone recurrence rate reaches 45-60% [Zacco S. Overview of nonsurgical management of gallbladder stones. UpToDate, 2023]
Given the cost of drugs (and the patient is doomed to lifelong use of them), the use of this technique is rarely justified.

Stone crushing – extracorporeal shock wave lithotripsy, not currently used. Technically, stones can be crushed, but their fragments must somehow be removed from the gallbladder. There is only one way – through the common bile duct. And the migration of stones into the common bile duct, as you already know, leads to life-threatening complications. The risk of lithotripsy far exceeds the risk of the disease itself, which means that this type of treatment is not applicable, and is currently recognized as dangerous and ineffective.

My YouTube videos on this topic

Is it possible to remove stones from the gallbladder without removing the organ itself?

Possible. And even easier than removing the gallbladder. It just makes no sense…

This operation (cholecystolithotomy) was no longer performed worldwide in the 80s of the last century, with the exception of three situations:

with anatomical or pathological changes in the gallbladder zone, making its removal extremely risky. In such cases, percutaneous drainage of the gallbladder is used, and then stones are removed through the drainage channel using an endoscope.

2. An extremely pronounced acute inflammatory process in the area of ​​the gallbladder, making it impossible to differentiate anatomical structures in the area of ​​the hepatoduodenal ligament. In this case, indeed, part of the gallbladder can be left by removing the stones (subtotal cholecystectomy). And we ourselves write about this in national clinical guidelines (your obedient servant is one of the authors)

3. Someone really wants to make money on people’s health and the desire to leave their gallbladder. Here there have always been and there are a couple of people who want to.

Removing stones from the gallbladder is technically even easier than removing it, but it makes no sense. That is why this far from the most complicated operation is performed only in a few clinics in the world.
All the reasons for the recurrence of stones remain, plus a scar is added to the bladder, further impairing its ability to contract.
The result is obvious – a recurrence of cholelithiasis, with a worse course than before.

But the question is so common that I even recorded a separate video:

Surgery for cholelithiasis

Laparoscopic cholecystectomy is recognized worldwide as the best method for gallbladder removal . Other methods (surgery from a mini-access, traditional surgery from a large incision) are used by us extremely rarely in case of serious complications and technical difficulties, predicted both before the operation and during the intervention itself. All details will be explained in detail by your surgeon.
Laparoscopic cholecystectomy is performed through 3-4 small (5-15 mm) punctures in the anterior abdominal wall. The technique allows you to significantly reduce the intensity of postoperative pain, achieve a good cosmetic result and return to normal life as quickly as possible. The length of stay in the clinic most often does not exceed a day.

Now, with the latest generation of equipment in GMS Hospital , I have the opportunity to make this operation even less traumatic by performing it from three- and five-millimeter approaches. This technology is already called “ mini laparoscopy” and allows patients to comfortably go home as early as the next day after surgery.

Read more about the operation in article
“Gallbladder removal: the main thing in a nutshell”

When to operate, how to operate,
recommendations for rehabilitation and nutrition

Here you can see how I perform the operation.
Video 18+

6 months after laparoscopic surgery with cosmetic intradermal sutures.
Arrows indicate postoperative scars

What complications can occur during gallbladder removal?

Any operation has a certain risk of complications. In the case of cholecystectomy, their list includes bleeding, damage to the bile ducts, complications from postoperative wounds, and a number of others.

At our clinic, patient safety is a top priority. The experience and qualifications of surgeons, the latest technologies and equipment provide a minimal risk of complications (<1%), most of which are “small”, that is, do not pose a threat to life and health.

More information about the possible consequences of gallbladder removal

Is it possible to live a full life after gallbladder removal?

Yes, of course. If you look at the diagram, you will see that the gallbladder is somewhat away from the “main route” of bile entry into the duodenum. During the operation, we turn off only the cystic duct, leaving the main ducts for the free flow of bile into the gastrointestinal tract. Only one thing changes – after the removal of the gallbladder, unconcentrated bile constantly enters the duodenum, regardless of food intake. That is why we recommend that you eat often and in small portions after the operation, “give bile a job” and limit fatty foods. Some time after the operation, the digestive system adapts to the new functioning conditions, and the bile ducts partially take over the reservoir function of the gallbladder. , any complications (for example, pancreatitis) – according to modern clinical recommendations, diet and observation are sufficient. The risk of complications in such a situation is about 2% annually.

If you have had at least one attack of pain, the risk of complications of the disease increases significantly, in which case you need surgery gallbladder removal surgery

Before surgery:

• Avoid alcohol the day before surgery
• Avoid food and water the night before surgery

After surgery:

• You can drink a little water in the first hours after surgery
• If you feel pain, call a nurse who will administer pain medication in consultation with your doctor
• After discharge (usually the next day), take medication
• Prepare to limit activity for the first few days
• Avoid heavy lifting (more than 10 kg) for three months after surgery
• You can shower the next day after surgery
• Diet: you need to limit fat intake, eat often (4-5 times a day) in small portions
• Sports (running, swimming) can be resumed after 4-6 weeks.