What are the common symptoms of gallstones. How are gallstones diagnosed and treated. Can gallstones be prevented through diet and lifestyle changes. What complications can arise from untreated gallstones.

What Are Gallstones and How Do They Form?

Gallstones are hardened deposits that can form in the gallbladder, a small organ located under the liver. They develop when substances in bile, such as cholesterol and bilirubin, crystallize and clump together. While gallstones can vary in size from tiny grains to golf ball-sized masses, most are small enough to pass through the biliary system without causing issues.

How do gallstones form? There are several factors that can contribute to their development:

• Excess cholesterol in bile
• High levels of bilirubin
• Concentrated bile due to inefficient gallbladder emptying
• Genetic predisposition
• Obesity and rapid weight loss
• High-fat, high-cholesterol diets

Understanding the composition and formation of gallstones is crucial for identifying risk factors and developing prevention strategies.

Common Symptoms of Gallstones: When to Seek Medical Attention

While many people with gallstones remain asymptomatic, others may experience a range of uncomfortable symptoms. Recognizing these signs is essential for timely diagnosis and treatment.

What are the most common symptoms of gallstones?

• Sudden, intense pain in the upper right abdomen or center of the abdomen
• Pain that radiates to the right shoulder or between the shoulder blades
• Nausea and vomiting
• Fever and chills
• Jaundice (yellowing of the skin and eyes)
• Clay-colored stools

These symptoms often occur after eating fatty meals and may last for several hours. If you experience persistent or severe pain, seek medical attention immediately, as this could indicate a more serious complication.

Risk Factors for Gallstone Development: Are You at Higher Risk?

Certain factors can increase your likelihood of developing gallstones. By understanding these risk factors, you can take proactive steps to reduce your chances of gallstone formation.

Who is most at risk for developing gallstones?

• Women (especially those who are pregnant, taking hormone therapy, or using birth control pills)
• People over 40 years old
• Individuals with a family history of gallstones
• Those who are overweight or obese
• People with diabetes or metabolic syndrome
• Individuals on rapid weight loss diets
• Those with certain medical conditions (e.g., Crohn’s disease, cirrhosis)

While some risk factors are beyond your control, maintaining a healthy weight and balanced diet can help reduce your risk of gallstone formation.

Diagnosing Gallstones: Medical Tests and Procedures

Accurate diagnosis of gallstones is crucial for determining the appropriate treatment plan. Healthcare providers use a variety of tests and imaging techniques to detect and evaluate gallstones.

How are gallstones diagnosed?

• Ultrasound: The most common and non-invasive method for detecting gallstones
• CT scan: Provides detailed images of the gallbladder and surrounding organs
• HIDA scan: Assesses gallbladder function and checks for blockages
• Blood tests: Help identify signs of infection or inflammation
• Endoscopic retrograde cholangiopancreatography (ERCP): Allows for both diagnosis and potential treatment of gallstones in the bile ducts

Your doctor will determine which tests are necessary based on your symptoms and medical history. Early detection can prevent complications and guide treatment decisions.

Treatment Options for Gallstones: From Watchful Waiting to Surgery

The treatment approach for gallstones depends on the severity of symptoms and the presence of complications. Options range from conservative management to surgical intervention.

What are the main treatment options for gallstones?

1. Watchful waiting: For asymptomatic gallstones, monitoring without intervention may be recommended
2. Medications: Ursodeoxycholic acid can help dissolve small gallstones over time
3. Lithotripsy: Sound waves are used to break up gallstones (less common and only suitable for certain cases)
4. Cholecystectomy: Surgical removal of the gallbladder, often performed laparoscopically

The gold standard for symptomatic gallstones is cholecystectomy, as it prevents recurrence and eliminates the risk of future gallbladder-related complications. However, your doctor will consider your individual circumstances when recommending a treatment plan.

Lifestyle Changes and Diet Modifications to Prevent Gallstones

While not all gallstones can be prevented, certain lifestyle changes and dietary modifications can reduce your risk of developing them.

How can you lower your risk of gallstone formation?

• Maintain a healthy weight through balanced diet and regular exercise
• Avoid rapid weight loss and crash diets
• Eat a diet rich in fiber and low in saturated fats
• Stay hydrated by drinking plenty of water
• Limit alcohol consumption
• Include coffee in your diet (moderate consumption has been linked to lower gallstone risk)
• Consider including foods high in vitamin C, which may help prevent gallstone formation

Remember, these lifestyle changes not only reduce your risk of gallstones but also promote overall health and well-being.

Complications of Untreated Gallstones: When to Worry

While many gallstones remain asymptomatic, untreated symptomatic gallstones can lead to serious complications. Understanding these potential risks underscores the importance of seeking medical attention when symptoms arise.

What complications can arise from untreated gallstones?

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

These complications can be life-threatening if left untreated. If you experience severe abdominal pain, fever, or jaundice, seek immediate medical care.

Living Without a Gallbladder: What to Expect After Cholecystectomy

For many people with symptomatic gallstones, cholecystectomy (surgical removal of the gallbladder) is the recommended treatment. While the prospect of living without this organ may seem daunting, most people adapt well to life post-surgery.

How does life change after gallbladder removal?

• Digestion continues normally for most people
• Some individuals may experience temporary diarrhea or digestive upset
• Gradual reintroduction of fatty foods is typically recommended
• Long-term dietary restrictions are usually unnecessary
• Regular follow-ups with your healthcare provider ensure proper healing and adjustment

While the gallbladder plays a role in fat digestion, the body can adapt to its absence. Most people return to their normal diets and activities within a few weeks of surgery.

Dietary Considerations After Gallbladder Removal

After cholecystectomy, some dietary adjustments may be necessary to ensure comfort and optimal digestion. While individual experiences vary, here are some general guidelines:

• Start with a low-fat diet and gradually reintroduce fats
• Eat smaller, more frequent meals
• Increase fiber intake to help normalize bowel movements
• Stay hydrated to support digestion
• Consider probiotic supplements to promote gut health

Working with a dietitian can help you develop a personalized eating plan that meets your nutritional needs and minimizes discomfort.

Alternative Treatments and Natural Remedies for Gallstones

While medical treatments are the most effective for symptomatic gallstones, some people explore alternative or complementary approaches. It’s important to note that these methods are not scientifically proven and should not replace professional medical advice.

What alternative treatments are sometimes suggested for gallstones?

• Gallbladder flushes or cleanses
• Herbal supplements (e.g., milk thistle, peppermint)
• Acupuncture
• Castor oil packs

Always consult with your healthcare provider before trying any alternative treatments, as some may interact with medications or pose risks.

The Role of Genetics in Gallstone Formation

Research has shown that genetic factors play a significant role in gallstone development. Understanding the genetic component can help identify individuals at higher risk and guide preventive strategies.

How do genetics influence gallstone formation?

• Certain genetic variations affect cholesterol metabolism
• Family history is a strong risk factor for gallstone development
• Specific ethnic groups (e.g., Native Americans) have higher gallstone prevalence
• Genetic testing may help identify susceptibility in the future

While you can’t change your genetic makeup, knowing your family history can help you and your healthcare provider make informed decisions about prevention and screening.

Gallstones in Special Populations: Pregnancy and Pediatrics

Gallstones can affect people of all ages, but certain populations face unique challenges and considerations. Pregnant women and children with gallstones require specialized care and management approaches.

How do gallstones affect pregnant women and children?

• Pregnancy increases the risk of gallstone formation due to hormonal changes
• Management during pregnancy focuses on conservative treatments when possible
• Pediatric gallstones are often associated with underlying conditions or risk factors
• Treatment in children may differ from adults and requires careful consideration

Close monitoring and collaboration between specialists are crucial for managing gallstones in these special populations.

Emerging Research and Future Treatments for Gallstones

The field of gallstone research continues to evolve, with new insights and potential treatments on the horizon. Staying informed about these developments can provide hope for improved management and prevention strategies.

What are some promising areas of gallstone research?

• Gene therapy to prevent gallstone formation
• Novel medications to dissolve gallstones more effectively
• Improved imaging techniques for early detection
• Minimally invasive treatments to replace traditional surgery

While many of these approaches are still in the experimental stage, they highlight the ongoing efforts to improve gallstone treatment and prevention.

The Economic Impact of Gallstone Disease

Gallstone disease not only affects individual health but also has significant economic implications. Understanding the financial burden can help inform public health policies and resource allocation.

What are the economic consequences of gallstone disease?

• High healthcare costs associated with diagnosis and treatment
• Lost productivity due to illness and recovery time
• Strain on healthcare systems, particularly in regions with high prevalence
• Potential for preventive measures to reduce overall economic burden

By investing in prevention and early detection, societies can potentially reduce the long-term economic impact of gallstone disease.

Gallstones and Associated Conditions: Understanding the Connections

Gallstone disease often coexists with or shares risk factors with other health conditions. Recognizing these associations can lead to more comprehensive healthcare and prevention strategies.

What conditions are commonly associated with gallstones?

• Metabolic syndrome
• Type 2 diabetes
• Cardiovascular disease
• Non-alcoholic fatty liver disease (NAFLD)
• Certain gastrointestinal disorders

Managing these associated conditions may help reduce the risk of gallstone formation and improve overall health outcomes.

The Psychological Impact of Living with Gallstone Disease

While the physical symptoms of gallstones are well-documented, the psychological impact of the condition is often overlooked. Chronic pain, dietary restrictions, and the fear of complications can significantly affect a person’s quality of life and mental well-being.

How can gallstone disease affect mental health?

• Anxiety about potential pain attacks or complications
• Depression related to chronic symptoms or dietary limitations
• Stress from managing the condition and its impact on daily life
• Body image concerns, particularly after surgery

Addressing the psychological aspects of gallstone disease is crucial for comprehensive patient care. Support groups, counseling, and stress-management techniques can be valuable resources for those affected.

Global Perspectives on Gallstone Disease: Prevalence and Management

Gallstone disease affects populations worldwide, but its prevalence and management approaches can vary significantly across different regions and cultures. Understanding these global perspectives can provide valuable insights into risk factors, treatment strategies, and healthcare practices.

How does gallstone disease differ globally?

• Prevalence rates vary widely between countries and ethnic groups
• Dietary habits and lifestyle factors influence regional differences
• Access to healthcare and treatment options vary across developed and developing nations
• Cultural beliefs may impact treatment preferences and outcomes

Studying these global variations can lead to improved understanding of gallstone disease and more culturally sensitive approaches to prevention and treatment.

Gallbladder cleanse: A ‘natural’ remedy for gallstones?

What is a gallbladder cleanse? Is it an effective way to flush out gallstones?

Answer From Brent A. Bauer, M.D.

A gallbladder cleanse — also called a gallbladder flush or a liver flush — is an alternative remedy for ridding the body of gallstones. However, there’s no reliable evidence that a gallbladder cleanse is useful in preventing or treating gallstones or any other disease.

In most cases, a gallbladder cleanse involves eating or drinking a combination of olive oil, herbs and some type of fruit juice over several hours. Proponents claim that gallbladder cleansing helps break up gallstones and stimulates the gallbladder to release them in stool.

Although olive oil can act as a laxative, there’s no evidence that it’s an effective treatment for gallstones. Also, people who try gallbladder cleansing might see what looks like gallstones in their stool the next day. But they’re really seeing globs of oil, juice and other materials.

Gallbladder cleansing is not without risk. Some people have nausea, vomiting, diarrhea and abdominal pain during the flushing or cleansing period. The ingredients used in a gallbladder cleanse can present their own health hazards.

Gallstones that cause no symptoms typically require no treatment. If you have gallstones that require treatment, discuss proven treatment options with your doctor, such as surgical removal, bile salt tablets or sound wave therapy.

• Can you recommend a diet after gallbladder removal?

April 03, 2020

Show references

1. Rakel D, ed. Cholelithiasis. In: Integrative Medicine. 4th ed. Elsevier; 2018. https://www.clinicalkey.com. Accessed Feb. 10, 2020.
2. “Detoxes” and “cleanses”: What you need to know. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/detoxes-cleanses. Accessed Feb. 10, 2020.
3. Treatment of gallstones. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/gallstones/treatment. Accessed Feb. 10, 2020.

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Symptoms of a Gallbladder Problem

What Can Go Wrong

Some common gallbladder problems include:

Gallstones (cholelithiasis) This is a condition in which small stones, or sometimes larger ones, develop inside the gallbladder.

These stones form from substances found in bile, including cholesterol and a pigment called bilirubin.

Gallstones may cause pain known as biliary colic (see below), but about 90 percent of people with gallstones will have no symptoms.

Most symptomatic gallstones will have been present for a number of years.

For unknown reasons, if you have gallstones for more than 10 years, they are less likely to cause symptoms. (3,4)

Biliary colic This term is often used to describe severe episodes of pain that can occur when gallstones block the flow of bile to the small intestine.

The gallbladder contracts vigorously against the blockage, causing severe pain in spasms, or sometimes constant pain.

Biliary colic episodes usually last one to five hours, with mild pain lingering for up to 24 hours. They’re especially common after large or fatty meals, particularly if you’ve been fasting beforehand. (5)

Inflamed gallbladder (cholecystitis) Inflammation of the gallbladder can be caused by gallstones, excessive alcohol use, infections, or even tumors that cause bile buildup.

But the most common cause of cholecystitis is gallstones.

In this case, irritation by gallstones causes the gallbladder walls to become swollen and painful.

An episode of inflammation can last for several hours, or even a few days. Fever is not unusual.

Sometimes, the inflamed gallbladder is invaded by intestinal bacteria and becomes infected.

Suspected episodes of cholecystitis always require medical attention, particularly if you have a fever. (6)

Perforated gallbladder An inflamed gallbladder can lead to a number of serious complications, including a torn, or perforated, gallbladder. This is a potentially life-threatening condition and requires emergency surgery to remove the gallbladder. (6)

Acalculous biliary pain This refers to pain in the bile ducts that isn’t followed by any gallstones appearing in imaging tests.

It may be due to improper emptying of the gallbladder, overly sensitive bile ducts or small intestine, or gallstones that are too small to be seen on imaging scans or that have passed through already.

Surgery to remove the gallbladder is often successful at resolving biliary pain without gallstones. (7)

Common bile duct infection Most cases of inflammation in the bile duct system, called cholangitis, are caused by a combination of obstruction of a bile duct (by gallstone or biliary strictures) and a bacterial infection.

If bacteria builds up above the blockage, it can back up into the liver and may cause severe infection. Antibiotics are needed to treat a bacterial infection. Doctors may also need to drain the fluid in the bile duct to determine the cause of blockage. (8,9)

AIDS-related narrowing of bile ducts In people with AIDS, a weakened immune system can lead to frequent and widespread infections, some of which can result in the bile ducts narrowing. (7)

Primary sclerosing cholangitis This refers to inflammation that causes scarring and narrowing of the bile ducts, and isn’t caused by any other known condition.

While the causes of primary sclerosing cholangitis aren’t completely understood, doctors believe it’s most likely an autoimmune disorder, in which the immune system mistakenly attacks the body’s own tissues. (7)

Gallbladder abscess Sometimes a severe gallbladder infection can lead to an abscess on the organ, also called empyema of the gallbladder. Antibiotics alone may not be enough to treat abscesses and they may need to be drained. (10)

Porcelain gallbladder This occurs when the walls of the gallbladder become so calcified that they resemble porcelain on an X-ray. Porcelain bladders are thought to be associated with a very high risk of cancer and should be removed surgically. (4)

Gallbladder polyps These are growths that protrude from the surface of the inner gallbladder wall. Some polyps form as a result of inflammation or because of cholesterol deposits in the gallbladder wall.

Others are tumors, which may be cancerous, though about 95 percent of gallbladder polyps are benign. According to the American Cancer Society, gallbladder polyps larger than 1 centimeter are more likely to be cancerous and therefore most doctors recommend they be removed. (11,12)

Gallbladder disease This is a blanket term that encompasses inflammation, infection, gallstones, or blockage of the gallbladder.

Gallstones – Symptoms – NHS

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

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

Abdominal pain (biliary colic)

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

The pain can be felt:

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

The pain is constant and isn’t relieved by going to the toilet, passing wind or being sick. 

It’s sometimes triggered by eating fatty foods, but may occur at any time of day and may wake you up during the night.

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

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

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

Other symptoms

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

If this happens, you may develop:

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

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

Read more about the complications of gallstones.

When to get medical advice

Make an appointment to see your GP if you think you may have biliary colic.

Contact your GP immediately for advice if you develop:

• jaundice
• abdominal pain lasting longer than 8 hours
• a high temperature and chills
• abdominal pain so intense that you can’t find a position to relieve it

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

Page last reviewed: 10 October 2018
Next review due: 10 October 2021

Cholecystitis: Gallbladder Inflammation, Symptoms, Treatment

Overview

Anatomy of the gallbladder, featuring gallstones stuck in the cystic duct.

What is cholecystitis?

Cholecystitis is an inflammation of the gallbladder. Your gallbladder is a small pear-shaped organ tucked away under your liver in the upper right section of your abdomen. The gallbladder’s job is to store bile – a fat-digesting fluid made by the liver – and to release it after you eat a meal. Cholecystitis usually develops when the bile gets trapped in your gallbladder, and becomes infected with bacteria. Bile gets trapped when gallstones block the flow of bile out of your gallbladder.

What are gallstones and how do they block the flow of bile?

Gallstones are hardened deposits of the digestive fluids that form in your gallbladder, and can range in size from a tiny grain of sand (called sludge) to a golf ball. They are made up of either cholesterol or pigment stones. Gallstones made of cholesterol are yellow-greenish in color, and are more common. Pigment stones are mostly made of bilirubin, a substance that is created when the liver breaks down red blood cells.

Gallstones themselves are not necessarily a problem. It’s possible to have gallstones sitting in your gallbladder, never bothering you and, in that case, they don’t need to be treated. However, gallstones that leave the gallbladder can get stuck in your ducts (tubes). They block the flow of bile out of your gallbladder, which causes a buildup of bile. These events cause the walls of your gallbladder to become inflamed and swell, and that can lead to bacterial infection of the bile. Your life can even be in danger unless you seek prompt medical and surgical help.

How does the gallbladder work?

The gallbladder connects to your liver by a duct system (tubes) that look like a tree trunk with branches. There are many ducts, or “branches” inside your liver. These tree branches connect to two main tree limbs in your liver, called the right and left hepatic ducts. These two ducts merge (like the trunk of a tree) to form your common hepatic duct. One main “tree limb” coming off the common hepatic duct is called the cystic duct. It connects directly into your gallbladder. The common hepatic duct, the “tree trunk,” continues but its name changes to the common bile duct. Your common bile duct empties into the duodenum section of the small intestine.

Bile, a fat-dissolving liquid substance that is made continuously by your liver, travels through the duct system and enters your digestive system at the duodenum. When you are not eating, a valve structure at the common bile duct and duodenum connection, called the major duodenal papilla, is usually closed. This allows the bile to reflux back through the cystic duct into your gallbladder to be stored. During mealtime, your gallbladder contracts, and the valve opens, pushing the stored bile out of your gallbladder, through the cystic duct and down the common bile duct into your intestine. Bile mixes with the partially digested food, further helping the breakdown of the fat in your diet.

Gallstones, or even sludge, in the gallbladder can obstruct this normal flow of bile, leading to cholecystitis.

How common is cholecystitis?

Approximately 120,000 Americans are treated for acute cholecystitis every year. Women make up 60% of this number.

Who is at risk to get cholecystitis?

You are at greater risk of developing cholecystitis if you:

• Have a family history of gallstones.
• Are a woman age 50 or older.
• Are a man or woman age 60 or older.
• Eat a diet high in fat and cholesterol.
• Are overweight or obese.
• Have diabetes.
• Are of Native American, Scandinavian or Hispanic descent.
• Are currently pregnant or have had several pregnancies.
• Are a woman who takes estrogen replacement therapy or birth control pills.
• Have lost weight rapidly.

Symptoms and Causes

What causes cholecystitis?

Cholecystitis is commonly caused by gallstones that have blocked your cystic duct, which prevents bile from exiting your gallbladder. Your gallbladder becomes swollen and may become infected with bacteria. Less common causes include blocked bile ducts due to scarring, reduced blood flow to your gallbladder, tumors that block the flow of bile from your gallbladder, or viral infections that inflame your gallbladder.

Structure of the digestive anatomy showcasing the liver, stomach, pancreas and gallbladder.

What are the symptoms of cholecystitis?

Symptoms can be acute or chronic.

Acute cholecystitis comes on suddenly and causes severe, ongoing pain. More than 95% of people with acute cholecystitis have gallstones. Pain begins in your mid to upper right abdomen and may spread to your right shoulder blade or back. Pain is strongest 15 to 20 minutes after eating and it continues. Pain that remains severe is considered a medical emergency.

Chronic cholecystitis means you’ve had repeated attacks of inflammation and pain. Pain tends to be less severe and doesn’t last as long as acute cholecystitis. The repeated attacks are usually caused by gallstones blocking the cystic duct intermittently.

Other signs and symptoms of cholecystitis may include:

• Tenderness in your abdomen when it’s touched.
• Nausea and bloating.
• Vomiting.
• Fever above 100.4 F (38 C). Fever may not be present in older adults and usually doesn’t occur in people with chronic cholecystitis.
• Chills.
• Abdominal pain that gets worse when taking a deep breath.
• Abdominal pain and cramping after eating – especially fatty foods.
• Jaundice (a yellowing of skin and eyes).

Diagnosis and Tests

How is cholecystitis diagnosed?

Your healthcare professional will ask about your symptoms. They may order blood work to check your white blood cell count and how well your liver is working. A higher than normal white blood cell count is a sign of an infection, inflammation, or an abscess.

Imaging tests that could be ordered include:

• Abdominal ultrasound: This test uses sound waves to examine the gallbladder and the bile ducts. It helps identify signs of inflammation in your gallbladder, the presence of gallstones, and thickening or swelling of the gallbladder wall.
• Hepatobiliary nuclear imaging (HIDA scan): This is an imaging test that involves an injected radioactive substance. A gamma camera sees the radiation as it moves through the different tracts of the digestive system. If that substance doesn’t enter your gallbladder, then the healthcare provider knows the organ is blocked, indicating cholecystitis. This test can also detect the function of the gallbladder and its ability to eject the bile once stimulated. This is called the ejection fraction of the gallbladder, which is considered normal when it is above 30-35%.
• Magnetic Resonance Cholangiopancreatography (MRCP): This type of MRI shows details of your liver, gallbladder, bile ducts, structures and ducts of the pancreas as well. It can show gallstones, inflammation or blockage of the bile ducts and gallbladder and if there is any inflammation of the pancreas.
• Abdominal Computed Tomography (CT Scan): This X-ray test shows details of your liver, gallbladder and bile ducts. It shows inflammation of the gallbladder.

Management and Treatment

How can cholecystitis be treated?

Treatment of cholecystitis usually takes place in the hospital. Treatments may include:

• Fasting, to rest the gallbladder.
• IV fluids to prevent dehydration.
• Pain medication.
• Antibiotics to treat infection.
• Removing the gallbladder. This surgery, called a cholescystectomy, is usually performed by making tiny cuts (incisions) through the abdomen to insert a laparoscope (tiny camera) to see inside the abdomen and surgical instruments to remove the gallbladder. The gallbladder is usually removed within 24 to 48 hours of admission if you have a confirmed case of acute cholecystitis.
• Draining the gallbladder to treat and prevent the spread of infection. This procedure, called percutaneous cholecystostomy, is usually reserved for those who are too ill to undergo surgery.
• Removing gallstones in the area blocking the common bile duct. This procedure, done by an endoscopist, called endoscopic retrograde cholangiopancreatography (ERCP), is reserved for patients with a suspected or confirmed blocked common bile duct, and can clear the duct of stones and sludge.

What is it like to recover from gallbladder surgery?

Recovery from gallbladder surgery, when done laparoscopically, is usually uneventful. As with any surgery there can be minimal pain at the incision sites. Most patients are discharged from the hospital shortly after the surgery, and do not require additional testing or interventions. If the surgery is done through a larger wound (open surgery) then the recovery can be slower and require more days in the hospital.

Can I live without my gallbladder?

Yes, you can live a normal life without a gallbladder. Since the gallbladder’s main role is the storage of the bile, and bile is made continuously by the liver, you don’t need your gallbladder for normal digestion. Bile can still flow directly from your liver, through the common bile duct and into the small intestine.

What complications can occur if cholecystitis is not treated?

Complications can range from ongoing infection to possible death.

• Severely Infected gallbladder: A blocked gallbladder that is extremely uncomfortable and painful. Without treatment, it could lead to an overwhelming infection, or even gangrene of the gallbladder.
• Cholangitis: An acute infection of the main bile ducts and liver that can be extremely life-threating if not promptly treated.
• Inflamed pancreas (Pancreatitis): Your common bile duct and the pancreatic duct share the same “valve” into the duodenum. If a gallstone blocks that valve, the potent pancreatic enzyme juice excreted by the pancreases gets backed up causing pancreatitis, which can also be severe and life threatening.

What if I have cholecystitis during pregnancy?

During early and later pregnancy cholecystitis can be treated by antibiotics. Surgery is usually a safe option during the second trimester, but can also be performed safely at any time if antibiotics fail to treat the infection

Prevention

How can cholecystitis be prevented?

You can reduce your risk of developing cholecystitis by:

• Eating a healthy diet: Choose to eat a healthy diet – one high in fruits, vegetables whole grains and healthy fats – such as the Mediterranean diet. Stay away from foods high in fat and cholesterol.
• Exercising: Exercise reduces cholesterol, and the lower the cholesterol level the lower the chance of getting gallstones.
• Losing weight slowly: If you are making efforts to lose weight, don’t lose more than one to two pounds a week. Rapid weight loss increases your risk for developing gallstones.

Outlook / Prognosis

What is the outlook for patients with cholecystitis?

There is a higher rate of the symptoms recurring if cholecystitis is treated only with medications. There is a higher risk of death, as well, for patients who do not address the worsening conditions.

Surgery to remove the gallbladder (cholecystectomy) is usually the definitive treatment. The benefits of the surgery outweighs the risks in most cases, since the surgical treatment carries very low risk of complications in most cases. Your surgeon will assess your risks for the surgery and discuss all of your treatment options before the operation.

Living With

What’s the difference between cholecystitis and cholelithiasis?

Cholelithiasis is the formation of gallstones. Cholecystitis is the inflammation of the gallbladder.

How do I take care of myself if I have a diagnosis of cholecystitis?

Educate yourself about the symptoms of cholecystitis so that you and your healthcare provider can identify it and treat it as early as possible.

When should I see my healthcare provider?

Abdominal pain of any sort should always be an alarm. If you have sudden pain or bouts of pain in your upper right area of your abdomen or right shoulder or back, contact your healthcare provider.

When should I go to emergency room?

Don’t hesitate to go to the emergency room if you have severe abdominal pain that does not spontaneously resolve or that continues to worsen.

What questions should I ask my doctor?

• Is my pain cholecystitis, for sure, or could it be caused by something else?
• Should my cholecystitis be treated with medication or with surgery, or both?
• What do you think caused these symptoms?
• How quickly am I likely to recover from surgery?
• Keeping my other medical conditions in mind, are there any risks in getting surgery?
• Could I have any non-surgical treatments?
• How quickly should I have surgery?
• What specialist should I follow up with?
• What foods should I eat/avoid?

A note from Cleveland Clinic

If you have pain in the upper right quadrant of your abdomen, seek immediate answers from a healthcare provider. Gallbladder inflammation, whether it’s chronic or acute, requires swift and vigilant care!

Symptoms of Gallstones | Rhode Island Hospital Patient Guide

Typical symptoms of gallstones are of three types: 

• Pain between the breast bone and the belly button (epigastric) pain or discomfort
• Pain beneath the breastbone (substernal), which may seem like a heart attack
• Pain in the right upper quadrant, which may shoot to the right side of the back or up to the right shoulder

These pains, which are referred to as biliary colic, may be mild or severe, sharp or crampy, and may last from minutes to hours.  They typically occur a few hours after eating and most commonly at night or early morning.  They frequently wake the patient from sleep.  The pain may be associated with nausea and vomiting.  It is often associated with bloating.  In fact, bloating and fullness are common symptoms that may be related to gallstones and unassociated with pain. 

However, bloating and fullness may occur for other reasons.  If that is the case, treatment of the gallstones will not lead to relief of the symptoms.  In fact, the only reliable symptoms of gallbladder disease, which will almost always be eliminated by removing the gallbladder, are the three pain syndromes noted above.

Gallstone Q&A

Do the pain and symptoms occur in all patients with gallstones?

No.  There are over 20 million Americans with gallstones but only about 750,000 gallbladders removed per year.  In addition, about 1 million new cases will be diagnosed each year.  Therefore, most patients with gallstones have no symptoms or symptoms so mild they do not affect their lifestyle.  It is estimated that only 20% of people with gallstones and no symptoms will develop symptoms during the next twenty years of their life.  However, people who do have symptoms are likely to continue to have symptoms.  Furthermore, in a large percentage of symptomatic patients, the frequency and severity of the attacks increase over time.

Why do these symptoms occur?

After we eat there are chemical (hormonal) and nerve signals from our intestinal tract (duodenum) which cause the gallbladder to contract.  When there are no stones present, the gallbladder empties its bile freely.  However, when stones are present, the stones can block the exit of the gallbladder at the cystic duct.  This leads to secretion of water into the gallbladder to relieve the obstruction by increasing the force of contraction. However, because the exit is blocked, this leads to distention (swelling) of the gallbladder, which in turn causes the epigastric and or substernal pain.  

Continued distention of the gallbladder leads to reduced blood flow to the wall of the gallbladder and to inflammation.  This is associated with pain in the right side of the upper abdomen. The nausea, vomiting and bloating are a non-specific intestinal response (visceral response) to these insults.  

Usually after a period of time, the stone will fall out, bile will exit, the distention is relieved and the pain goes away.  However, if there was a lot of inflammation, some residual discomfort may remain for hours to days.  The length of time this residual pain is present is related to the severity of the attack.  Occasionally, the stone gets firmly stuck and does not fall back into the gallbladder.  This leads to continued inflammation and pain known as acute cholecystitis.  This situation is similar to acute appendicitis although the gallbladder is not as likely to rupture as the appendix is.  Typically, patients with acute cholecystitis have large gallstones.  They are much sicker than patients with biliary colic, frequently have a fever and need emergency or urgent surgery.

What are my chances of more symptoms?

The National Cooperative Gallstone Study was performed in the early 1980’s to evaluate this question as well as other.  The results of these studies revealed that 70% of patients with previous symptoms had at least one more episode of pain during a two year period if the gallstones were not treated.  Furthermore, approximately 50% had severe attacks and 20% had more than one attack.  Therefore, you can expect attacks in the future if you have had them in the past.  The question is when they will occur.  Unfortunately, they often will occur when you least want them, Murphy’s Law.

Is the size or number of the stones related to whether or not patients have symptoms?

No.  Patients may have one small stone and have severe and repetitive symptoms while others with multiple large stones may have none.  However, it is important to note that the type of symptoms and complications of gallstone disease are related to the size of the stones.  For example, patients with gallstones greater than one centimeter in size are more likely to get acute cholecystitis than those with gallstones less than one centimeter in size.  Patients with gallstones greater than 3 centimeters in diameter are more likely to get  gallbladder cancer than those with stones smaller than 3 centimeters or no stones. (Nonetheless, gallbladder cancer is so rare it is not a problem worth worrying about.)  Patients, on the other hand, with small, less than 1/2 centimeter stones are more likely to get passage of the stones through the cystic duct into the common duct.  This can lead to two severe and life threatening problems: pancreatitis and obstructive jaundice.

• Pancreatitis is a chemical inflammation of the pancreas, the organ that makes insulin and digestive enzymes that break up food in our intestinal tract.  It results from the passage of a stone down the common duct and out the end of the common duct into the intestine.  As the stone passes through, it can block the exit of the duct from the pancreas which also empties into the common duct or the intestine near the common duct.  Because the pancreatic duct contains digestive enzymes that breakdown food, the blockage can lead to digestion of the pancreas itself. As a result, patients with acute pancreatitis can develop severe complications and death.  Acute pancreatitis is usually associated with severe pain in the epigastrium that radiates straight back, is worse lying down and better sitting up.  It is associated with vomiting and retching.
• Obstructive jaundice from stones (choledocholithiasis) is the condition whereby stones enter and block the flow of bile in the common duct from the liver to the duodenum.  This results in a back up of bile which causes the liver to not work correctly, fats to be malabsorbed, the eyes and skin to turn yellow, the urine to turn tea colored and the stool to turn clay colored.  Because the bile becomes stagnant in the common bile duct, the risk of infection is great and can be life threatening.  It is usually associated with severe pain in the epigastrium.

More about the gallbladder and gallstones

Gallbladder Disease: Signs, Symptoms, and Complications

The most common symptom of gallbladder disease is pain in the upper right side of the abdomen, where the gallbladder is located. Depending on the type of gallbladder disease present and whether any complications are occurring, a person may also experience fever, nausea, vomiting, and/or jaundice.

The complications of gallbladder disease result mainly from the presence of gallstones and may include an infection of the common bile duct (called ascending cholangitis), inflammation of the pancreas (called pancreatitis), gangrene of the gallbladder (called gangrenous cholecystitis), or a bowel obstruction from a gallstone (called gallstone ileus).

© Verywell, 2018 

Frequent Symptoms

Pain in the upper right side of the abdomen is the most common symptom of gallbladder disease and most frequently results from gallstones.

Abdominal Pain

While most gallstones stay in the gallbladder and cause no symptoms, some become lodged in the cystic duct (a tube located at the neck of the gallbladder) or in the common bile duct (a tube that carries bile from the gallbladder to the intestines). An obstruction of the cystic duct with a gallstone is called biliary colic. A gallstone in the common bile duct is called choledocholithiasis and may cause intermittent or constant discomfort.

Biliary colic is an intense, dull ache that usually is located in the upper right side of the abdomen. It also can occur in the upper middle part of the abdomen (called the epigastrium) or, less often, beneath the sternum. Sometimes the pain travels (radiates) to the right shoulder blade or to the back. The pain caused by biliary colic can be steady or intermittent and often, but not always, is triggered by eating a meal that’s high in fat.

Besides a gallstone attack, upper right-sided abdominal pain may occur in other gallbladder diseases, such as:

• Cholecystitis: This condition refers to gallbladder inflammation. While it most commonly occurs as a complication of gallstones (called acute cholecystitis), it may also occur in people without gallstones (called acalculous cholecystitis). Unlike a gallstone attack, the biliary-like pain of cholecystitis lasts longer than six hours and is usually associated with fever and an elevated white blood cell count.
• Biliary dyskinesia: This condition causes upper abdominal pain and occurs when the sphincter of Oddi (a muscular structure located at the junction where the bile ducts drain into the small intestine) does not function properly, causing bile blockage.
• Functional gallbladder disorder: In this disorder, a person has no evidence of gallstones or sphincter of Oddi problems but continues to experience episodes of upper abdominal pain.
• Advanced gallbladder cancer: A person with gallbladder cancer generally does not have symptoms. As the cancer grows, though, pain in the upper right side of the abdomen may occur along with palpable lumps on the belly, jaundice, nausea, fatigue, and weight loss.

Jaundice

Jaundice, signaled by yellowing of the whites of the eyes and skin, may occur in gallbladder diseases that obstruct the bile ducts.

DermNet / CC BY-NC-ND

Nausea and Vomiting

Nausea and vomiting may occur with a gallstone attack but are more commonly seen in cholecystitis (inflammation of the gallbladder) or pancreatitis (inflammation of the pancreas).

Fever

Fever should not occur with a gallstone attack but may occur with gallbladder inflammation or with infection/inflammation of the biliary tract.

Rare Symptoms

Besides upper right-sided abdominal pain, people have reported other symptoms of gallbladder disease. Due to their atypical nature, though, experts question whether these symptoms are actually part of a coexisting disease; in other words, a person may be experiencing gallstones and another medical condition, like gastroesophageal reflux disease (GERD) or peptic ulcer disease.

Less Common Symptoms

Some of these less common symptoms include:

• Chest pain
• Burping
• Feeling full sooner than usual after eating
• Regurgitating fluids
• Bloating
• Burning sensation behind the breastbone or in the upper central abdomen
• Nausea and/or vomiting without biliary colic

Pruritus

Pruritus (itching) is another symptom, occurring commonly with a condition called primary sclerosis cholangitis, a chronic, inflammatory disease of both the gallbladder and liver. The pruritus is often very debilitating and likely occurs as a result of bile acid accumulation. People with primary sclerosing cholangitis may also experience upper right-sided abdominal pain, jaundice, and fatigue.

Complications

There are several complications that may occur as a result of gallbladder disease.

Acute Cholangitis

Acute cholangitis is caused by a bacterial infection of the biliary tract in a person with biliary obstruction. In addition to a fever and upper right-sided abdominal pain, a person may experience jaundice, low blood pressure, and confusion.

Pancreatitis

Pancreatitis refers to inflammation of the pancreas and most commonly occurs as a complication of gallstones. This is because the gallbladder and pancreas share a bile drainage duct, so an obstructing gallstone can prevent the flow of pancreatic enzymes.

Symptoms of gallstone pancreatitis include the often rapid onset of severe, epigastric pain, as well as nausea and vomiting. Treatment entails hospitalization for nutrition and fluids, pain control, and monitoring for severe complications, including necrotizing pancreatitis, which can be life-threatening. Usually procedures to remove the duct blockage, or the entire gallbladder, also are performed.

Gangrenous Cholecystitis

This is the most common complication of cholecystitis, especially in older people, people with diabetes, or people who delay seeking treatment for their gallbladder attacks. Gangrenous cholecystitis is considered a medical emergency, requiring surgical removal of the gallbladder (a cholecystectomy) right away.

Gallbladder Perforation

If the gallbladder becomes gangrenous, a perforation (or a hole in the wall of the gallbladder) may develop resulting in a pericholecystic abscess (a collection of pus within the gallbladder). This complication is serious and life-threatening, requiring an emergent cholecystectomy.

Cholecystoenteric Fistula/Gallstone Ileus

If a hole (perforation) forms in the gallbladder, a fistula (passage) into the small intestine may develop. If a gallstone passes through the fistula, a bowel obstruction may occur (called gallstone ileus).

Emphysematous Cholecystitis

Infection of the wall of the gallbladder with gas-forming bacteria may lead to emphysematous cholecystitis. People most at risk for this gallbladder complication include those of an older age and those with diabetes.

When to See a Doctor

If you are experiencing any abdominal pain, it’s important to see your doctor for a proper diagnosis. If your doctor diagnoses you with gallstones, he will likely refer you for a surgical evaluation, especially if you are experiencing recurrent episodes of biliary colic.

Gallbladder Disease Doctor Discussion Guide

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If you are experiencing abdominal pain that is severe, persistent, and/or associated with fever, severe nausea, vomiting, and/or jaundice, be sure to seek medical attention right away at the hospital. 

Gallstones can be a pain in the back

Gallstones form when bile stored in the gallbladder hardens into stone-like material. Too much cholesterol, bile salts, or bilirubin (bile pigment) can cause gallstones.

What are the symptoms of gallstones?

At first, most gallstones do not cause symptoms. However, when gallstones become larger, or when they begin obstructing bile ducts, symptoms or “attacks” begin to occur. Attacks of gallstones usually occur after a fatty meal and at night. Symptoms may include:

• Steady, severe pain in the upper abdomen that increases rapidly and may last from 30 minutes to several hours
• Pain in the back between the shoulder blades
• Pain in the right shoulder
• Nausea
• Vomiting
• Fever
• Chills
• Jaundice (yellowing of the skin or eyes)
• Abdominal bloating
• Intolerance of fatty foods
• Belching or gas
• Indigestion

People who also experience the following symptoms should consult a doctor immediately:

• Sweating
• Chills
• Low-grade fever
• Yellowish color of the skin or whites of the eyes
• Clay-colored stools

Some people with gallstones do not have any symptoms. These stones are called “silent stones,” because they do not interfere with the function of the gallbladder, liver, or pancreas, and do not require treatment in most cases.

The symptoms of gallstones may resemble other conditions or medical problems, such as heart attack, appendicitis, ulcers, irritable bowel syndrome, hiatal hernia, pancreatitis, or hepatitis. Always consult your health care provider for a diagnosis.

What are the risk factors for gallstones?

• Obesity. Being overweight is a major risk factor.
• Estrogen. Excess estrogen from pregnancy, hormone replacement therapy or birth control pills appears to increase cholesterol levels in bile and decrease gallbladder movement.
• Gender. Women are twice as likely to develop gallstones as men.
• Age. People over 60 are more likely to develop gallstones than younger people.
• Cholesterol-lowering drugs. Drugs that lower cholesterol in blood can actually increase the amount of cholesterol secreted in bile.
• Diabetes. People with diabetes generally have high levels of fatty acids, called triglycerides, which increase the risk for gallstones.
• Rapid weight loss. As the body metabolizes fat during rapid weight loss, it causes the liver to secrete extra cholesterol into bile, which can cause gallstones.
• Fasting. Fasting decreases gallbladder movement, which causes the bile to become over-concentrated with cholesterol.

Reduce your risk of gallstones

There is no way to prevent gallstones, but you can take steps to reduce the likelihood that you will form gallstones that will cause symptoms.

• Maintain a healthy weight. Take care not to lose weight quickly through dieting and then gain it back.
• Eat regular, balanced meals that include whole grains, fiber and calcium. Limit foods high in cholesterol.
• Exercise regularly, in order to maintain a healthy weight and keep cholesterol levels down.

Worried that you are experiencing gall bladder symptoms? OSF OnCall can provide guidance as to the best course of action.

Treatment of gallstones in Israel

The essence of gallstones

The gallbladder is a small pear-shaped organ located under the liver, in the upper right side of the abdominal cavity. The main function of the gallbladder is to concentrate and store bile, and then, at the appropriate time, excrete it through the bile ducts into the intestines to aid the digestion process. Bile is a cinnamon-yellowish liquid that is constantly produced in the liver.Bile contains water, cholesterol, bile salts, bilirubin, bile pigments, which give bile a characteristic color. The liver is capable of producing about three cups of bile per day. The gallbladder stores about a cup of concentrated bile. Gallstones are chunks of solid material generated in the gallbladder of various sizes and shapes. Gallstones in the gallbladder are formed from crystal-hard particles. Bile dark pigment stones containing a complex water-insoluble bilirubin occur in 20% of patients with liver and blood diseases.Cholesterol gallstones of white or yellow and light shades, containing cholesterol and calcium salts, are found in 80% of patients. Among patients suffering from gallstones, the prevalence of cholesterol stones is 85%. The size of gallstones ranges from the smallest, the size of a grain of sand, to the largest, the size of a ping-pong ball. Sometimes a single large stone forms in the gallbladder. Sometimes many small stones are formed, the number of which can reach several thousand.The presence of gallstones is usually not painful and does not require treatment. However, when gallstones begin to move from the gallbladder through the bile ducts, it can disrupt the flow of bile and obstruct the biliary tract.

The cause of gallstone disease

According to the observations of specialists at the Ichilov (Sourasky) hospital, gallstones are formed as a result of several factors that occur in the human body:

• Chemical processes in the liver
• Overweight
• Disorder of gallbladder motility
• Heredity
• Improper diet, etc.

Cholesterol stones form when bile contains too much cholesterol and too little bile salts. In addition, the presence of proteins and bile in the liver can contribute to the formation of cholesterol gallstones. Incomplete emptying of the gallbladder can lead to gallstones.

Symptoms of gallstone disease

The presence of stones in the gallbladder in most cases goes away without symptoms. In such cases, there is no need for treatment.However, if gallstones change their location, they can block the flow of bile and complications such as cholecystitis and jaundice can occur. The presence of gallstones usually presents with acute pain in the right upper abdomen, pain in the back, right shoulder blade, or chest. Gallstones can cause nausea and vomiting. The intervals between colic can occur in a week, a month, or even years.

Diagnosis of the disease

At the Tel Aviv Sourasky Medical Center (Ichilov), gallstones are diagnosed by ultrasound (ultrasound).Some gallstones are difficult to identify and require more sophisticated diagnostic methods such as endoscopic ultrasound, magnetic resonance imaging (MRI), nuclear magnetic resonance, or endoscopic retrograde cholangiopancreatography (ERCP).

Treatment of the disease

At the Tel Aviv Sourasky Medical Center (Ichilov), the most common method of treating gallstones in patients with symptoms of gallstones is a minimally invasive procedure – laparoscopic surgery – removal of the gallbladder.

To ensure proper flow of bile from the liver to the intestines and to remove gallstones from the bile ducts in high-risk patients, Ichilov’s highly skilled surgeons use a visual endoscopic retrograde cholangiopancreatographic (ERCP) technique called endoscopic papillotomy.

Cholelithiasis – inflammation of the gallbladder and ducts due to stone formation .: causes, complaints, diagnostics and treatment methods on the website of the clinic “Alfa-Health Center”

Inflammatory lesion of the gallbladder and bile ducts due to the formation of stones in them, accompanied by sharp pain, nausea, vomiting, and sometimes jaundice.

With age, the risk of gallstones and the incidence of gallstone disease increase. Approximately every tenth inhabitant of Russia suffers from it; hundreds of thousands of cholecystectomy operations (removal of the gallbladder) are performed every year. Gallstones are cholesterol and pigmented; the mechanisms of formation of stones of different compositions are different. In developed countries, three quarters of patients have cholesterol stones. The main method for detecting gallstones is ultrasound (ultrasound).

Complaints

Gallstones are usually asymptomatic, but can cause transient obstruction (blockage) of the cystic duct, which manifests as biliary colic. With a more prolonged violation of the outflow of bile, cholecystitis and its complications develop.

Asymptomatic gallstones

Previously, in many medical centers, cholecystectomy was performed as soon as gallstone disease was detected, regardless of the presence of clinical manifestations.This was especially often done if the patient suffered from diabetes mellitus, since with him the risk of complications of cholecystitis is increased. However, over the past 5 years, new data on the course of asymptomatic gallstone disease have appeared, which have changed the approach to its treatment. With rare exceptions, cholecystectomy is not required for asymptomatic gallstones. The risk of biliary colic in the first 10 years after detection of stones is 2-3% per year, and subsequently decreases to less than 1% per year. Therefore, most patients need surgery only if there are clinical manifestations.

Biliary colic

The most common manifestation of gallstone disease is biliary colic. In fact, it is not entirely correct to call this condition colic. Usually the pain is constant, intense, localized in the right hypochondrium, it can radiate to the right shoulder girdle or shoulder blade, to the middle of the abdomen (epigastrium) or to other areas of the chest or abdomen. Belching, bloating, intolerance to fatty foods are not typical. Biliary colic should be distinguished from other conditions that cause persistent abdominal pain, such as peptic ulcer disease.In laboratory research, no deviations are found. In 60% of cases, colic goes away on its own. In 70% of patients, after weeks, months or years, repeated attacks may occur. In 10–20% of patients with biliary colic, complications develop, such as acute cholecystitis, cholangitis, or pancreatitis. Therefore, biliary colic requires treatment; usually cholecystectomy (removal of the gallbladder) is done.

Treatment

Treatment for gallstone disease is aimed at eliminating symptoms and preventing complications.Over the past 15 years, the possibilities of conservative and surgical treatment have expanded significantly. Since the operation can permanently save the patient from this disease, regardless of the size, number and composition of stones, conservative treatment is used only in special cases; after its cancellation, relapses often occur. Sometimes conservative treatment is recommended for patients with high operational risk.

Cholecystectomy has been and remains the main treatment for gallstone disease.This is usually a safe operation and complications are rare. It eliminates biliary colic in 90% of patients and prevents its recurrence. In addition, cholecystectomy can detect early stages of gallbladder cancer and remove the tumor.

Previously, they preferred delayed operations (6-8 weeks after an attack of biliary colic), since it was believed that with active inflammation it is more difficult to operate and complications develop more often. However, studies have shown that the complication rate is lower with earlier surgeries.

Endoscopic (laparoscopic) cholecystectomy reduces hospital stay, disability time, postoperative pain intensity and complication rates. Damage to the bile ducts during laparoscopic operations are observed no more often than with open ones. The transition to open surgery due to the inability to isolate the gallbladder, massive bleeding or other intraoperative complications occurs in only 5% of cases.

90,000 Cholelithiasis: signs, symptoms, treatment

Signs of pathology

A person does not even know about the development of gallstone disease: at the first stages, the pathology does not manifest itself in any way.The onset of pronounced symptoms occurs during a period of active progression. A characteristic symptom is a sudden, pronounced pain under the right rib. Sometimes the pain syndrome responds in the region of the heart, under the right shoulder blade or shoulder.

Most often, painful sensations occur after eating spicy, fatty, spicy foods and alcohol. The mentioned symptom also appears after stress or heavy physical exertion.

Other symptoms accompanying cholelithiasis:

• bitterness in the mouth, especially in the morning;
• nausea and vomiting, not relieving;
• belching;
• flatulence;
• Stool violation.

The general condition of the body is sluggish, irritability and increased fatigue are observed. An additional symptom of the disease is an increase in body temperature and a feverish state. In some cases, there is a yellowish tinge of the skin (icteric) and a feeling of heaviness in the abdomen after eating.

Causes of development and prevention

Medicine identifies several reasons for the development of gallstone disease. One of the most common is eating disorders.An unbalanced diet, a passion for fast food and foods with an excess of cholesterol become a common cause of the disease. However, with the rejection of fatty foods or a sharp transition to a diet, bile becomes unclaimed, which causes changes in its structure and gradual crystallization. Because of this, the metabolism is disturbed – cholesterol and fat.

Among other causes of the development of the disease, there are:

• Anatomical structural anomalies;
• heredity;
• inflammatory processes of the gallbladder;
• organ infections;
• stagnation of bile.

Stagnation of bile and, as a consequence, cholelithiasis, occur against the background of other factors. Our specialists often find adhesions, tumors, kinks of the bladder, scar formations.

Classification of stones, stages of disease

Stones collected in the gallbladder have different chemical composition, which helps to distinguish two groups:

1. Cholesterol – appear when cholesterol absorption is impaired. The substance begins to accumulate in the liver, gradually forming stones.
2. Bilirubin – formed when there is an excess of hemoglobin in the body. They are inferior in size to the first group, but outnumber them.

There is also a classification by size: large (over 3 cm) cause health problems, provoking acute pain. Small ones (less than 3 cm) do not cause discomfort and do not manifest themselves in any way.

There are several stages of cholelithiasis:

1. Pre-stone – the first stage, during which there is a change in the composition of bile.The main symptoms are absent, the person does not feel discomfort and does not know about the developing disease. The problem is revealed, as a rule, by chance – with a biochemical study of bile.
2. Latent – active stone formation begins at this stage. A special study helps to identify the problem. This degree is also characterized by no discomfort or mild symptoms.
3. Active stage – ailments are manifested in full, accompanied by acute pain.

Diagnostics and treatment

If you suspect the onset of cholelithiasis, you need to urgently make an appointment with a specialist. First of all, a visual examination and questioning of the patient about disturbing symptoms is carried out. Diagnostic measures include a general and biochemical blood test, ultrasound of the abdominal cavity. A thorough examination may require MRI and other instrumental studies.

Depending on the type of stones, the method of treatment is selected.Stones that can be “dissolved” are treated with special medications or shock wave therapy.

There are a number of restrictions for the treatment of a disease with medicines, which must be taken into account when choosing a method of exposure. Under the influence of drugs, stones are destroyed and removed from the body. Herbal medicine can be an additional method of treatment. But it should be carried out according to the prescription and supervision of a specialist.

Very often, cholelithiasis is diagnosed quite late, when the drug effect is no longer effective.In this case, they resort to surgical treatment, which involves the removal of stones and the gallbladder.

Diet plays an important role in the treatment regimen. Throughout the course of treatment of the disease, food should be taken in small portions 5-6 times a day. It is necessary to exclude from the diet “harmful” types of foods, alcohol, chocolate and sugary carbonated drinks. Allowed for gallbladder disease:

• fermented milk products;
• bran and other types of fiber;
• vegetable fats;
• low-fat fish varieties;
• liquid porridge;
• weak broths.

In case of bile duct disease, it is recommended to observe the drinking regime. Preferred options are green tea and purified water.

Prevention after treatment

Diseases of the gallstone bladder are not completely removed by medicines. Therefore, dietary recommendations must be followed strictly. In case of exacerbation, make an appointment as soon as possible, do not self-medicate.

After medical and surgical treatment of the disease, it is necessary to engage in prophylaxis.Such measures can help reduce the risk of developing health problems in middle age.

A balanced diet, moderate physical activity, and rejection of bad habits will help to eliminate stagnation of bile in the ducts. Regular examination in one of the MEDKOM centers will be important. Our specialists monitor the health of people with a tendency to obesity and genetic predisposition.

Treatment of gallstone disease complicated by choledocholithiasis

Gallstone disease occurs in about 10% of the adult population.With this disease, dense calculi – the so-called stones – form in the gallbladder. In some cases, small stones enter the bile ducts and linger there. This condition is called choledocholithiasis and requires special treatment.

At MEDSI, gallstone disease complicated by choledocholithiasis is treated using modern endoscopic techniques and performed by experienced specialists with many years of practice.

Description and symptoms of choledocholithiasis

This complication develops in 10-25% of patients with gallstones.The severity of symptoms depends on how much the formation prevents the movement of bile through the ducts.

• If a large enough calculus enters the duct and severely interferes with its patency, then symptoms may develop suddenly
• If it is a small stone, then over time it usually increases in size and begins to close the lumen of the duct, gradually causing more and more pronounced symptoms

The increase in symptoms is due to the fact that the bile produced cannot fully move along the ducts into the duodenum, stagnating over the location of the stone.The pressure builds up in the bladder, it stretches, which causes severe pain in the patient.

Classic symptoms of the disease:

• Pain, distention in the right hypochondrium (in the region of the liver, left upper abdomen), which noticeably increase after eating or during physical exertion
• Nausea, vomiting
• Metallic, bitter taste in the mouth in the morning
• Sometimes – yellowness of the skin, mucous membranes, sclera of the eyes
• In some cases – increased body temperature

Diagnosis of choledocholithiasis

It is possible to determine the presence of a stone in the bile duct using a number of studies:

• Ultrasound of the abdominal organs with examination of the liver and gallbladder
• MR-cholangiopancreatography
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Biochemical blood test with determination of liver enzymes and bile pigments
• Complete blood count with detection of inflammatory changes (increase in the number of leukocytes)

Dangers of choledocholithiasis

In some cases, gallstone disease with choledocholithiasis can cause complications:

• Cholangitis – inflammation of the bile ducts with high fever, severe liver symptoms
• Hepatic colic – an attack of severe pain in the liver area caused by a sharp stretching of the gallbladder due to complete blockage of the ducts
• Pancreatitis – inflammation of the pancreas, which is located near the biliary tract and may be involved in the inflammatory process

With prolonged choledocholithiasis, other serious disorders may occur: dropsy of the gallbladder, cirrhosis of the liver.Therefore, immediately upon the appearance of signs of choledocholithiasis or in case of accidental detection of an asymptomatic form of this disease, it is recommended to immediately consult a doctor for treatment.

Treatment

Minimally invasive non-surgical treatment:

• At MEDSI, endoscopic removal of stones from the bile ducts is carried out with modern video duodenoscopes. The endoscope is inserted through the mouth into the stomach and duodenum, then under X-ray control, through the working channel of the video duodenoscope, a special instrument is passed through the mouth of the bile duct to the location of the stone.With the help of special baskets or balloons, stones are removed from the bile ducts. Thus, minimally invasive treatment of complications of gallstone disease is carried out without the need for a large and traumatic surgical intervention
• Extraction (removal) of bile duct stones during ERCP. This is a medical and diagnostic technique used to establish obstacles (stones, tumor lesions) in the bile ducts from the inside using a video duodenoscope and modern X-ray equipment.

If necessary, for large stones, the procedure is complemented by papillotomy – an operative endoscopic intervention, which consists in partial dissection of the large duodenal papilla (BDS), then endoscopic lithotripsy is performed (destruction of stones inside the ducts with an endoscopic lithotripter) and extraction of fragments of the destroyed stone. For large stones, targeted contact laser lithotripsy or electrohydraulic lithotripsy may be performed.

Surgical treatment with minimally invasive techniques:

• Choledochotomy is an operation that consists in dissecting the wall of the common bile duct with a laparoscopic instrument. This technique is used for large calculi that cannot be removed by other methods. The operation can be performed using gentle endosurgical techniques – without incisions, through small punctures on the abdomen.

Benefits of choledocholithiasis treatment at MEDSI

• Experienced highly qualified specialists carry out accurate diagnosis and effective treatment of choledocholithiasis in any form of the disease and any size of calculi
• Diagnosis of the disease is performed using OLYMPUS expert endoscopic devices with ultra-thin probes
• Treatment of cholelithiasis with choledocholithiasis is possible with the help of modern endoscopic techniques that allow for manipulations and interventions in less traumatic ways

Cholelithiasis – ProMedicina Ufa

In recent years, there has been a clear trend towards an increase in the number of patients suffering from cholelithiasis (or, as the people say, cholelithiasis).This disease is chronic.

A sick person for a long time may not be aware of the presence of stones in the gallbladder. He will periodically be bothered by indirect complaints: a feeling of heaviness in the right side, periodic heartburn, nausea, bitterness in the mouth. These symptoms are easily explained: with the development of gallstone disease, the stomach and pancreas begin to suffer.

Patients suffering from cholelithiasis may not go to the doctor for a long time and explain the above complaints by other reasons: non-compliance with the diet, excessive physical activity, etc.The task of the medical community is to educate the population about the need to consult specialists (first, a gastroenterologist, he will prescribe an examination; then a surgeon, he will present indications for surgery, explain the possible risks of stone bearing, etc.) dealing with this pathology.

There are good reasons for this, since the complications that develop during prolonged stoning and often lead to serious consequences!

Possible complications:

The first is a painful attack with the development of an acute inflammatory process, up to gangrene, which requires surgical treatment for health reasons, which exponentially increases the frequency of probable complications.

The most common example is that at night a patient, exhausted by pain, arrives at the “emergency department” and begs for an operation “through punctures”.

In most cases, the doctor is forced to refuse for one of the reasons:

– does not know the method;

– no technical feasibility;

– an inflammatory process has started, in which the implementation of minimally invasive technologies is fraught with complications.

Second complication. The appearance of obstructive jaundice in a patient.Most often, this is a yellowing of the skin and sclera in a patient against the background of colic. This complication is quite serious, the probable cause of it is the “slipping” of a stone from the gallbladder into the bile duct, its lumen is blocked, the outflow of bile is disrupted, and the most powerful intoxication of the body develops.

Treatment of this complication requires serious preparation and additional examination. The operation in this case usually consists of several stages and the likelihood that the patient will be offered a “large, abdominal” operation is very high.The postoperative period and rehabilitation will be long.

The third complication is less common, but its consequences can be fatal. It has been proven that long-term stone carriage can provoke the development of gallbladder cancer with all the ensuing consequences.

We have listed only a few of the complications, in fact there are many more.

Disease diagnosis

To diagnose the disease, in most cases, it is sufficient to perform an ultrasound of the abdominal organs.Its information content reaches 95-97%. In difficult diagnostic cases, CT or MRI is used. The task of the doctor when diagnosing “gallstone disease” is to explain the risks and possible complications to the patient and refer them to the surgeon. this disease is treated only by surgery and consists in removing the gallbladder together with the stones.

Preparations

A few words must be said about the preparations “dissolving stones”. Yes, such drugs exist, but their effect applies only to a certain type of stones, and since there are several varieties of such stones, it is reliably impossible to find out what kind of stone the patient has.These drugs do not dissolve large stones and do not eliminate the cause of the formation of stones, and accordingly, theoretically, they can only delay the attacks, but will not cure the patient.

So, gallstone disease is a disease that requires an integrated approach. Timely diagnosis (ultrasound) and treatment (surgery) will allow you to avoid serious complications.

Removal of the gallbladder – Euromed clinic

Endoscopic cholecystectomy

One of the most common operations in the field of general surgery is endoscopic cholecystectomy (removal of the gallbladder).The surgeon, head of the surgical department of the EuroMed Clinic, Andrey Vladimirovich Pinchuk, tells us about the danger of gallstone disease and explains why almost the only way of treatment is surgical.

The diagnosis of “cholelithiasis (gallstones)” is usually made when ultrasound revealed the presence of stones (calculi) in the gallbladder and / or bile ducts. Often, cholelithiasis is complicated by acute calculous cholecystitis – an acute inflammation of the gallbladder. In the presence of small stones, obstructive jaundice may appear due to blockage of the biliary tract.

Gallbladder – is a reservoir in which bile produced by the liver accumulates, where it becomes more viscous and concentrated, which contributes to more efficient digestion. When food enters the duodenum from the stomach, special hormones are released, which are a signal to the pancreas that it is time for the secretion of digestive juice, and the gallbladder – that it is time to contract. And with this reduction, the accumulated bile (released around the clock), having reached the desired consistency, through the sphincter of Oddi that has opened due to the aforementioned hormones, is released into the duodenum.The juice secreted by the pancreas also gets there, after which the sphincter of Oddi closes again, and the digestive process begins. Bile is needed in order to emulsify fats, that is, to break large droplets into small ones that can be processed by pancreatic enzymes.
Symptoms

With gallstones, the symptoms depend on the form of the disease and can be asymptomatic or cause acute biliary colic.
In the presence of stones in the gallbladder, the latter is ineffectively contracted and, accordingly, ceases to cope with its function of accumulation and release of bile.In addition, if the stones are small, the next contraction of the gallbladder (during digestion, during stress, even simply due to a sudden movement) can cause the stone to shift into the bile duct, which causes biliary colic. The danger of biliary colic lies not only in a sudden sharp pain, but also in the fact that because of it, bile ceases to be secreted, which leads to acute cholecystitis, with the subsequent development of complications (biliary peritonitis, obstructive jaundice), and this can provoke even fatal Exodus.

There is a common misconception that if you are not bothered by pain with gallstone disease, then you can do nothing. This is fundamentally wrong! If stones are found in the gallbladder, it means that it no longer fulfills its function, that is, leaving it from this point of view is meaningless. But he is practically a time bomb – an attack can happen at any time and lead to a life-threatening condition.
In a calm state, until the pain begins, the operation will be much easier, faster, the risk of postoperative complications is minimized.If the disease is neglected, the risk of complications both during the operation and after it increases significantly. The pancreas suffers, the function of bile secretion, the risk of developing obstructive jaundice is high, the work of natural sphincters is disrupted, the risk of stones formation in the biliary tract increases, etc.
The National Guidelines for Abdominal Surgery states the following: “Cholelithiasis and acute cholecystitis are potentially life-threatening diseases. Since doctors cannot yet accurately predict the nature of the course of the disease and the likelihood of developing life-threatening complications, removal of the gallbladder is currently the preferred method of treating cholelithiasis and acute cholecystitis.Timely surgical intervention leads to recovery, allows to fully restore the patient’s working capacity and significantly improves the quality of life. ”
Operation

Before the operation, the doctor prescribes a standard list of examinations: blood and urine tests, ECG, fibrogastroscopy, fluorography. Patients over 40 years of age still need to obtain a therapist’s opinion.
The intervention is performed under anesthesia under the control of a video camera. 4 small incisions (0.5-1 cm) are made on the abdomen through which a laparoscope is inserted into the abdominal cavity.The duration of the operation depends on the state of the gallbladder – with an uncomplicated course of the disease, it is 20-30 minutes.

After the intervention, the patient remains in the hospital for two days under the supervision of a doctor ; a sick leave is issued for 10-12 days.
In the first month after surgery, it is recommended to limit physical activity and follow a diet low in fat, cholesterol-rich foods, and spices. A fractional diet should be maintained.

Later, if the patient feels good, he calmly returns to his usual way of life.

In conclusion, I would like to emphasize once again: if you have stones in the gallbladder, do not delay the visit to the doctor! The sooner you start solving this problem, the more favorable the prognosis of treatment.

Surgical and endoscopic treatment of bile duct stones

Relevance

Gallstones are a common problem in the population and often cause pain (gallbladder colic) and gallbladder infections (acute cholecystitis).Gallstones can sometimes escape from the gallbladder and enter the duct between the gallbladder and the small intestine (common bile duct). Here, they block the flow of bile from the liver and gallbladder into the small intestine and cause pain, jaundice (yellowish eyes, dark urine, and pale stools), and sometimes severe bile infections (cholangitis). About 10-18% of people who have had cholecystectomy for gallstones have common bile duct stones.

Treatment includes removal of the gallbladder and gallstones from the duct.There are several ways to do this. An operation is performed to remove the gallbladder. In the past, it was performed through one large incision in the abdomen (open cholecystectomy). More modern methods of laparoscopic surgery are now the most common for gallbladder removal. Removal of trapped gallstones in the common bile duct can be performed with an open incision or with a keyhole technique. An endoscope (a narrow, flexible tube equipped with a camera) is inserted through the mouth into the small intestine to allow the removal of trapped gallstones from the common bile duct.This procedure can be performed before, during, and after surgery to remove the gallbladder. This systematic review attempts to answer the question of the safest and most effective way to remove trapped gallstones (by open surgery or laparoscopic versus endoscopic removal) and whether common bile duct stones should be removed during surgery. removal of the gallbladder (as a one-stage intervention) or should be done separately before or after surgery (two-stage intervention).

Review Questions

We analyzed the results of randomized clinical trials found in the literature to assess the benefits and harms of these procedures

Quality of evidence

We found 16 studies with 1758 participants. All trials were at high risk of bias (defects in study design that could lead to overestimation of benefits or underestimation of harm). In general, the evidence is of moderate quality due to the risk of bias or bias (defects in study design), as well as random errors (insufficient number of participants in the studies), which can lead to incorrect conclusions.