Where are gallstones typically found. What are the common symptoms of gallstones. How are gallstones formed and what causes them. What treatment options are available for gallstones. Can gallstones be prevented. How is gallbladder surgery performed. What lifestyle changes can help manage gallstones.

Understanding Gallstones: Formation and Location

Gallstones are solid deposits that form in the gallbladder, a small organ located in the upper right abdomen, just below the liver. These stones develop when substances found in bile, such as cholesterol, harden and crystallize. The gallbladder, a pouch-like organ, stores bile – a green-yellow liquid crucial for digestion. While gallstones are common, they often remain asymptomatic, with only about 10% of diagnosed individuals developing noticeable symptoms within five years.

Types of Gallstones

There are primarily two types of gallstones:

• Cholesterol stones: Yellow in color, these are the most common type, forming when there’s an excess of cholesterol in the bile.
• Pigment stones: Dark brown or black, these stones develop due to excess bilirubin in the bile, often associated with liver conditions or blood disorders.

Recognizing Gallstone Symptoms

While many gallstones remain “silent,” some can cause significant discomfort. The primary symptom is pain in the upper right abdomen or the center of the stomach. This pain often occurs after consuming high-fat foods but can happen at any time. Gallstone pain typically lasts for a few hours but can be quite severe.

Are there other symptoms associated with gallstones? Yes, if left untreated, gallstones can lead to more serious complications, including:

• High fever
• Rapid heartbeat
• Jaundice (yellowing of skin and eyes)
• Itchy skin
• Diarrhea
• Chills
• Confusion
• Loss of appetite

These symptoms may indicate a gallbladder infection or inflammation of the gallbladder, liver, or pancreas. It’s crucial to seek medical attention if experiencing these symptoms, as they can mimic other serious conditions like appendicitis or pancreatitis.

The Root Causes of Gallstone Formation

The exact cause of gallstones is not fully understood, but researchers believe it stems from a chemical imbalance in the bile within the gallbladder. Several factors can contribute to this imbalance:

Excess Cholesterol in Bile

When the liver produces more cholesterol than the bile can dissolve, it can lead to the formation of yellow cholesterol stones. This excess cholesterol crystallizes and forms solid deposits in the gallbladder.

Elevated Bilirubin Levels

Bilirubin, a byproduct of red blood cell breakdown, is normally processed by the liver and excreted from the body. However, certain conditions can cause the liver to produce excess bilirubin. When the gallbladder can’t break down this excess, pigment gallstones may form.

Concentrated Bile Due to Gallbladder Issues

If the gallbladder doesn’t empty properly, bile can become overly concentrated. This concentrated bile is more likely to form stones, as the substances within it are more prone to crystallization.

Diagnosing Gallstones: When to Seek Medical Attention

Given that many gallstones are asymptomatic, they’re often discovered incidentally during imaging tests for other conditions. However, if you’re experiencing persistent abdominal pain, particularly after meals, it’s important to consult a healthcare provider.

How are gallstones diagnosed? Doctors typically use a combination of methods:

• Ultrasound: This non-invasive imaging technique is the most common method for detecting gallstones.
• CT scan: Provides detailed images of the gallbladder and surrounding organs.
• HIDA scan: A specialized imaging test that evaluates gallbladder function.
• Blood tests: To check for signs of infection or inflammation.

Treatment Options for Gallstones

The treatment approach for gallstones depends on the severity of symptoms and the individual’s overall health. In many cases, asymptomatic gallstones don’t require immediate treatment. However, for those experiencing pain or complications, several options are available:

Surgical Intervention: Cholecystectomy

Cholecystectomy, the surgical removal of the gallbladder, is the most common and effective treatment for symptomatic gallstones. There are two primary types of cholecystectomy:

1. Laparoscopic cholecystectomy: This minimally invasive procedure involves making small incisions in the abdomen. A laparoscope (a thin, lighted tube) is inserted to guide the removal of the gallbladder. Most patients can go home the same day or the day after surgery.
2. Open cholecystectomy: This traditional surgery is performed when the gallbladder is severely inflamed, infected, or scarred. It requires a larger incision and a longer recovery period.

Is it possible to live without a gallbladder? Yes, the gallbladder is not an essential organ, and many people lead healthy lives after its removal. The body adapts by allowing bile to flow directly from the liver to the small intestine.

Non-Surgical Approaches

In some cases, particularly for high-risk surgical candidates, non-surgical treatments may be considered:

• Medications: Oral medications like ursodeoxycholic acid can help dissolve small gallstones over time. However, this method is slow and has a high recurrence rate.
• Lithotripsy: This technique uses shock waves to break up gallstones, but it’s rarely used and only effective for certain types of stones.
• Lifestyle modifications: Dietary changes and weight management can help prevent the formation of new gallstones.

Preventing Gallstone Formation: Lifestyle Factors

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

Dietary Considerations

What dietary changes can help prevent gallstones?

• Maintain a healthy weight: Obesity increases the risk of gallstone formation.
• Avoid rapid weight loss: Crash diets can increase the risk of gallstones.
• Eat a balanced diet: Include plenty of fruits, vegetables, and whole grains.
• Limit high-fat foods: Reduce consumption of fried and processed foods.
• Stay hydrated: Adequate water intake can help prevent bile concentration.

Regular Exercise

Physical activity can help maintain a healthy weight and improve overall digestive health. Aim for at least 30 minutes of moderate exercise most days of the week.

Living with Gallstones: Management and Monitoring

For those who have had gallstones or are at risk of developing them, ongoing management is important:

Regular Check-ups

Schedule regular appointments with your healthcare provider to monitor your condition, especially if you’ve had gallstones in the past.

Dietary Adjustments

Work with a nutritionist to develop a diet plan that supports gallbladder health. This may involve reducing fat intake and increasing fiber consumption.

Stress Management

Chronic stress can affect digestive health. Incorporate stress-reduction techniques like meditation, yoga, or deep breathing exercises into your routine.

Gallstones in Special Populations

Certain groups may be at higher risk for gallstone formation or may require special considerations in treatment:

Pregnancy and Gallstones

Pregnant women are at increased risk of developing gallstones due to hormonal changes. Management during pregnancy often involves conservative approaches unless complications arise.

Elderly Patients

Older adults may have a higher risk of gallstone-related complications. Treatment decisions should consider overall health status and potential surgical risks.

Individuals with Chronic Conditions

People with conditions like diabetes or liver disease may have an increased risk of gallstones and may require more frequent monitoring.

Understanding gallstones, their causes, and treatment options is crucial for managing this common condition. While many gallstones remain asymptomatic, those that cause discomfort or complications can significantly impact quality of life. By recognizing the symptoms, seeking timely medical attention, and making appropriate lifestyle changes, individuals can effectively manage gallstone-related issues and maintain overall digestive health.

As research in this field continues, new treatment options and preventive strategies may emerge, offering hope for improved management of gallstone disorders. Always consult with a healthcare professional for personalized advice and treatment plans tailored to your specific situation.

Symptoms, Causes, Treatment, and More

Gallstones are deposits of digestive fluid made of solidified substances found in bile, like cholesterol. They are common and may or may not produce symptoms. People with symptoms usually need to have their gallbladders taken out.

Read on to learn more about gallstones, the symptoms they can cause, and how to treat them.

Your gallbladder is a small organ in your upper right abdomen, right below your liver. It’s a pouch that stores bile, a green-yellow liquid that helps digestion. Issues with your gallbladder typically occur when something is blocking its bile duct—like a gallstone.

Most gallstones are created when substances found in bile, like cholesterol, harden. Gallstones are very common and routinely asymptomatic.

However, about 10 percent of people who are diagnosed with gallstones will develop noticeable symptoms within 5 years.

Photo: Bruce Blaus | Wikimedia Commons | https://commons.wikimedia.org/wiki/File:Gallstones. png

Gallstones can lead to pain in the upper right abdomen or the center of your stomach. You may experience gallbladder pain from time to time after you eat foods that are high in fat, such as fried foods, but the pain can occur at almost any time.

Pain caused by gallstone issues usually lasts for only a few hours, but it can feel severe.

If gallstones are left untreated or unidentified, the symptoms may increase to include:

• a high temperature
• rapid heartbeat
• yellowing of the skin and whites of the eyes (jaundice)
• itchy skin
• diarrhea
• chills
• confusion
• a loss of appetite

These symptoms can be signs of a gallbladder infection, or inflammation of the gallbladder, liver, or pancreas.

Because gallstone symptoms may mimic the symptoms of other serious issues like appendicitis and pancreatitis, no matter what, if you’re dealing with one or more of these issues — it’s time to see a doctor or get yourself to the ER.

If you need help finding a urologist, then check out our FindCare tool here.

Asymptomatic gallstones

Gallstones themselves don’t cause pain. Rather, pain occurs when gallstones block the movement of bile from the gallbladder.

According to the American College of Gastroenterology, about 80 percent of people who have gallstones have “silent gallstones.” This means they don’t experience pain or have symptoms. In these cases, your doctor may discover the gallstones from X-rays or during abdominal surgery.

The actual cause of gallstones is thought to be due to a chemical imbalance of bile inside of the gallbladder. While researchers still aren’t clear about what exactly causes that imbalance to happen, there are a few possible reasons:

Too much cholesterol in your bile

Having too much cholesterol in your bile can lead to yellow cholesterol stones. These hard stones may develop if your liver makes more cholesterol than your bile can dissolve.

Too much bilirubin in your bile

Bilirubin is a chemical produced during the normal breakdown of red blood cells. After it’s created, it passes through the liver and is eventually excreted out of the body.

Some conditions, such as liver damage and certain blood disorders, cause your liver to produce more bilirubin than it should. Pigment gallstones form when your gallbladder can’t break down the excess bilirubin. These hard stones are often dark brown or black.

Concentrated bile due to a full gallbladder

Your gallbladder needs to be able to empty its bile to function properly. If it fails to empty its bile content, the bile becomes overly concentrated, which can cause stones to form.

Most of the time, you won’t need treatment for gallstones unless they cause you pain. Sometimes you can pass gallstones without even noticing. If you’re in pain, your doctor will likely recommend surgery. In rare cases, medication may be used.

If you’re at high risk for surgery complications, there are a few nonsurgical ways to attempt to treat gallstones. However, if surgery isn’t performed, your gallstones may come back — even with additional treatment. This means you may need to keep an eye on your condition for the majority of your life.

Surgery

Cholecystectomy, which is surgery to remove the gallbladder, is one of the most common operations performed on adults in the United States. Because the gallbladder isn’t an essential organ, it’s possible to live a healthy life without it.

There are two types of cholecystectomy:

• Laparoscopic cholecystectomy. This is a common surgery that requires general anesthesia. The surgeon will usually make three or four incisions in your abdomen. They’ll then insert a small, lighted device into one of the incisions, check for stones, and carefully remove your gallbladder. You can usually go home on the day of the procedure or the day after if you have no complications.
• Open cholecystectomy.This surgery is typically performed when the gallbladder is inflamed, infected, or scarred. This surgery may also happen if problems occur during a laparoscopic cholecystectomy.

You may experience loose or watery stools after gallbladder removal. Removing a gallbladder involves rerouting the bile from the liver to the small intestine. Bile no longer goes through the gallbladder and it becomes less concentrated. The immediate result is a laxative effect that can cause diarrhea, but this issue should resolve on its own for most people.

Nonsurgical treatments

If surgery can’t be performed, such as if the patient is a much older individual, there are a few other ways doctors can try to get rid of your gallstones.

• Oral dissolution therapy typically includes using the medications ursodiol (Actigall) and chenodiol (Chenix) to break up gallstones. These medications contain bile acids, which work to break up the stones. This treatment is best suited for breaking up cholesterol stones and can take many months or years to work completely.
• Shock wave lithotripsy is another option. A lithotripter is a machine that generates shock waves that pass through a person. These shock waves can break gallstones into smaller pieces.
• Percutaneous drainage of the gallbladder involves placing a sterile needle into the gallbladder to aspirate (draw out) bile. A tube is then inserted to help with additional drainage. This procedure isn’t typically a first line of defense and tends to be an option for individuals who may not be suited for other procedures.

Some risk factors for gallstones are related to diet, while other factors are not as controllable. Uncontrollable risk factors are things like age, race, sex, and family history.

Lifestyle risk factors

• living with obesity
• a diet high in fat or cholesterol and low in fiber
• undergoing rapid weight loss
• living with type 2 diabetes

Genetic risk factors

• being born female
• being of Native American or Mexican descent
• having a family history of gallstones
• being 60 years or older

Medical risk factors

• living with cirrhosis
• being pregnant
• taking certain medications to lower cholesterol
• taking medications with a high estrogen content (like certain birth controls)

While some medications may increase your risk of gallstones, don’t stop taking them unless you have discussed it with your doctor and have their approval.

Your doctor will perform a physical examination that includes checking your eyes and skin for visible changes in color. A yellowish tint may be a sign of jaundice, the result of too much bilirubin in your body.

The exam may involve using diagnostic tests that help your doctor see inside your body. These tests include:

• Ultrasound. An ultrasound produces images of your abdomen. It’s the preferred imaging method to confirm that you have gallstone disease. It can also show abnormalities associated with acute cholecystitis.
• Abdominal CT scan. This imaging test takes pictures of your liver and abdominal region.
• Gallbladder radionuclide scan. This important scan takes about one hour to complete. A specialist injects a radioactive substance into your veins. The substance travels through your blood to the liver and gallbladder. On a scan, it can reveal evidence to suggest infection or blockage of the bile ducts from stones.
• Blood tests. Your doctor may order blood tests that measure the amount of bilirubin in your blood. The tests also help determine how well your liver is functioning.

To help improve your condition and reduce your risk of gallstones, try these tips:

• Eat fewer refined carbs (like cookies and white bread) and less sugar.
• Increase your intake of healthy fats, like fish oil and olive oil, which may help your gallbladder contract and empty on a regular basis.
• Eat the proper amount of fiber per day (women need about 25 grams a day, men need about 38 grams a day).
• Get some sort of physical activity every day.
• Keep yourself properly hydrated.

If you plan to lose weight, do it slowly. Rapid weight loss may increase your risk of gallstones and other health problems.

While there is no foolproof way to completely prevent gallstones, cholesterol seems to play a major role in their formation. If you have a family history of gallstones, your doctor may advise you to limit foods with a high saturated fat content. Some of these foods include:

• fatty meat, like sausage and bacon
• cakes and cookies
• lard and cream
• certain cheeses

Because people living with obesity are more predisposed to gallstones, keeping your weight within a moderate range is another way to limit the possibility of their formation.

If your doctor has diagnosed you with gallstones and decides you need surgery to remove them or your gallbladder, the outlook is often positive. In most cases of stone removal, stones don’t return.

If you aren’t able to have surgery and decide to take medication to dissolve the stones, the gallstones can return, so you and your doctor will need to monitor your progress.

If your gallstones aren’t causing symptoms, you will most likely not need to do anything. Still, you may want to make lifestyle changes to prevent them from getting bigger and causing problems.

Gallstones: Treatments, symptoms, and causes

Gallstones are stones or lumps that develop in the gallbladder or bile duct when certain substances harden.

The gallbladder is a small sac located on the right-hand side of the body, on the underside of the liver. Some of the chemicals that exist in the gallbladder can solidify into either one large stone or several small ones.

There are approximately 20 million Americans with gallstones. A 2008 study revealed that the prevalence of gallstones in adults in industrialized countries was around 10 percent and appeared to be rising.

Fast facts on gallstones

• The gallbladder is a small organ located on the underside of the liver.
• Stones can form when there is a chemical imbalance in the gallbladder.
• People with overweight and obesity are more likely to develop gallstones.
• Experts believe a low-fat, high-fiber diet may help prevent gallstones.

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The majority of people with gallstones experience no symptoms at all. This is because the stones stay in the gallbladder and cause no problems.

Sometimes, however, gallstones may lead to cholecystitis, or an inflamed gallbladder.

The primary symptom is pain that comes on suddenly and quickly gets worse. This pain can occur on the right side of the body, just below the ribs, between the shoulder blades, or in the right shoulder.

Other symptoms include:

• nausea
• vomiting
• sweating
• restlessness

Doctors only treat gallstones if they have caused gallbladder inflammation, blockage of the bile ducts, or if they have moved from the bile ducts into the intestines.

Treatments for gallstones include:

Cholecystectomy

Cholecystectomy means the surgical removal of the gallbladder. This is usually performed with laparoscopic surgery. Laparoscopic surgery is not possible for about 10 percent of people, who will need open cholecystectomy.

With open cholecystectomy, a large cut is made in the abdomen. People who undergo open surgery require a longer hospital stay and recovery time. If a person’s gallbladder is severely inflamed, they generally will need open surgery.

For a large proportion of those who undergo a cholecystectomy, gallstones come back within a year. To help prevent this, doctors give many people with gallstones ursosdeoxycholic acid, which is the acid found in bile.

Ursodeoxycholic acid

Ursosdeoxycholic acid lowers the cholesterol content of bile, making it less likely that stones will form.

If a gallstone is made of cholesterol, it can sometimes be slowly dissolved with ursodeoxycholic acid. This type of treatment, known as dissolution, may take up to 24 months to be effective. It is not as effective as surgery but is sometimes the only choice for people who cannot have a general anesthetic.

Endoscopic retrograde cholangiopancreatolography

When a person with gallstones cannot have surgery or ursodeoxycholic acid, they may undergo endoscopic retrograde cholangiopancreatolography (ERCP), which requires a local anesthetic.

A doctor places a flexible fiber-optic camera, or endoscope, into the person’s mouth, then passes it through the digestive system and into the gallbladder.

An electrically heated wire widens the opening of the bile duct. The doctor can then remove the stones or leave them to pass into the intestine.

Lithotripsy

A doctor aims ultrasonic shock waves at the gallstones to break them up. If gallstones become small enough, they can then pass safely in a person’s stools. This type of treatment is uncommon and is only used when there are few gallstones present.

In many cases, a medical professional will discover a person’s gallstones by accident when treating the person for a different condition. A doctor may suspect gallstones after a cholesterol test, an ultrasound scan, a blood test, or even an X-ray.

The doctor may use blood tests to look for signs of infection, obstruction, pancreatitis, or jaundice.

Other diagnostic tests include:

Cholangiography

A medical professional injects a dye either into the bloodstream, so that it concentrates into the bile ducts or gallbladder, or straight into the bile ducts using an ERCP. The dye shows up on X-rays.

The doctor will then be able to look at the X-rays and identify possible gallbladder or bile duct disorders, such as pancreatitis, cancer of the pancreas, or gallstones. The X-rays will indicate to the doctor whether the dye is reaching the liver, bile ducts, intestines, and gallbladder.

If the dye does not move into one of these areas, it generally means that a gallstone is causing a blockage. An expert will have a better idea of where the gallstone is located.

The medical professional can also use ERCP to locate and remove stones in the bile duct.

CT scan

This is a non-invasive X-ray that produces cross-section pictures of the inside of the human body.

Cholescintigraphy (HIDA scan)

A medical professional injects a small amount of harmless radioactive material into the patient. This is absorbed by the gallbladder, which the medical professional then stimulates to contract. This test may diagnose abnormal contractions of the gallbladder or an obstruction of the bile duct.

It used to be the case that doctors would advise people with gallstones who were not yet ready for surgery to follow an extremely low-fat diet to prevent gallstone growth.

Researchers have recently concluded this approach is less helpful than previously thought, as rapid weight loss can cause gallstones.

Instead, the recommendation is that people with gallstones eat a balanced diet with regular meals. This will not cure gallstones, but it can have a positive impact on any symptoms and pain.

Avoiding foods high in saturated fats such as butter, hard cheese, cakes, and cookies can help reduce the risk of gallstones developing. Cholesterol is thought to have a role in forming gallstones.

People can also make positive dietary steps changes to help prevent the condition, such as eating more nuts and consuming less alcohol.

Gallstones may form when the chemicals in the gallbladder are out of balance, such as cholesterol, calcium bilirubinate, and calcium carbonate.

There are two main types of gallstones.

Cholesterol gallstones may form if there is too much cholesterol in the bile. They are the main type of gallstones in the United States.

Pigment gallstones form when the bile has too much bilirubin. They are more common among people with liver disease, infected bile tubes, or blood disorders, such as sickle-cell anemia.

Experts are not completely sure why some people develop the chemical imbalance in their gallbladder that causes gallstones, while others do not.

However, gallstones are more common among people with obesity, especially women. A study revealed that having a waist size of 36 inches or more almost doubles a woman’s chances of developing gallstones and the need for surgery to remove them.

Other risk factors for gallstones include:

• having been pregnant
• having a family history of gallstones
• having recently lost lots of weight
• taking oral contraceptives
• being sedentary
• undergoing high-dose estrogen therapy
• having a gene variant that significantly increases the risk of developing gallstones
• having a high intake of dietary fat
• being over 60 years of age
• having Native American heritage
• taking cholesterol-lowering drugs called statins
• having diabetes

More women get gallstones than men. In addition, men who intentionally lost weight rapidly and then regained it may have an increased risk for gallstones later in life.

Additionally, research has linked hormone replacement therapy (HRT) for women during menopause to a higher risk of gallbladder problems. A study found that HRT administered by skin patches or gels poses a smaller risk than HRT taken orally.

Below is a 3-D model of gallstones, which is fully interactive.

Explore the model using your mouse pad or touchscreen to understand more about gallstones.

If the bile duct or duodenum are blocked by gallstones, it can block the flow of digestive juices to the pancreas. This can cause jaundice and acute pancreatitis. Treatment usually involves the surgical removal of the gallbladder.

It is common for people who have had their gallbladder removed to experience feelings of bloating and indigestion, especially when they have a high-fat meal. Some may pass stools more often than before.

Living without a gallbladder

A person can survive without a gallbladder. The liver produces enough bile to digest a normal diet. If a person’s gallbladder is removed, the bile reaches the small intestine from the liver via the hepatic ducts, rather than being stored in the gallbladder.

A small proportion of people who have had their gallbladder removed will experience softer and more frequent stools for a while because their bile flows into the small intestine more often.

Other complications

Other potential complications of gallstones include:

Biliary colic

When a stone gets stuck in the opening of the gallbladder and will not easily pass through, the contraction of the gallbladder may cause severe pain. When this happens, an individual may experience a painful condition called biliary colic.

The pain is felt in the upper part of the abdomen, but can also exist in the center or to the right of the abdomen. Pain is more common about an hour after eating, especially if an individual has had a high-fat meal.

The pain will be constant, last a few hours, and then subside. Some people will experience non-stop pain for 24 hours, while others may experience waves of pain.

Infection

If the gallstones have caused a gallbladder infection, the person with the condition may have a fever and experience shivering. In the majority of gallstone infection cases, people will be hospitalized for the removal of the gallstone.

Jaundice

If a gallstone leaves the gallbladder and gets stuck in the bile duct it may block the passage of bile into the intestine. The bile will then seep into the bloodstream, causing signs of jaundice.

In most cases, this complication will require the surgical removal of the gallstone. For some people, the gallstone eventually passes into the intestine.

Pancreatitis

If a small gallstone passes through the bile duct and blocks the pancreatic duct, or causes a reflux of liquids and bile into the duct, an individual may develop pancreatitis.

A person can’t change some of the factors that can increase their risk of developing gallstones, such as age, sex, and ethnic origin.

However, it is possible that following a vegetarian diet may reduce the risk of developing gallstones. Vegetarians have a significantly lower risk of developing gallstones compared with people who eat meat.

Many experts say that a diet low in fat and high in fruit and vegetables, including plenty of dietary fiber, also may help protect people from developing gallstones.

A person may also try controlling body weight to help prevent the formation of gallstones. However, crash dieting and rapid weight loss increase the risk of developing gallstones.

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Cholelithiasis – Clinic 29

Gallstone disease (GSD) is a disease in which stones form in the gallbladder or bile ducts. Gallstone disease has been known since ancient times. Galen also discovered gallstones during the autopsy of corpses. Mentions of cholelithiasis are found in the writings of doctors of the Renaissance. Currently, every tenth inhabitant of our planet suffers from gallstone disease, and this disease of civilization is becoming a social problem.

Causes of cholelithiasis

Gallstone disease in both adults and children is a multifactorial disease. The main factors are:

• Power failure
• Poor quality drinking water
• Heredity
• Physical inactivity
• Bad habits
• Disruption of intestinal microflora
• Stress
• Uncontrolled intake of drugs, etc., that is, all those factors that lead to metabolic disorders, especially cholesterol metabolism.

Leading links in the process of stone formation: stagnation of bile in the gallbladder and an increase in the concentration of salts in bile due to metabolic disorders.

Can provoke gallstone disease:

• overeating, starvation, irregular meals;
• sedentary lifestyle, especially sedentary work;
• pregnancy;
• taking hormonal contraceptives;
• obesity;
• biliary dyskinesia;
• diseases of the pancreas.

Clinical picture

There are three variants of the clinical picture of cholelithiasis:

• asymptomatic lithiasis;
• clinical manifestation, manifested by abdominal pain and dyspeptic disorders;
• gallstone colic.

Asymptomatic stone carrying is assumed when there are no complaints, and stones in the gallbladder (ducts) are an incidental diagnostic finding, more often on ultrasound. Unfortunately, the stones do not dissolve by themselves, and the disease will manifest itself in other forms over time.

Abdominal pain and dyspeptic disorders are the main complaints. In adults, pain is usually in the right hypochondrium, more often in the form of a feeling of heaviness and is provoked by a violation of the diet (overeating, fatty, fried foods). The nature of the pain depends on the size of the stones. Dull, drawing, vague pains are characteristic of patients with single stones or large stones. Multiple, small, easily moving stones, as a rule, give acute paroxysmal pain – gallstone colic.

Sometimes a small stone passes from the gallbladder into the bile ducts. In this case, an attack of gallstone disease occurs: there is a sharp pain in the right hypochondrium or in the upper abdomen. It can “give” to the right collarbone, right arm or back under the shoulder blade. In this case, bitterness appears in the mouth, nausea and vomiting, which does not bring relief, the sclera of the eyes may turn yellow. If the stone (with a relatively small size) was able to bypass the ducts and fall into the duodenum, the attack stops on its own, and the stone comes out with feces. Otherwise, there is a blockage of the biliary tract and there is a danger of developing acute cholecystitis and mechanical (subhepatic) jaundice. In this case, in addition to the typical picture of colic, yellowness of the skin, discolored stools, and dark urine appear. Pain can spread to other areas of the upper abdomen, often there are “girdle” pains – a sign of blockage not only of the biliary tract, but also of the pancreatic duct. Obturation (blockage) of the excretory ducts is a very dangerous condition!

Diagnosis of cholelithiasis

Diagnosis is based on the clinical picture, on examination of the patient – the doctor can determine tenderness at specific points, on changes in blood and urine tests in the presence of inflammation in the gallbladder and / or a violation of the outflow of bile. Ultrasound reveals formations in the gallbladder, but with symptoms of severe cholecystitis (inflammation), stones may not be visible, ultrasound does not always detect stones that have entered the ducts. Then X-ray methods of research are used: retrograde cholecystopancreatography (RCPG) is the most common method.

Treatment of cholelithiasis

The tactics of treatment of cholelithiasis is determined by the clinical picture, the position of the stones and the timing of the patient’s request for medical help. Non-surgical methods of treatment are rarely used, mainly in children during the period of hormonal instability, in adults in the preoperative period. In case of cholelithiasis, it is prescribed:

• diet with the exception of fatty, fried, smoked, spicy. Food should be fractional, without overeating. Particular importance is attached to the use of vegetables and fruits, wheat bran and other foods containing dietary fiber. They bind bile acids in the intestine, which promotes their synthesis in the liver.
• motor mode: we avoid both hypodynamia and excessive physical exertion. Walking, table tennis, billiards are shown.
• Cholagogue preparations, herbs and tubes are contraindicated!

Surgical treatment

If you have applied for a planned appointment outside the acute phase of gallstone disease, the stones are located only in the gallbladder, and not in the ducts, then you will perform a laparoscopic cholecystectomy (removal of the gallbladder). If stones are localized only in the gallbladder, radical surgery – cholecystectomy in most cases leads to a permanent cure for cholelithiasis. Cholecystectomy is a pathogenetically substantiated operation: the shock organ is removed, i.e. already a defective organ with impaired function and a constant source of infection. All this leads to an acceleration of the circulation of bile acids between the intestines and the liver, a decrease in the stone-forming properties of hepatic bile, and the prevention of the formation of gallstones.

If you delayed the operation for cholelithiasis or tried to “expel” the stones and there was an obstruction of the biliary tract. Such a situation can end with a laparotomy (large abdominal incision), sometimes even with the removal of part of the biliary tract and the imposition of various non-physiological, but vital, connections between organs for the outflow of bile.

Do not be afraid of the operation! The only radical way to treat gallstone disease is to remove the diseased gallbladder. Currently, a special technique has been developed for laparoscopic surgery (the operation is performed using several punctures of the abdominal wall). It is less traumatic, and the patient can get up on the day of the operation. The cosmetic effect is also important – the absence of seams on the body. This issue is especially of concern to girls, because no one wants past illnesses and operations to be read on his body.
After removal of the gallbladder, you can safely return to normal life and practically do not adhere to any diet.

Complications of cholelithiasis

– Infections. The most serious complication of acute cholecystitis caused by gallstones is infection, which occurs in about 20% of cases.

– Gangrene and abscess. Severe inflammation can cause abscess and necrosis (destruction) of tissue in the gallbladder, leading to gangrene. At high risk are men over 50 who have a history of cardiovascular disease.

– Perforation (rupture) of the gallbladder. An estimated 10% of cases of acute cholecystitis due to gallstones have gallbladder perforation, a life-threatening condition. In general, it occurs in people who have not sought help for too long, or in people who do not respond to treatment. Gallbladder perforation is most common in people with diabetes. After the wall of the gallbladder has been perforated, the pain may temporarily decrease. This dangerous delusion threatens with the development of peritonitis and the spread of infection into the abdominal cavity.

– Empyema. Pus in the gallbladder (empyema) occurs in 2 to 3% of patients with acute cholecystitis. Patients usually experience abdominal pain for more than 7 days. Physical examination often does not always immediately reveal the cause. Empyema can be life-threatening, especially if the infection spreads to other parts of the body.

– Fistula. In some cases, inflammation of the gallbladder spreads and leads to perforation of nearby organs, such as the small intestine. In such cases, a fistula is formed between the organs, which is a channel or opening. Sometimes, in such cases, gallstones may actually pass into the small intestine. This can be very serious and requires immediate surgery.

— Gallstone obstruction. Gallstone blockage of the bowel is known as gallstone ileus. It primarily occurs in patients over 65 years of age and can sometimes be fatal. Depending on where the stone is located, surgery may be required to remove it.

– Infection of the common bile duct (cholangitis). Infection of the common bile duct is a very dangerous serious disease. If antibiotics are given immediately, the infection is cured in 75% of patients. If cholangitis is not stopped, the infection can spread and become life-threatening.

– Pancreatitis. Common bile duct stones are responsible for most cases of pancreatitis (inflammation of the pancreas).

– Cancer of the gallbladder. Gallstones occur in about 80% of people with gallbladder cancer. There is a strong relationship between gallbladder cancer and gallstone disease, chronic cholecystitis, and inflammation. Symptoms of gallbladder cancer usually do not appear until the disease has reached the last stage, and may include weight loss, anemia, recurrent vomiting, and foreign body sensation in the abdomen. However, this cancer is very rare, even among people with gallstones.

– Porcelain gallbladder. The gallbladder is called porcelain when its walls are calcified, i.e. coated with calcium. Porcelain gallbladder is associated with a very high risk of cancer. This condition may develop due to a chronic inflammatory response, which may, in fact, be responsible for the risk of developing cancer. The risk of developing cancer also depends on the presence of specific factors, such as partial calcification of the inner lining of the 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 tests:

• Ultrasound of the abdominal cavity
• 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 develop 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 probe 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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Andreev Alexander Sergeevich
Artemov A.V., Rozikov Yu.Sh. R. Cheminava // Medical visualization. 2006. – No. 6. -S. 60-65.

Gabunia R.I., Kolesnikova E.K. Computed tomography in clinical diagnostics. M.: Medicine, 1995. -350s.

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