Fact Finding: Gallstones vs. Kidney Stones

Did you know you could have gallstones and not even know it? Gallstones are pretty common, but only a fraction of the people who have them even know they are there. General surgeon Mitchel McKenzie, MD, UnityPoint Health, explains gallstone symptoms, treatment, causes and the difference between gallstones vs. kidney stones.

Gallbladder Function

The gallbladder is a storage organ connected to the liver by a network of bile ducts.

“The liver is constantly producing bile, which is a liquid used in the absorption of fats in our diet,” Dr. McKenzie says. “When we are fasting, the bile isn’t released into our bowel and fills the gallbladder where it is stored. When we eat a meal containing fats, our bowel sends a signal to the gallbladder that it’s time to release bile.”

Dr. McKenzie says certain things can cause an imbalance in the bile stored in the gallbladder or lead to decreased emptying of the gallbladder, which results in gallstone formation.

Gallstone Causes

“Gallstones are very common. Roughly 20 percent of the population will develop gallstones in their life. However, only 20-30 percent will develop symptoms from them,” Dr. McKenzie says.

What causes gallbladder stones may include:

• Fasting
• Rapid weight loss
• High cholesterol
• Obesity
• Chronic illness
• Pregnancy
• Multiple pregnancies
• Hemolytic blood issues (blood disease resulting in anemia)
• Genetics

“Classically, gallstones are most typical in those over age 40. However, with the current obesity issues, younger individuals are developing gallstones as early as their teens,” Dr. McKenzie says.

Gallstone Pain & Symptoms

If you develop gallstones, Dr. McKenzie says you’ll likely get multiple firm stones at one time all varying in size. Remember, only 20-30 percent of people who get gallstones will notice any pain or symptoms associated with the stones. Those who do experience symptoms often complain of:

• Right upper quadrant pain. This is the area to the right of your belly button, under your right ribs down to your pelvis. The classic symptoms are pain in this area following a fatty or greasy meal.
• Back pain. The pain can radiate from the right upper quadrant through the right hip (right flank) to the back.
• Chest pain & indigestion. Those with gallstones might even notice chest pain and indigestion.
• Nausea and vomiting. Both can be gallstone symptoms.
• Steatorrhea. Some people develop very loose, greasy, foul-smelling stools.

“Gallstone pain can vary person to person. Some only have indigestion, while others feel they are having a heart attack and describe it as the worst pain in their life,” Dr. McKenzie says.

Gallstones vs.

Kidney Stones

Dr. McKenzie says while they are both stones, gallstones and kidney stones are two very different things. 

Passing Gallstones

The good news is you can pass small gallstones. Dr. McKenzie says some small gallstones leave your gallbladder and pass into your bile ducts. The stones that don’t get stuck move into the small bowel and are passed in your stool. However, the stones that get stuck are the ones that cause problems.

Gallstones can get stuck in the gallbladder itself (acute cholecystitis), causing inflammation and even infection in the gallbladder. Stones can also become stuck outside of the gallbladder in the bile ducts, causing an infection (ascending cholangitis), which can be life threatening.

Gallstone Treatment

No matter if the gallstones get stuck in the gallbladder or in the bile ducts, the gallbladder is normally removed in order to prevent future complications from stones. A gallbladder removal (cholecystectomy) usually takes about 30 minutes, and it’s performed laparoscopically. That means there are only three or four small (1-centimeter) cuts.

If there are also gallstones in the bile ducts, Dr. McKenzie says a surgeon or gastroenterologist will take a scope through the patient’s mouth into the small bowel and the duct in the small bowel to access the stone and remove it. This is called an ERCP.

Gallbladder Diet

Dr. McKenzie says there are no specific foods that will cause gallstones to form. If you want to avoid gallstones, he suggests maintaining a healthy lifestyle and focusing on avoiding high cholesterol and weight gain.

“Gallstone formation is a complex process that can lead to a need for surgery in those who have gallstones. If you are concerned you may have a gallbladder problem or are experiencing symptoms, make an appointment with your primary care provider or general surgeon for assessment,” Dr. McKenzie says.

Gallstones | nidirect

Gallstones are small stones, usually made of cholesterol, that form in the gallbladder. The gallbladder is a small, pouch-like organ found underneath the liver.

Symptoms of gallstones 

Most cases of gallstones don’t cause any symptoms. But if a gallstone becomes trapped in a duct (tube connecting to the gallbladder) or irritates the inside of the gallbladder it can cause a sudden severe abdominal (tummy) pain.

The pain can be felt:

• in the midline of your abdomen (tummy), above the umbilicus (belly button)
• just under the ribs on your right-hand side – it may spread from here to your side or shoulder blade

The pain is sometimes triggered by eating fatty foods, but may occur at any time of day and it may wake you up during the night.

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

• persistent pain
• jaundice (a term used to describe the yellowing of the skin and the whites of the eyes.  It’s caused by a build-up of a substance called bilirubin in the blood and body’s tissues)
• a fever

• Find out more about the symptoms of gallstones on the NHS website

Treating gallstones 

Treatment is usually only necessary if gallstones are causing:

• symptoms – such as abdominal pain
• complications – such as jaundice or acute pancreatitis (a serious condition where the pancreas becomes inflamed over a short period of time). The pancreas is a small organ located behind the stomach and below the ribcage.

In these cases, surgery to remove the stone or the gallbladder may be recommended.

• Find out more about treating gallstones on the NHS website

When to seek medical help 

If you think you may be experiencing symptoms described above you should make an appointment with your GP.

Contact your GP immediately for advice if you develop:

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

If your own GP surgery is closed, you should contact your local out of hours service (OOH).

• Find your local out of hours service

Causes of gallstones

The main purpose of the gallbladder is to store and concentrate bile (a liquid to help you digest fats). Gallstones are thought to develop because of an imbalance in the chemical make-up of bile inside the gallbladder.

In most cases the levels of cholesterol in bile become too high and the excess cholesterol forms into stones.

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

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

Preventing gallstones

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

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

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

• Find out more about gallstones on the NHS website

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1. What is cholelithiasis and its causes
2. Symptoms and diagnosis of gallstones
3. Treatment of disease

1.

What is gallstone disease and its causes

Gallstones are crystals of cholesterol or bile salts – solid particles that vary in size and shape. The gallbladder is an organ that is a reservoir for bile, which is involved in the digestion of fats.

The gallbladder is located on the anterior side of the liver and plays an important role in the functioning of the gastrointestinal tract and metabolism. That is why gallstones – cholelithiasis or cholelithiasis – are considered a serious disease.

In order to understand the causes of gallstones, it is necessary to consider in more detail the features of its functioning. Gall Bladder is a small reservoir of bile that comes regularly from the liver. During meals, the gallbladder releases fluid into the duodenum, improving the process of digestion.

Bile has a complex chemical composition and contains a fairly large amount of cholesterol and bilirubin, a pigment produced by the liver. With prolonged stagnation of bile in the gallbladder, cholesterol begins to be deposited on protein particles that are formed from bile components. The result of this process is the emergence of microscopic stones, which over time are interconnected, increase in size and form large stones – stones in the gallbladder. The formation of stones is a rather long process, taking from 5 to 20 years.

The main causes of gallstones include:

• Increased cholesterol levels in bile. An increase in cholesterol levels can be caused by eating fatty foods, obesity, metabolic disorders in the body and diseases such as diabetes mellitus.
• Violation of the outflow of bile. Dyskinesia, a violation of the contractile function of the gallbladder, flatulence, a sedentary lifestyle, improper diet, and pregnancy can lead to stagnation of bile.
• Infection in the gallbladder. Infection in this gallbladder is accompanied by inflammation of its mucous membrane and the creation of favorable conditions for the deposition of bile components.

In a healthy body, bile in the gallbladder is in a liquid state and does not form solid compounds. Only under the influence of the above factors, some substances from its composition begin to precipitate, contributing to the formation of stones. Consider the following risk factors that increase the likelihood of solid junctions in the gallbladder:

• Genetic predisposition. Some people have a hereditary tendency to form gallstones. Therefore, if at least one member of your family has a similar pathology, you are also at increased risk.
• Obesity. This factor is considered one of the main reasons for the development of gallstones, since obesity significantly increases the level of cholesterol, which leads to a violation of the full emptying of the gallbladder.
• Ethnic origin. Nationality also affects the likelihood of a person developing a similar pathology. Numerous studies have found that Americans, for example, are more prone to developing gallstones.
• The hormone estrogen. Estrogen in some cases contributes to the deterioration of gallbladder motility. High estrogen levels are common in pregnant women, as well as in women taking birth control pills and other hormonal medications.
• Age and gender. Most often, gallstone disease occurs in the elderly and women.

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2. Symptoms and diagnosis of gallstones

Cholelithiasis is characterized by asymptomatic course. A person for many years may not be aware of the presence of stones in the gallbladder. The occurrence of signs of this disease depends primarily on the location of solid formations, as well as on their size and number. As a rule, signs of gallstone disease appear when stones block the ducts, preventing the outflow of bile.

Here are the main symptoms of cholelithiasis:

• vomiting and nausea;
• long and agonizing pains in upper abdomen and back;
• gastrointestinal disorders: heartburn, indigestion, etc. ;
• bitterness and dry mouth;
• fever.

The detection of gallstones begins with a medical examination, during which the gastroenterologist checks whether the gallbladder is enlarged, determines the degree of its sensitivity, etc. For further diagnosis of this disease, the specialist prescribes a blood test and ultrasonography of the abdominal organs. Ultrasound data helps the doctor determine the size of stones in the gallbladder and their number. Moreover, on their basis, the doctor can analyze the condition of the gallbladder and identify the possible cause of the development of stones. Among other more complex diagnostic methods, one can single out the study of the gallbladder with the help of special preparations – oral cholecystography and retrograde cholangiopancreatography – the introduction of a contrast agent into the bile ducts.

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3.

Treatment of disease

Treatment of gallstone disease is a systematic and multifaceted process. It includes following a diet and lowering cholesterol levels in the body. The treatment is based on the removal of stones from the gallbladder, which can be carried out in the following ways:

• Stone dissolution. Without surgery, cholelithiasis can only be cured with drugs: ursodeoxycholic and chenodeoxycholic acid. They reduce the level of substances in the bile that promote the formation of stones, and increase the level of substances that dissolve solid compounds. This method is effective only in the early stages of the disease.
• Crushing of gallstones. This technique for the treatment of gallstone disease is based on the effect of high pressure on gallstones through ultrasound. As a result, the stone is destroyed and crushed into small particles, which are subsequently dissolved with the help of medications.
• Removal of the gallbladder. This treatment for gallstones is used for inflammation of the gallbladder walls, very large stones and other complications of gallstone disease.

The method of treatment for gallstone disease is determined by the doctor and depends on the stage of the disease, so doctors recommend that you be attentive to your health, undergo preventive examinations for gallstones if your family has a tendency to develop them, and immediately consult a doctor if you have symptoms of stones in gallbladder.

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Stones in the bile ducts – causes, symptoms, who treats

What should be done to diagnose and treat stones in the bile ducts ? To solve this problem, the first step for the patient is to make an appointment with a gastroenterologist. After the initial examination, the doctor may prescribe additional studies:

• Abdominal ultrasound
• Abdominal MRI with MR cholangiography
• Abdominal CT with CT cholangiography
• endoscopic ultrasound
• endoscopic retrograde cholangiography.

Choledocholithiasis is the presence of gallstones in the common bile duct. Gallstones usually form in the gallbladder. The bile duct is a small tube that carries bile from the gallbladder to the intestines. The gallbladder is a pear-shaped organ below the liver in the upper right part of the abdomen. Stones usually remain in the gallbladder or pass unhindered through the common bile duct.

Bile duct symptoms

Gallstones in the bile duct may not cause symptoms for months or even years. But if the stone gets stuck in the duct and blocks it, you may feel the following symptoms:

• abdominal pain in the upper right or middle upper abdomen
• fever
• jaundice
• loss of appetite
• nausea and vomiting
• clay colored chair.

Pain caused by gallstones in the bile ducts may be sporadic or prolonged. Severe pain requires immediate medical attention. The most severe symptoms can be confused with a heart attack, such as a heart attack.

When a gallstone gets stuck in the bile duct, the bile can become infected. Infection bacteria spread rapidly and enter the liver. If this happens, the infection becomes life-threatening. Other possible complications include biliary cirrhosis and pancreatitis.

Causes of gallstones in the bile ducts

There are 2 types of gallstones: cholesterol gallstones and pigment gallstones.

Cholesterol gallstones often look yellow and are the most common type. Scientists believe that cholesterol gallstones are formed due to bile containing:

• too much cholesterol
• too much bilirubin
• insufficient amount of bile salts.

They also occur when the gallbladder is not emptied completely or often enough.

The cause of pigment stones is unknown. They appear in patients suffering from:

• cirrhosis of the liver
• biliary tract infection
• hereditary blood disorders in which the liver produces too much bilirubin.

Risk factors

Patients with gallstones or gallbladder disease are at risk for developing gallstones. Even patients who have had their gallbladder removed may experience this disease. The following factors increase the likelihood of developing gallstones:

• obese
• low-fiber, high-fat diet
• pregnancy
• long fasting
• rapid weight loss
• lack of exercise.

Some of these risk factors for gallstones can be reduced through lifestyle changes. Risk factors that cannot be changed include:

• age
• gender – women are more likely to form gallstones
• family history – genetics play a role.

How a doctor diagnoses bile duct stones

If there are signs, a gastroenterologist will check for a gallstone in the common bile duct. He will use one of the following imaging modalities:

• transabdominal abdominal ultrasound, an imaging procedure that uses high frequency sound waves to examine the liver, gallbladder, spleen, kidneys, and pancreas
• Abdominal CT – X-ray of the abdomen in cross section
• endoscopic ultrasound – an ultrasound transducer is inserted into a flexible endoscopic tube and inserted through the mouth to examine the digestive tract
• endoscopic retrograde cholangiography – a procedure used to detect stones, tumors and narrowings in the bile ducts
• magnetic resonance cholangiopancreatography – MRI of the gallbladder, bile ducts and pancreatic ducts
• percutaneous transhepatic cholangiogram – X-ray of the bile ducts.

Your doctor will also order one or more of the following blood tests to look for infection and check liver and pancreatic function:

• complete blood count
• bilirubin
• pancreatic enzymes
• liver function tests.

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Bryukhovetsky Yu. A. Ultrasound examination of the biliary system / Yu. A. Bryukhovetsky // Clinical Guide to Ultrasound Diagnostics / ed. V. V. Mitkova. Moscow: Vidar, 1996.-T. 1.-S. 94-140.

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