What are gallstones and how do they form. What symptoms indicate the presence of gallstones. How are gallstones diagnosed and treated. Who is at risk for developing gallstones. Can gallstones be prevented through lifestyle changes.

Understanding Gallstones: Formation and Types

Gallstones are solid, pebble-like formations that develop 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 masses. The gallbladder’s primary function is to store and release bile, a digestive fluid produced by the liver. When bile composition becomes imbalanced, it can lead to the formation of gallstones.

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.

How do gallstones form?

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

1. Excess cholesterol in bile: When the liver produces more cholesterol than the bile can dissolve, the excess may crystallize and form stones.
2. High bilirubin levels: Certain conditions can cause the liver to produce too much bilirubin, leading to pigment stone formation.
3. Incomplete gallbladder emptying: If the gallbladder doesn’t empty properly, bile can become concentrated, increasing the risk of stone formation.

Recognizing Gallstone Symptoms: When to Seek Medical Attention

Many people with gallstones remain asymptomatic for years. However, when a stone blocks a bile duct, it can cause a “gallbladder attack,” characterized by intense, knife-like pain in the upper abdomen. Other symptoms may include:

• Pain in the right shoulder or back
• Nausea and vomiting
• Digestive issues such as indigestion, heartburn, and gas

When should you seek immediate medical attention for gallstone symptoms? If you experience severe abdominal pain lasting several hours, fever and chills, or yellowing of the skin and eyes (jaundice), it’s crucial to consult a healthcare professional promptly. These signs may indicate a serious infection or inflammation requiring urgent treatment.

Risk Factors: Who Is More Likely to Develop Gallstones?

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

Demographic and genetic factors:

• Family history of gallstones
• Female gender
• Age over 40
• Native American or Mexican descent

Lifestyle and health-related factors:

• Obesity
• High-fat, high-cholesterol diet with low fiber intake
• Sedentary lifestyle
• Rapid weight loss or fasting
• Use of birth control pills or hormone replacement therapy
• Pregnancy
• Diabetes
• Intestinal diseases like Crohn’s
• Hemolytic anemia or cirrhosis of the liver
• Use of cholesterol-lowering medications

Are there ways to reduce the risk of gallstone formation? While some risk factors are beyond control, adopting a healthy lifestyle can help. This includes maintaining a balanced diet, regular exercise, and avoiding rapid weight fluctuations.

Diagnosing Gallstones: Medical Tests and Procedures

When gallstones are suspected, healthcare providers employ various diagnostic tools to confirm their presence and assess their impact on the biliary system. The diagnostic process typically begins with a physical examination and may include several tests:

Blood tests

These can reveal signs of infection or blockage and help rule out other conditions that may mimic gallstone symptoms. What specific markers do blood tests look for? Elevated liver enzymes or bilirubin levels may indicate bile duct obstruction or inflammation.

Imaging studies

• Ultrasound: This non-invasive technique uses sound waves to create images of the gallbladder and surrounding structures.
• CT scan: Specialized X-rays provide detailed cross-sectional images of the abdominal organs.
• Magnetic Resonance Cholangiopancreatography (MRCP): This advanced MRI technique produces high-resolution images of the biliary and pancreatic ducts.

Specialized diagnostic procedures

• Cholescintigraphy (HIDA scan): This nuclear medicine test assesses gallbladder function and can help diagnose cholecystitis.
• Endoscopic Retrograde Cholangiopancreatography (ERCP): This procedure allows for both diagnosis and potential treatment of gallstones in the bile ducts.
• Endoscopic ultrasound: Combining endoscopy and ultrasound, this technique can detect gallstones in hard-to-see locations, such as the common bile duct near the pancreas.

How do these diagnostic tools help in treatment planning? By providing detailed information about the size, location, and number of gallstones, these tests enable healthcare providers to determine the most appropriate treatment approach for each patient.

Treatment Options for Gallstones: From Watchful Waiting to Surgery

The management of gallstones depends on the severity of symptoms and the presence of complications. Treatment options range from conservative approaches to surgical interventions.

Watchful waiting

For asymptomatic gallstones, active treatment may not be necessary. Regular monitoring is often recommended to ensure that complications do not develop over time.

Surgical intervention

When gallstones cause symptoms or complications, surgical removal of the gallbladder (cholecystectomy) is the most common treatment. There are two main surgical approaches:

1. Laparoscopic cholecystectomy: This minimally invasive procedure is the most common and preferred method. It involves making small incisions in the abdomen and using specialized instruments to remove the gallbladder.
2. Open cholecystectomy: In some cases, a traditional open surgery may be necessary, especially if there are complications or the patient has had previous abdominal surgeries.

Can you live without a gallbladder? Yes, the body can adapt to the absence of a gallbladder. Bile will flow directly from the liver to the small intestine, allowing for continued digestion of fats.

Non-surgical treatments

In certain cases, alternative treatments may be considered:

• Oral dissolution therapy: Medications like ursodeoxycholic acid can sometimes dissolve small cholesterol stones over time.
• Lithotripsy: This technique uses shock waves to break up gallstones, but it’s rarely used due to high recurrence rates.

Preventing Gallstones: Lifestyle Modifications and Health Practices

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

Dietary modifications

• Maintain a balanced diet rich in fruits, vegetables, and whole grains
• Limit intake of high-fat and high-cholesterol foods
• Increase fiber consumption
• Stay hydrated by drinking plenty of water

Weight management

Achieving and maintaining a healthy weight is crucial in gallstone prevention. However, it’s important to avoid rapid weight loss, as this can actually increase the risk of gallstone formation. How can you lose weight safely to prevent gallstones? Aim for gradual weight loss of 1-2 pounds per week through a combination of diet and exercise.

Regular exercise

Engaging in physical activity can help maintain a healthy weight and improve overall metabolic health. What types of exercise are beneficial for gallstone prevention? Both aerobic exercises (like walking, swimming, or cycling) and strength training can be effective when performed regularly.

Medications and supplements

In some cases, healthcare providers may recommend medications or supplements to reduce the risk of gallstone formation, especially for individuals with a high risk of recurrence after treatment.

Complications of Gallstones: Understanding the Risks

While many gallstones remain asymptomatic, they can sometimes lead to serious complications that require prompt medical attention. Understanding these potential risks is crucial for early detection and treatment.

Cholecystitis

This condition refers to inflammation of the gallbladder, often caused by a gallstone blocking the cystic duct. Symptoms include severe abdominal pain, fever, and nausea. How is cholecystitis treated? Treatment typically involves hospitalization, antibiotics, and often surgical removal of the gallbladder.

Choledocholithiasis

When gallstones migrate from the gallbladder into the common bile duct, they can cause a blockage known as choledocholithiasis. This condition can lead to jaundice, severe pain, and potentially life-threatening infections like cholangitis.

Gallstone pancreatitis

In some cases, gallstones can block the pancreatic duct, leading to inflammation of the pancreas. This condition, known as gallstone pancreatitis, can be severe and may require intensive treatment.

Gallbladder cancer

While rare, long-standing gallstone disease may increase the risk of gallbladder cancer. What are the warning signs of gallbladder cancer? Symptoms can include abdominal pain, jaundice, and unexplained weight loss, but early-stage gallbladder cancer often has no symptoms.

Understanding these potential complications underscores the importance of timely medical evaluation and treatment when gallstone symptoms arise. Regular check-ups and awareness of risk factors can help in early detection and prevention of these serious conditions.

Living with Gallstones: Management and Long-Term Outlook

For individuals diagnosed with gallstones, understanding how to manage the condition and what to expect in the long term is crucial for maintaining quality of life and preventing complications.

Dietary considerations

While dietary changes alone may not eliminate existing gallstones, they can help manage symptoms and reduce the risk of future stone formation. What foods should be avoided with gallstones? High-fat and fried foods, as well as foods high in cholesterol, should be limited. Instead, focus on a diet rich in fruits, vegetables, lean proteins, and whole grains.

Monitoring and follow-up care

Regular check-ups with a healthcare provider are important for individuals with gallstones, even if they are asymptomatic. These visits allow for monitoring of any changes in the gallstones and early detection of potential complications.

Managing recurrence risk

After gallbladder removal, the risk of developing new gallstones is significantly reduced. However, stones can still form in the bile ducts. Maintaining a healthy lifestyle and following medical advice can help minimize this risk.

Coping with post-cholecystectomy syndrome

Some individuals may experience ongoing digestive symptoms even after gallbladder removal, a condition known as post-cholecystectomy syndrome. How can these symptoms be managed? Dietary modifications, over-the-counter medications, and in some cases, prescription medications can help alleviate these symptoms.

Alternative and complementary therapies

While not a substitute for medical treatment, some individuals find relief from gallstone symptoms through complementary therapies such as acupuncture or herbal remedies. It’s important to discuss these options with a healthcare provider before trying them.

Living with gallstones or adapting to life after gallbladder removal may require some lifestyle adjustments, but with proper management and care, most individuals can maintain a high quality of life. Regular communication with healthcare providers and adherence to recommended treatments and lifestyle modifications are key to long-term health and well-being.

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.