What are gallstones and how do they form. What causes gallstones to develop. How can you recognize the symptoms of gallstones. What treatment options are available for gallstones. Who is at risk of developing gallstones. How can gallstones be prevented. When should you seek medical attention for gallstones.

What Are Gallstones and How Do They Form?

Gallstones are solid, pebble-like deposits that form in the gallbladder, a small pear-shaped organ located beneath the liver. Despite their name, gallstones are not actually stones. They are hardened deposits of digestive fluid that can vary in size from as small as a grain of sand to as large as a golf ball.

There are two main types of gallstones:

• Cholesterol stones: Yellow-green in color, these account for about 80% of all gallstones.
• Pigment stones: Smaller and darker, these are made up of bilirubin, a fluid produced by the liver and stored in the gallbladder.

Gallstones form when there is an imbalance in the chemical composition of bile, the digestive fluid stored in the gallbladder. This imbalance can cause the liquid components of bile to crystallize and form solid particles. Over time, these particles can grow larger and become gallstones.

What Causes Gallstones to Develop?

The exact cause of gallstones can vary from person to person, but several factors can contribute to their formation:

• Excess cholesterol in bile
• Too much bilirubin in bile
• Incomplete emptying of the gallbladder
• Genetic predisposition
• Hormonal changes
• Rapid weight loss or frequent fasting

Are certain people more prone to developing gallstones? Yes, some individuals have a higher risk of gallstone formation due to various factors:

1. Being female, especially during pregnancy or when taking hormone replacement therapy
2. Being over 40 years old
3. Having a family history of gallstones
4. Being overweight or obese
5. Having diabetes
6. Consuming a diet high in fat and cholesterol
7. Leading a sedentary lifestyle
8. Having liver disease or blood disorders like sickle cell anemia

Recognizing the Symptoms of Gallstones

Many people with gallstones may not experience any symptoms at all. However, when gallstones block a bile duct, they can cause significant discomfort and other health issues. The most common symptoms of gallstones include:

• Sudden and intense pain in the upper right abdomen or center of the abdomen, just below the breastbone
• Pain that radiates to the right shoulder or between the shoulder blades
• Nausea and vomiting
• Fever and chills (if an infection is present)
• Jaundice (yellowing of the skin and whites of the eyes)
• Clay-colored stools

How long do gallstone attacks typically last? Gallstone attacks, also known as biliary colic, can last anywhere from several minutes to a few hours. The pain usually subsides as the gallstone moves and the blockage is relieved.

Diagnosing Gallstones: Medical Tests and Procedures

If gallstones are suspected, a healthcare provider may use various diagnostic tools to confirm their presence:

• Ultrasound: This is the most common and preferred method for detecting gallstones.
• CT scan: Provides detailed images of the gallbladder and surrounding tissues.
• MRI: Offers high-resolution images of the biliary system.
• HIDA scan: A nuclear medicine test that evaluates gallbladder function.
• Blood tests: To check for signs of infection or obstruction.

How accurate are these diagnostic tests for gallstones? Ultrasound is highly accurate, detecting gallstones in about 95% of cases. Other imaging tests can provide additional information about the size, location, and potential complications of gallstones.

Treatment Options for Gallstones: From Medication to Surgery

The treatment for gallstones depends on the severity of symptoms and the individual’s overall health. Here are the main approaches:

Watchful Waiting

For asymptomatic gallstones, a “wait and see” approach may be recommended. Many people with gallstones never develop symptoms and don’t require treatment.

Medications

Oral medications such as ursodeoxycholic acid (Ursodiol) can be used to dissolve small gallstones. However, this treatment can take months or years to be effective and is not suitable for everyone.

Surgical Removal

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

• Laparoscopic cholecystectomy: A minimally invasive procedure performed through small incisions.
• Open cholecystectomy: A traditional surgery involving a larger incision, usually reserved for complicated cases.

Is it possible to live without a gallbladder? Yes, the gallbladder is not an essential organ. After its removal, bile flows directly from the liver to the small intestine, and most people can digest food normally without any long-term consequences.

Preventing Gallstones: Lifestyle Changes and Dietary Considerations

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

• Maintain a healthy weight
• Avoid rapid weight loss or crash diets
• Exercise regularly
• Eat a balanced diet rich in fiber and low in saturated fats
• Stay hydrated
• Limit alcohol consumption

What foods should be avoided to prevent gallstones? Foods high in saturated fats and cholesterol, such as fried foods, fatty meats, and full-fat dairy products, may increase the risk of gallstone formation. Instead, focus on consuming more fruits, vegetables, whole grains, and lean proteins.

Complications of Untreated Gallstones: When to Seek Immediate Medical Attention

While many gallstones remain asymptomatic, untreated symptomatic gallstones can lead to serious complications:

• Cholecystitis: Inflammation of the gallbladder
• Choledocholithiasis: Blockage of the common bile duct
• Cholangitis: Infection of the bile ducts
• Gallstone pancreatitis: Inflammation of the pancreas due to gallstone blockage
• Gallbladder cancer: A rare but potential long-term complication of chronic gallstone disease

When should you seek immediate medical attention for gallstone symptoms? If you experience severe abdominal pain lasting more than a few hours, fever with chills, or yellowing of the skin and eyes, seek emergency medical care. These symptoms could indicate a serious gallstone complication that requires prompt treatment.

Living with Gallstones: Management and Long-term Outlook

For individuals who have undergone gallbladder removal or are managing asymptomatic gallstones, certain lifestyle adjustments may be beneficial:

• Gradually reintroduce fatty foods to your diet after surgery
• Eat smaller, more frequent meals
• Stay hydrated and maintain a high-fiber diet
• Monitor for any recurring symptoms
• Attend regular follow-up appointments with your healthcare provider

What is the long-term outlook for people with gallstones? For most individuals, the prognosis is excellent after appropriate treatment. Those who undergo gallbladder removal typically experience complete resolution of symptoms and can lead normal, healthy lives without their gallbladder.

In conclusion, understanding gallstones—their causes, symptoms, and treatment options—is crucial for maintaining good digestive health. By recognizing the risk factors and early warning signs, individuals can take proactive steps to prevent gallstone formation or seek timely medical intervention when necessary. Whether through lifestyle modifications, medication, or surgical procedures, effective management of gallstones is possible, allowing most people to live comfortably and free from gallstone-related complications.

What Causes Gallstones and How Can You Get Rid of Them?

Contrary to the name, gallstones aren’t exactly stones. Instead, they’re solid pieces of material that can start forming in the gallbladder, which is a small organ right under your liver. Many of us have gallstones but just don’t know it. Then, once they block one of your bile ducts, that’s when you feel the pain, and thus treatment is necessary.

Blockages can cause digestive enzymes to get trapped in the pancreas. This can lead to a very painful inflammation called gallstone pancreatitis. If those ducts stay blocked for a long time, the outcome can be fatal. At the very least, infections can occur to the gallbladder, liver or pancreas.

There are two main types of gallstones:

• Cholesterol stones, which are yellow-green in color, and the most common, representing 80% of all gallstones.
• Pigment stones, which are smaller and darker, comprised of bilirubin, a fluid made by your liver and stored in the gallbladder.

Essentially, gallstones are hardened-deposits of digestive fluid that form in the gallbladder, a pear-shaped organ that houses a digestive fluid referred to as bile. That bile is routinely released into your small intestine. Gallstones can be as small as a grain of sand to as large as a golf ball. Some people get one, some get several. Medications and gallbladder removal surgery are usually the remedies. If you don’t exhibit symptoms, no surgery or treatment is required.

Causes

There can be many causes of gallstones; the exact cause of yours will be determined by a doctor at your visit. Gallstones can have many originations, including:

• Family history
• Weight
• History of gallbladder problems
• Diet
• High cholesterol
• Failure of the gallbladder to empty properly

You may be at a higher risk for gallstones if you’re obese, take birth control pills, or hormone replacement therapy for menopause symptoms, are pregnant (due to the extra estrogen), have diabetes, or have pigment stones (common in those suffering from cirrhosis or sickle cell anemia).

Other risk factors you should be on the lookout for include:

• Being female
• Being over the age of 40
• Being sedentary
• Eating a high-fat or high-cholesterol diet
• Having diabetes
• Experiencing rapid weight loss
• Having liver disease

Symptoms

As we said above, you may not be aware you even have gallstones until you experience pain or your doctor finds it through a physical exam or testing. Other symptoms can include:

• Pain in the stomach or upper back that lasts for hours on end
• Sudden and rapidly intensifying pain in the upper right part of the abdomen or just below the breastbone
• Pain between the shoulder blades or right shoulder
• Nausea
• Vomiting
• Digestive issues, such as bloating, gas, indigestion and heartburn

Wondering when you should see a doctor? You should call your doctor immediately if you feel stomach pain that’s so intense you can’t sit or lie down comfortably, have yellow skin or whites of the eyes, or have a high fever with the chills.

Treatment

Those who don’t feel pain or otherwise have symptoms don’t need to take action. However, if you experience any of the above symptoms, get to a gastroenterologist right away.

The first thing your doctor will do if he or she suspects you have gallstones is to give you a thorough exam, then order some blood tests. These will check to see if you have an infection or obstruction. Depending on those results, you will then get an ultrasound, CT scan, MRI or endoscopic ultrasound.

Your doctor may prescribe medications such as chenodiol, ursodiol, or a combination of the two, as they are designed to dissolve gallstones. This is a very conservative approach, as sometimes it can take months or years to dissolve your gallstones in this way. Plus, if you stop taking the meds, your gallstones can come back.

Another option is to have gallbladder removal surgery, called cholecystectomy. This is the optimal treatment, as gallstones frequently recur. After removal of the gallbladder, bile will flow right from your liver into your small intestine. Much like your appendix, you can live without your gallbladder, and having it removed doesn’t affect how you digest food. One immediate effect can be an increase in diarrhea, but this is normal and temporary.

Please note, the information provided throughout this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and video, on or available through this website is for general information purposes only. If you are experiencing related symptoms, please visit your doctor or call 9-1-1 in an emergency.

Gallstones – NHS

Gallstones are small stones, usually made of cholesterol, that form in the gallbladder. In most cases, they do not cause any symptoms and do not need to be treated.

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Symptoms of gallstones

Gallstones often have no symptoms.

But if a gallstone becomes trapped in an opening (duct) inside the gallbladder, it can trigger a sudden, intense pain in your tummy that usually lasts between 1 and 5 hours.

This type of abdominal pain is known as biliary colic.

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

This can cause:

• persistent pain
• yellowing of the skin and eyes (jaundice)
• a high temperature

When gallstones cause symptoms or complications, it’s known as gallstone disease or cholelithiasis.

The gallbladder

The gallbladder is a small pouch-like organ found underneath the liver. Its main purpose is to store and concentrate bile.

Bile is a liquid produced by the liver to help digest fats. It’s passed from the liver into the gallbladder through a series of channels known as bile ducts.

The bile is stored in the gallbladder and, over time, becomes more concentrated, which makes it better at digesting fats.

The gallbladder releases bile into the digestive system when it’s needed.

What causes gallstones?

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.

Gallstones are very common. It’s estimated more than 1 in every 10 adults in the UK has gallstones, although only a minority of people develop symptoms.

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

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

Treating gallstones

Treatment is usually only necessary if gallstones are causing:

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

This procedure, known as a laparoscopic cholecystectomy, is relatively simple to perform and has a low risk of complications.

It’s possible to lead a normal life without a gallbladder.

Your liver will still produce bile to digest food, but the bile will drip continuously into the small intestine, rather than build up in the gallbladder.

Outlook

Gallstone disease is usually easily treated with surgery. 

Very severe cases can be life threatening, particularly in people who are already in poor health.

But deaths from gallstone disease are rare in the UK.

Video: gallstones

In this video, a doctor explains what gallstones are, the symptoms and the treatment options.

Media last reviewed: 1 May 2021
Media review due: 1 May 2024

Community content from HealthUnlocked

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

Gallstones | Johns Hopkins Medicine

What are gallstones?

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.

When gallstones are present in the gallbladder itself, it is called
cholelithiasis. When gallstones are present in the bile ducts, it is called
choledocholithiasis. Gallstones that obstruct bile ducts can lead to a
severe or life-threatening infection of the bile ducts, pancreas, or liver.
Bile ducts can also be obstructed by cancer or trauma, but this is not
related to gallstones.

What causes gallstones?

Cholesterol stones are believed to form when bile contains too much
cholesterol, too much bilirubin, not enough bile salts, or when the
gallbladder does not empty as it should for some other reason.

Pigment stones tend to develop in people who have cirrhosis, biliary tract
infections, and hereditary blood disorders such as sickle cell anemia. The
causes of these stones are uncertain.

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. The following are the most common symptoms of
gallstones. However, each individual may experience symptoms differently.
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. A yellowing of the skin or eyes.

• Abdominal bloating

• Intolerance of fatty foods

• Belching or gas

• Indigestion

People who experience the following symptoms should consult their doctor
immediately:

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.

How are gallstones diagnosed?

In some cases, asymptomatic gallstones are discovered by
accident–during testing for another diagnosis. However, when pain
persists or happens again and again, your health care provider may want
to conduct a complete medical history and physical examination, in
addition to the following diagnostic procedures for gallstones:

• Ultrasound.
  A diagnostic technique that uses high-frequency sound waves to
  create an image of the internal organs.

• Cholecystography.
  X-ray that shows the flow of contrast fluid through the
  intestines into the gallbladder.

• Blood tests.
  These look for signs of infection, obstruction, jaundice,
  and/or pancreatitis.

• 
  Computed tomography scan (also called a CT or CAT scan).
  
  A diagnostic imaging procedure that uses a combination of
  X-rays and computer technology to produce horizontal, or axial,
  images (often called slices) of the body. A CT scan shows
  detailed images of any part of the body, including the bones,
  muscles, fat, and organs. CT scans are more detailed than
  general X-rays.

• 
  Endoscopic retrograde cholangiopancreatography (ERCP).
  
  A procedure that involves inserting an endoscope (viewing tube)
  through the stomach and into the small intestine. A special dye
  injected during this procedure shows the ducts in the biliary
  system.

• Sphincterotomy.
  Opening the muscle sphincter, a ring of muscle around a natural
  opening that acts like a valve, wide enough so stones can pass
  into the intestine.

Treatment for gallstones

Specific treatment for gallstones will be determined by your health
care provider based on:

• Your age, overall health, and medical history

• Extent of the condition

• Your tolerance of specific medicines, procedures, or therapies

• Expectations for the course of the condition

• Your opinion or preference

If the gallstones cause no symptoms, treatment is usually not
necessary. However, if pain persists, treatment may include:

• Gallbladder removal (cholecystectomy).
  Once removed, the bile flows directly from the liver to the
  small intestine. Side effects of this may include diarrhea
  because the bile is no longer stored in the gallbladder.

• Oral dissolution therapy.
  Drugs made from bile acid are used to dissolve the stones.

• Methyl-tert-butyl ether.
  A solution injected into the gallbladder to dissolve stones.

• Extracorporeal shockwave lithotripsy (ESWL).
  A procedure that uses shock waves to break stones up into tiny
  pieces that can pass through the bile ducts without causing
  blockages.

• Contact dissolution therapy.
  An experimental procedure that involves injecting a drug
  directly into the gallbladder to dissolve the stones.

Gallstones & Bile Duct Stones | MUSC Health

What are gallstones?

Gallstones, which are created in the gallbladder, form when substances in the bile create hard, crystal-like particles. Cholesterol stones, as the name implies, are made of cholesterol and appear light in color. Eighty percent of gallstones are formed this way.

Pigment stones are small, dark stones made of bilirubin and calcium salts that are found in bile. About twenty percent of gallstones are pigment stones. Risk factors for pigment stones include:

• cirrhosis of the liver
• biliary tract infections
• hereditary blood cell disorders (such as sickle cell anemia)

Gallstones can be as small as a grain of salt or as large as a golf ball. The gallbladder may develop many smaller stones, or a single, often large one. It may even develop several thousand stones.

What are bile duct stones?

Gallstones that move out of the gallbladder can pass into your stomach. However, a stone may become lodged in your bile duct due to the size of the stone or the anatomy of the biliary tree. Thus, bile duct stones are gallbladder stones that have become lodged in the bile duct. Stones that become stuck in the ducts that lead to the duodenum can be both agonizing and dangerous.

What causes gallstones?

Advancements have been made in better understanding the gallstone formation process. Gallstones may be caused by:

• inherited body chemistry
• body weight
• gallbladder movement (the gallbladder is a muscular sack that contracts)
• diet and lifestyle

Cholesterol gallstones

When the bile contains too much cholesterol and not enough bile salts, cholesterol gallstones may develop. Aside from a high concentration of cholesterol, there are two other factors that seem to be of importance in causing gallstones.

Movement of the gallbladder is referred to as gallbladder motility. This small but muscular organ squeezes to force bile into the bile duct. If the gallbladder does not perform as it should, the bile may not be able to makes its way into the bile duct, instead becoming concentrated and forming small crystals.

Gallstones may also be created by proteins in the liver and bile. These proteins may either promote cholesterol crystallization into gallstones.

Other factors also seem to play a role in causing gallstones but how is not clear.

• Obesity
• Low calorie, and rapid weight-loss diets
• Prolonged fasting
• Increased levels estrogen as a result of pregnancy
• Hormone therapy
• Birth control pills

No clear relationship has been proven between gallstone formation and a particular diet.

Who is at risk for gallstones?

Gallstones affect approximately one million people every year, with women being twice as likely to become afflicted than men. They will join the estimated 20 million Americans —roughly 10 percent of the population— who already have gallstones.

Those who are most likely to develop gallstones are:

• Women, ages 20 – 60
• Men and women, ages 60+
• Men and women who are overweight
• Men and women who go on “crash” diets or who lose of lot of weight quickly
• Pregnant women, or women who have used birth control pills or estrogen replacement therapy
• Native Americans
• Mexican-Americans

What are the symptoms of gallstones?

A person with gallstones may have what are called “silent stones”. Studies show that most people with silent stones may not experience any symptoms at all for awhile, remaining symptom-free for years and requiring no treatment. Silent stones may go undiagnosed until they begin to cause discomfort.

For those that are not quite so lucky, the symptoms my include

• Acute pain, possibly very severe, that occurs very suddenly. It may last a few minutes, or many hours
• Pain is usually located behind your breastbone, but may occur in the upper right abdominal area
• Pain between your shoulder-blades
• Chills and fever
• Jaundice
• Nausea and vomiting

It is not uncommon for attacks to be separated by weeks, months, or even years.

What problems can occur?

A common complication cause by gallstones is blockage of the cystic duct. Sometimes gallstones may make their way out of the gallbladder and into the cystic duct, the channel through which bile travels from the gallbladder to the small intestine. An inflammation of the gallbladder (cholecystitis) can occur if the flow of bile in the cystic duct is severely impeded or blocked by any gallstones.

A less common but more serious problem occurs if the gallstones become lodged in the bile ducts between the liver and the small intestine. This condition, called cholangitis, can block bile flow from the gallbladder and liver, causing pain, jaundice and fever.

Gallstones may also interfere with the flow of digestive fluids into the small intestine, leading to an inflammation of the pancreas, or pancreatitis. Prolonged blockage of any of these ducts can cause severe damage to the gallbladder, liver, or pancreas, which can be fatal.

How are gallstones diagnosed?

Diagnostic methods for detecting gallstones may include:

• ultrasound
• barium exam
• CT scan

When actually looking for gallstones, the most common diagnostic tool is ultrasound. An ultrasound examination, also known as ultrasonography, uses sound waves to create images of the various abdominal organs … including the gallbladder. If stones are present, the sound waves will bounce off the stones, revealing their location.

Ultrasound has several advantages.

• It is a noninvasive technique – nothing is injected into or penetrates the body
• It is painless – there are no known side effects
• It does not involve radiation

Occassionaly, other tests needed to detect small stones, or verify their non-existance, may be required.

• MRI/MRCP — a painless, magnetic imaging technique
• endoscopic ultrasound — a minimally invasive procedure that can visualize tissue
• ERCP — for diagnosis and management of stones in the bile duct

Other gallbladder diseases

Pain and inflammation of the gallbladder can occur in the absence of gallstones.

Acalculus cholecystitis

Acalculus cholecystitis, or inflammation of the gallbladder without stones, may occur in conjunction with other severe illnesses. This condition occurs when the gallbladder fluids become infected as a result of being stagnant during a long illness.

Biliary dyskinesia

Biliary dyskinesia, or disordered function of the gallbladder, describes a condition in which the gallbladder cannot empty properly due to inflammation or spasm of its drainage system (the cystic duct). When you eat a meal, the gallbladder is prompted to contract, and in doing so, bile is forced into the duodenum. If the gallbladder cannot contract, the pressure exerted on the gallbladder causes pain.

A scanning technique, known as an HIDA scan, uses radioactive isotopes to help diagnose both of these conditions. This shows whether the gallbladder is blocked, or cannot drain completely. These conditions are treated in the same way as gallbladder stones.

Gallbladder cancer

Cancer, which can develop in the gallbladder wall, appears to be more common in patients with gallstones. Unfortunately, it often does not cause symptoms until the cancer has spread to the liver or adjacent bile duct. If technically possible, surgical removal is the recommended course of action.

Treatments

Cholecystectomy

Each year more than 500,000 Americans have gallbladder surgery. This surgery, called cholecystectomy, is the most common method for treating gallstones despite the development of some nonsurgical techniques. There are two types of cholecystectomy: the standard “open” cholecystectomy; and, a less invasive procedure called laparoscopic cholecystectomy.

Open Cholecystectomy

The standard cholecystectomy is a major abdominal surgery in which the surgeon removes the gallbladder through a 5-to-8 inch incision. The person will remain in the hospital for about a week, and convalesce at home for several weeks after.

Laparoscopic cholecystectomy

Laparoscopic cholecystectomy is a more minimally invasive method of gallbladder removal that accounts for approximately 95% of all cholecystectomies performed. Laparoscopic cholecystectomy requires several small incisions in the abdomen to allow the insertion of surgical instruments and a small video camera. The surgeon is provided with a close-up view from inside the body sent by the camera to a video monitor. He is then able to perform the procedure by manipulating his surgical instruments all while watching the monitor.

Laparoscopic cholecystectomy does not require the abdominal muscles to be cut, and thus results in less pain, quicker healing, improved cosmetic results, and fewer complications such as infection. Recovery usually requires only a night in the hospital, and several days recuperation at home.

Non-surgical approaches

Several methods are available, but are used only in special circumstances.

Patients with acute inflammation of the gallbladder (and acalculus cholecystitis) may sometimes be treated first with “percutaneous drainage”. This involves inserting a tube and needle (also known as a catheter) straight into the gallbladder to siphon the harmful fluids. Cholecystectomy is performed after the acute situation has settled.

Special medicines can dissolve gallstones which are composed of cholesterol. However, this method works only when there is no blockage, and is usually more practical with smaller stones. However, treatment usually requires many months or years (and stones may return when the treatment is stopped). Thus, it is used only rarely in certain individuals who cannot tolerate surgery.

Extracorporeal shockwave lithotripsy (ESWL) is an excellent method for treating stones in the kidneys. However, ESWL often requires several treatments, and has other drawbacks, including the possibility of stone recurrence. As a result, this treatment method is rarely used.

ESWL can also be used to break up stones in the gallbladder. Resulting stone fragments usually then pass through into the small bowel.

Treatment of bile duct stones

 A bile duct stone as seen on ERCP.

Approximately 10% of patients with stones in the gallbladder also have stones in the bile duct. These can cause acute blockage to the bile duct with cholangitis, or acute pancreatitis. When blockage can cause life threatening illness, emergency treatment is best applied with ERCP. The gastroenterologistpasses an endoscope down to the bile duct opening, and then releases the stone into the duodenum with a small cutting incision (sphincterotomy).

Bile Duct Stones | Michigan Medicine

Bile duct stones are gallstones in the bile duct. They can start in the gallbladder and migrate into the bile duct or they can form in the bile duct itself. The stones can become lodged in the bile duct, causing a blockage. At the Bile Duct and Pancreatic Diseases Program, part of the University of Michigan’s Division of Gastroenterology, our multidisciplinary team provides the newest in minimally invasive treatments for bile duct stones. These treatments are not widely available and are performed by experienced gastroenterologists with high volumes in these procedures.  Gallstones and bile duct stones (also known as choledocholithiasis) are the same, just located in two different areas of the body. Stones may pass spontaneously out of the bile duct on their own. However, when a stone gets stuck in the bile duct, medical intervention is necessary, otherwise inflammation, bacterial infection, and even severe organ damage can occur. 

Symptoms for Bile Duct Stones

Often there are no symptoms for bile duct stones until a stone causes a blockage in the bile duct. Then symptoms can include: 

• Severe abdominal pain (can occur irregularly and last for hours at a time)
• Nausea
• Vomiting
• Fever
• Jaundice 

Diagnosing Stones in the Billiary Duct

To diagnose bile duct stones, we begin by conducting comprehensive exam and collecting a thorough history. Bile duct stones can sometimes be seen on an ultrasound or CT scan, although are most reliably diagnosed by either:

• Magnetic resonance cholangiopancreatography (MRCP): A type of MRI, this advanced imaging technique produces very detailed images of the bile ducts, as well as the liver, gall bladder and pancreas.
• Endoscopic ultrasound: Uses a thin, flexible tube called an endoscope passed through the mouth to examine the digestive tract. The ultrasound component produces sound waves that create detailed images. 

Treating Bile Duct Stones

Bile duct stones are typically removed using endoscopic retrograde cholangiopancreatography (ERCP), a minimally invasive procedure that combines x-ray and upper endoscopy—an exam of the upper gastrointestinal tract, consisting of the esophagus, stomach  and duodenum (the first part of the small intestine)—using an endoscope, which is a lighted, flexible tube, about the thickness of a finger. The doctor passes the tube through the mouth and into the duodenum, then injects a contrast dye into the bile ducts, which can then be seen on x-ray. Special tools can be guided through the endoscope to remove the stones. Large or difficult-to-remove bile duct stones require special ERCP treatments that are not widely available at hospitals throughout the country. They include:  Mechanical lithotripsy: This procedure involves breaking up a larger bile duct stone by capturing it and then crushing it in a wire “basket” that is inserted through the endoscope. Once the stones are crushed, they are removed using special tools through the endoscope. Intraductal electrohydraulic lithotripsy: For this procedure, we use a very fine probe inserted through a tiny scope that is passed through the ERCP endoscope. The probe, which is connected to a generator, provides a shock wave that breaks up the stone. Once the stones are crushed, they are removed using special tools through the endoscope. Patients can typically go home same day, once their sedation wears off. 

Other Information About Digestive and Liver Health

To see related medical services we offer, visit our Digestive and Liver Health overview page.

Make an Appointment

To schedule an appointment to discuss your need for bile duct stone treatment, call us at 888-229-7408.

Gallstones – Liver and Gallbladder Disorders

If gallstones cause disruptive, recurring episodes of pain, a doctor may recommend surgical removal of the gallbladder (cholecystectomy). Removal of the gallbladder prevents episodes of biliary colic yet does not affect digestion. No special dietary restrictions are required after surgery. During cholecystectomy, the doctor may also check for stones in the bile ducts.

About 90% of cholecystectomies are done using a viewing tube called a laparoscope. After small incisions are made in the abdomen, the laparoscope is inserted. Surgical tools are passed through the incisions and used to remove the gallbladder. Laparoscopic cholecystectomy has lessened the discomfort after surgery, shortened the length of hospital stays, provided better cosmetic results, and reduced the time needed to recover.

The rest of cholecystectomies are done by open abdominal surgery, which requires a larger incision in the abdomen.

Alternatively, gallstones can sometimes be dissolved with drugs, such as bile acids (ursodeoxycholic acid), taken by mouth. Such a drug, taken two or three times daily, can dissolve tiny stones in 6 months. Larger stones may take up to 1 to 2 years. Many never dissolve. Dissolving gallstones with drugs is most likely to work when stones are made of cholesterol and the opening of the gallbladder is not blocked. Even if the stones are successfully dissolved, half of these people develop gallstones again within 5 years. This treatment has limited use, and doctors use it only when surgery is too risky (for example, in people with major medical problems—see Surgery is the term traditionally used to describe procedures (called surgical procedures) that involve manually cutting or stitching tissue to treat diseases, injuries, or deformities. However… read more ).

Ursodeoxycholic acid can help prevent stones from forming in obese people who are losing weight rapidly after weight-loss surgery or who are on a very low calorie diet.

Gallstones vs. Kidney Stones | Florida Medical Clinic

Stones forming in the body might seem like a strange idea. Yet gallstones and kidney stones develop in many people every year! While many of their symptoms may be similar, they affect different organs, and have different causes and composition. You may be wondering: when comparing Gallstones vs. Kidney Stones, what’s the difference?

Gallstones vs. Kidney Stones

Both gallstones and kidney stones are, in essence, the buildup of certain materials in their respective organs. Pain occurs when the buildup blocks the organ from functioning normally. In both cases, the stones will need to be removed.

Gallstones

The gallbladder’s job is to store bile, which is produced by the liver and helps with digestion.

Gallstones are hard lumps which form in the bile duct or gallbladder.

Bile consists of cholesterol, water, fats, proteins, bile salts, and bilirubin, which is a yellow-brown pigment. Gallstones form when bile contains too much cholesterol or bilirubin. Obesity and diets high in cholesterol and fat can lead to gallstone formation. Women predominantly develop gallstones.

Gallstones can be asymptomatic. Many people have them and don’t know it! Other times, they can cause gallbladder attacks. Pain and other complications occur if a gallstone blocks a duct, causing an infection. In these cases, the gallstones will need to be removed.

Like kidney stones, gallstones can be removed without removing the gallbladder itself. However, if the gallbladder does need to be removed, don’t worry – your body doesn’t need your gallbladder to continue functioning normally! Gallbladders are often recommended to be removed because you will most likely produce more stones.

Kidney Stones

The kidney filters blood, which is then converted into urine. Kidney stones occur when mineral deposits build up in the kidneys. They usually result from insufficient liquid intake.

Kidneys use liquids in order to process minerals normally. Without enough liquid in your system, your kidneys won’t be able to process the mineral buildup efficiently, and stones will begin to form.

Other causes of kidney stone formation include obesity, heredity, diet, age, and calcium supplements, among others. Men are more likely to develop kidney stones than women.

As with gallstones, kidney stones can be asymptomatic. Pain begins when kidney stones grow large enough to block the ureter and cannot pass through naturally. Most of the time, with sufficient liquid intake, your system can pass kidney stones naturally. If the stone is too large, or other medical complications arise, you will need to have a surgery known as a lithotripsy to remove the stone.

Symptoms of Gallstones and Kidney Stones

Although gallstones and kidney stones affect different organs, their symptoms are similar.

Both can cause you to feel…

• Nauseous
• Sweaty
• Restless
• Feverish
• Chilled
• Pain under the ribs
• Pain between your shoulder blades

Differences between the two…

• Kidney stone pain can come in waves, instead of being constant
• Kidney stones can lead to blood in the urine
• Gallstones can lead to jaundice, or yellowed skin and whites of the eyes

If you are concerned about your symptoms, contact your doctor! It’s important to note that jaundice or high fevers with chills are indicative of a more serious problem, so seek immediate care if you develop either of these symptoms.

Can Gallstones and Kidney Stones be Prevented?

Both gallstones and kidney stones happen for a variety of reasons. In most people, kidneys stones can be prevented. For gallstones, there is no definite guarantee of prevention; however, there are plenty of precautions you can take to lower your risk!

For kidney stones, the best way to prevent them from forming is to stay hydrated. Drink lots of water! It’s also recommended that you avoid foods with high oxalate content.

For gallstones, you can lower your risk by eating a healthy diet, and avoid fatty foods or foods high in cholesterol. Vegetarian diets, or diets which include more vegetables, as well as adding fiber to your diet will also help. Weight loss is another great way to lower your risk!

Florida Medical Clinic

Florida Medical Clinic’s Gastroenterology Department is very experienced in dealing with both gallstones and kidney stones. We offer both general consultation as well as appointments for all your gallstone and kidney stone troubles! With six locations around Tampa, you’ll be able to find relief near you!

90,000 symptoms and when to see a doctor

For diagnostics and treatment of gallstones, read the link.

Get immediate help if you develop signs and symptoms of a serious complication of gallstones, for example:

• Abdominal pain is so severe that you cannot sit still or find a comfortable position
• Yellowing of the skin and whites of the eyes (jaundice)
• High temperature with chills

The number for calling an ambulance in Moscow is 103

Causes of ZhKB

It is not clear what causes gallstones.Doctors believe that gallstones can occur in the following cases:

Your bile contains too much cholesterol . Usually, your bile contains enough chemicals to dissolve the cholesterol secreted by your liver. But if your liver secretes more cholesterol than bile can dissolve, the excess cholesterol can turn into crystals and eventually stones.

Your bile contains too much bilirubin . Bilirubin is a chemical that is produced when red blood cells are broken down in the body.Under certain conditions, the liver produces too much bilirubin, including cirrhosis of the liver, biliary tract infections, and some blood disorders. Excess bilirubin contributes to the formation of gallstones.

Your gallbladder is not emptying properly. If the gallbladder is not emptied completely or frequently enough, bile can become very concentrated, which contributes to the formation of gallstones.

Types of gallstones

Types of gallstones that can form in the gallbladder include:

Cholesterol stones in the gallbladder.The most common type of gallstones, called cholesterol gallstones, are often yellow in color. These gallstones are composed primarily of undissolved cholesterol, but may contain other components as well.

Pigmented stones in the gallbladder. These dark brown or black stones form when your bile contains too much bilirubin.

Risk factors

Factors that can increase your risk of gallstones include:

• Female
• Age 40 and over
• Overweight or obese
• Sedentary lifestyle
• Pregnancy
• High fat diet
• High cholesterol diet
• Low Fiber Diet
• Family history of gallstones
• Diabetes
• Presence of certain blood disorders such as sickle cell anemia or leukemia
• Very fast weight loss
• Taking medications containing estrogen, such as oral contraceptives or hormone therapy.
• Liver disease

Complications

Complications of gallstones may include:

Inflammation of the gallbladder . A gallstone lodged in the neck of the gallbladder can cause inflammation of the gallbladder (cholecystitis). Cholecystitis can cause severe pain, peritonitis.

Blockage of the common bile duct . Gallstones can block the channels (ducts) that carry bile from the gallbladder or liver into the small intestine.This can lead to severe pain, jaundice, and bile duct infection.

Blockage of the pancreatic duct . The pancreatic duct is a tube that runs from the pancreas and connects to the common bile duct just before entering the duodenum. The pancreatic juices, which aid digestion, pass through the pancreatic duct.

A stone in the gallbladder can cause blockage of the pancreatic duct, which can lead to inflammation of the pancreas (pancreatitis).Pancreatitis causes severe, persistent abdominal pain and usually requires hospitalization. Severe forms of pancreatitis often end in the death of the patient.

Gallbladder cancer . People with gallstones have an increased risk of developing gallbladder cancer.

Prevention of ZhKB

You can reduce your risk of gallstones:

Don’t skip meals . Try to stick to your normal meal times every day.Skipping meals or fasting can increase your risk of gallstones.

Lose weight slowly . If you need to lose weight, take your time. Rapid weight loss can increase your risk of gallstones.

Eat more high-fiber foods . Include more fiber-rich foods such as fruits, vegetables, and whole grains in your diet.

Maintain a healthy weight . Obesity and being overweight increase the risk of gallstone formation.Work towards a healthy weight by reducing your calorie intake and increasing your physical activity. Once you reach a healthy weight, work to maintain it by continuing to eat a healthy diet and exercise.

City Clinical Hospital No. 31 – Gallstones

Many women carry gallstones. Is it always necessary to remove the gallbladder in this case? Is there an alternative to surgery?

Says the head of the Department of Hospital Surgery of the Russian State Medical University, surgeon of the 31st City Clinical Hospital.Moscow Doctor of Medical Sciences, Professor Sergey Georgievich Shapovalyants .

– Is it necessary to remove the gallbladder if only one small stone has formed in it? Is it worth sacrificing an entire organ?

– This question is asked by many patients, because few people want to immediately take drastic measures. They believe that small gallstones are not dangerous and can be simply watched. And sometimes this tactic is actually used.However, we must admit it is very, very dangerous. Even small stones can cause serious complications. If large formations can lead to bedsores, breakthroughs of the gallbladder, then small stones are insidious in their own way. They can migrate and enter the bile ducts. Wandering along them, the stones reach the level of the confluence in the duodenum and get stuck there. Due to a violation of the outflow of bile, the pigment bilirubin begins to accumulate in the blood, and obstructive jaundice occurs. In addition, severe acute pancreatitis can develop rapidly.In this case, there is no time for reflection – an ambulance is needed.

All patients should also know that if a stone appears in the gallbladder, it will never completely dissolve. The presence of even the smallest stones indicates that the work of the gallbladder is impaired, bile begins to precipitate. And if this trend has appeared, it will develop.

– But there is a method of dissolving stones with the help of medicines. Why not try it before you go to the surgeon?

– Indeed, there are drugs with which one can try to influence some gallstones.But not completely dissolve them – this does not happen, but only slightly reduce their size. This can be done only with a strict combination of the size of the stone, its chemical composition, contractile function of the gallbladder and drug tolerance.

Bile acids are used to dissolve stones. Two of them are used as drugs – chenodeoxycholic acid and ursodeoxycholic acid. These drugs are marketed by many companies under different names. Some of the most famous are Henofalk and Ursofalk.With the help of these funds, you can act exclusively on cholesterol stones. If the stones contain a lot of calcium or bilirubin, then the use of bile acids is useless. They never dissolve these substances.

Gallstones should be no more than 2 cm in diameter. Larger formations, of course, can be tried to be reduced. However, this will take a very long time, up to several years, because on average stones are reduced by 1 mm per month.

In addition, stones can be dissolved only if the function of the gallbladder is preserved, when it continues to contract normally and excrete bile.And in acute inflammatory diseases of the gallbladder and bile ducts, in liver diseases, gastric and intestinal ulcers, this is contraindicated and pointless.

It should be said that the intake of bile acids is very often accompanied by undesirable reactions, in particular, upset stools. But despite this, the patient must regularly and for a long time, at least several months, take these drugs. One has only to stop the treatment – and the stones grow again.So the drug method has very limited effectiveness.

-What can you say about the method of crushing gallstones? Crushed kidney stones?

– Analogies between the cleavage of kidney and gallstones are in fact drawn often. At one time, stones in the gallbladder were crushed by extracorporeal lithotripsy. Moreover, this method was very popular. During the lithotripsy session, multiple shock waves were sent to the stone outside the body. As a result of this impact, the stone was crushed into fragments.Then small fragments left the body on their own through the bile ducts and intestines. At the same time, large fragments that could not pass through the duct remained in the gallbladder.
But that’s half the trouble. The fragments formed as a result of crushing often got stuck in the bile ducts, clogged them and disrupted the entire process of bile secretion.

There is one more important point. Before lithotripsy, stones are usually even, smooth, adapted to the shape of the gallbladder.And a person often does not feel them. As soon as you crush it, turn it into a mass of small but sharp fragments, biliary colic and jaundice appear, and the pancreas becomes inflamed. The patient’s position can be severely deteriorated. So this method can be considered simply dangerous, and many foreign and domestic clinics refuse it.

– Clearly, all conservative methods do not bring much success. But if one decides to have an operation, why is it necessary to remove an entire organ? Is it possible to remove only stones and leave the gallbladder?

– Alas, this method is today recognized as ineffective, although in some places it is still practiced.It is believed that some patients, especially young ones, should not have their gallbladder removed. Still, it performs certain important functions in the body.

Proponents of this approach perform an operation during which a small incision is made in the gallbladder. Through it, gallstones are taken out, then the bladder is sutured, and after two or three days the satisfied patient returns home. No stones, and the gallbladder was in place.

However, not everything is so simple. Approximately 2-3 months after such an operation, gallstone disease raises its head again.The same symptoms and complications return as the person had before the intervention. The relapse rate at different intervals reaches almost 100%. This is due to the fact that one of the prerequisites for the formation of stones in the gallbladder is its poor contractility. Such a bubble is called stagnant. Another reason is the congenital features of the bile structure. When bile, in any diet, even a purely vegetarian one, is concentrated and precipitated. In this case, removing only stones is simply meaningless.The problem can be finally solved only by completely eliminating the gallbladder.

– Does this always require abdominal surgery?

– Of course not. In large clinics and hospitals, removal of the gallbladder is performed by laparoscopy. The operation is performed through three or four punctures in the abdominal wall. An optical system is introduced inside. The abdominal cavity is examined and the gallbladder is removed with special instruments.

As a rule, this is where all the patient’s troubles end.After a short period of adaptation, he can forget about gallstone disease forever. Moreover, the absence of a gallbladder will remain almost invisible for him. Indeed, in fact, his “biological loss” occurred much earlier – even at the stage of formation of stones. Even then, the gallbladder ceased to function normally, and other parts of the biliary system began to perform its work.

– Honestly, I know of cases when after such an operation people felt no better, but even worse … What can you say about this?

– You are right, there is such a thing as postcholecystectomy syndrome.It implies just the deterioration in well-being that you are talking about. Most often this happens if the operation is performed at an already advanced stage of the disease. When neighboring organs are involved in the inflammatory process. In this situation, only one thing can be said – do not take it to extremes. Do the surgery as planned, not when the thunder breaks out.

But there is another reason for the poor condition. And this is a rather serious problem with deep roots. The fact is that the operation to remove the gallbladder began to be considered technically simple for doctors and quite easily tolerated for patients.For these reasons, many people go to it without much hesitation. Although in reality it is not always worth doing this.

The circle of passed examinations of the patient is often limited to one ultrasound of the abdominal cavity. Moreover, according to its results, a person may not have stones as such, but “clots” or “suspensions” are found. True, the patient presents some complaints similar to the symptoms of gallstone disease. It is they who are taken as the basis for the decision.

The patient is operated quickly, and the operation does not bring relief.The question arises: was the gallbladder really the cause of poor health? After all, the same symptoms can occur due to other problems, in particular, due to duodenal dyskinesia. And if in such a situation the gallbladder is removed – a kind of buffer that softens unpleasant manifestations – then the existing problems will immediately worsen. Pain syndrome will appear, the whole complex of symptoms will emerge.

– What to do in such a situation?

– Sadly, to open a new case history.In general, in order to avoid such a development of events, before the operation, it is necessary to undergo a thorough examination not only of the gallbladder, but also of all organs located nearby. It is necessary to carefully assess the condition of the bile ducts, pancreas, duodenum, right kidney, stomach. Not all medical institutions are equipped with the necessary equipment for this. Therefore, it is better to go to large clinics and centers.

Endoscopic ultrasonography of the bile ducts is now successfully used in cases of suspected stones.After all, if there are also pebbles there, then first you need to eliminate them, and only then take up the gallbladder. In order to avoid those very complications.

Computed tomography will help to examine the liver and pancreas. A biochemical blood test will tell you many necessary details. Of course, not everyone needs this research. But if there are any doubts, they cannot be ignored.

So take a closer look at yourself. Take drastic measures deliberately and trusting your doctor.

Please note! The prerequisites for the occurrence of gallstone disease are:

1. Overweight;

2. Sedentary lifestyle;

3. Pregnancy.

Make an appointment with our specialists

You can make an appointment for a paid appointment to the doctor by calling of the Consultative and Diagnostic Center +7 (499) 936-99-89 , or by filling out the form presented.

Conditions for the provision of paid services can be found here

You can make an appointment with the compulsory medical insurance policy and in the direction of by calling +7 (499) 936-99-71 .

90,000 Modern view of the causes of gallstones

The gallbladder is a reservoir for the accumulation and thickening of bile, which is a complex liquid, consisting of 85% water. Bile contains organic and inorganic substances: bile acids; cholesterol; bilirubin; phospholipids; immunoglobulins; ions of non-metals; metals and other substances. Gallstones are hardened formations of substances found in bile.

Depending on the substance prevailing in the composition of gallstones, they are divided into two types. The most common type is cholesterol gallstones yellow-gray (up to 80%). They consist mainly of undissolved cholesterol, but may contain other components as well. The second type is pigmented gallstones , brown or black stones with a predominance of bilirubin.

The exact cause of the formation of stones in the gallbladder is still being established, according to available data, they appear when an excessive concentration of bile and an imbalance of the substances contained in it occurs in the gallbladder .

Causes of the formation of gallstones

When there is too much cholesterol in the bile

Usually, bile contains a sufficient amount of chemicals that dissolve the cholesterol secreted by the liver. But if your liver secretes more cholesterol than can be dissolved in bile, the excess cholesterol can be converted into crystals and eventually cholesterol stones.

When there is too much bilirubin in the bile

Bilirubin is a chemical that is produced when red blood cells (erythrocytes) are destroyed in the body.Certain conditions can stimulate your liver to produce too much bilirubin, including cirrhosis of the liver, biliary tract infections, and some types of anemias. Excess bilirubin contributes to the formation of pigment stones.

When there are gallbladder emptying disorders and bile stasis

If the gallbladder is not emptied completely or frequently enough, bile can become very concentrated, which contributes to precipitation and the formation of gallstones.

When there is a bacterial infection in the gallbladder

A chronic inflammatory process in the gallbladder leads to disturbances in its work and a change in the composition of bile and the formation of pigmented gallstones.

Risk factors for the formation of gallstones

There are factors that increase the risk of gallstones, and they differ depending on the type of stones.

Risk factors for the formation of cholesterol gallstones

• family predisposition;
• female;
• age 40 and older;
• congenital structural features of the gallbladder;
• sedentary lifestyle;
• diet high in fat and simple carbohydrates;
• high cholesterol, low fiber diet;
• overweight or obese;
• pregnancy;
• fast weight loss.
• type 2 diabetes mellitus;
• taking medications containing estrogen, for example, contraceptives or hormones and medications that affect the contractility of the gallbladder.

Risk factors for the formation of pigmented gallstones

• old age;
• the presence of diseases of the liver, blood and intestines;
• biliary tract infections and helminths.

How to reduce the risk of gallstones?

You can reduce your risk of gallstones with simple means, both on your own and with the help of your doctor.

Don’t skip meals . Try to stick to your regular meals every day. Skipping meals or fasting can increase your risk of gallstones.

Lose weight slowly . If you need to lose weight, take your time. Rapid weight loss can increase your risk of gallstones. Aim to lose 0.5-1 kilograms per week.

Include dietary fiber in your diet. It is recommended to consume up to 30 g of dietary fiber per day.Most of the fiber is found in cereals, slightly less in fruits. Whole grain bread, whole grain pasta, wholemeal or large cereal porridge are the staples of the diet for patients at risk of cholelithiasis.

Maintain a healthy weight . To lose weight, use a calorie-reduced diet and increase your physical activity. Once you’ve lost your weight, keep eating healthy and stay active.

Get medical attention . If there is a predisposition to the development of gallstone disease, observation of a gastroenterologist and preventive therapy in most cases will help to avoid the formation of stones in the gallbladder.

where is it, why is it needed and why stones are formed in it

In gallstones, as the name suggests, stones form in the gallbladder and bile ducts. What is it and why do they appear?

Content

Gallstone disease – where is the problem?

To understand what gallstone disease or cholelithiasis is, let’s look at the internal organs that are associated with it.First of all, this is the gallbladder, which is located next to the liver, in the area of ​​the right hypochondrium. It is a small – about the size of a chicken’s egg – a bag, inside of which is bile.

Bile is a liquid produced by the liver and is essential for digestion. Further, it is collected in the bile ducts of the liver, from there, through the common bile duct, it enters the gallbladder and into the duodenum, where it contributes to the digestion of food. It turns out that the gallbladder serves as a reservoir for storing bile and its rapid “throwing” into the intestine.

What are stones?

As the name suggests, gallstone disease is the formation of stones in the gallbladder and ducts. The stones have a different composition, but the overwhelming majority consists of more than 90% cholesterol, with the addition of calcium salts and bilirubin pigment.

The size of the stones is very different: they can be fine sand with particles no more than a millimeter, and can weigh tens of grams.

Stones can be located both in the bladder itself and in the ducts.The ducts are divided into two groups: hepatic (located inside the liver) and extrahepatic (these include the common, cystic and bile ducts). Cholesterol, from which gallstones are formed, is taken from the bile itself. Why is this happening?

Because of what cholesterol becomes stone

Experts believe that the reason for the formation of stones is an imbalance in the chemical composition of bile. Cholesterol, which is produced by the liver, in the bile is “packed” in a “shell” – particles of bile salts and lecithin substances.If, for one reason or another, this shell turns out to be unstable, cholesterol precipitates – and forms stones.

In addition, stones can form for other reasons – due to cholestasis and associated infections of the biliary system. Cholestasis is stagnation of bile or a violation of its outflow, while less bile enters the duodenum. Usually such a violation occurs due to mechanical blockage of the ducts. For example, another gallstone or as a result of strong or repeated kinking of the gallbladder.It also often happens as a result of side effects of drugs and for genetic reasons.

Who is at risk?

Gallstone disease is a very common disease. According to various estimates, it is found in about 20% of the population of developed countries.

Risk factors for the development of gallstone disease:

1. Being overweight (obesity)
2. Sudden weight loss (for example, due to extreme diets)
3. Unhealthy diet – eating foods high in saturated fat (sausages, butter , fatty meats, hard cheeses)
4. A sedentary lifestyle (it aggravates bile stagnation)

All of the listed risk factors are those that you can influence – it is in your power to adjust your lifestyle so as to reduce the likelihood of developing gallstone disease.

Other health factors that increase your risk include taking the hormone estrogen or the natural increase in estrogen levels due to pregnancy. The presence of diabetes mellitus, cystic fibrosis, surgical interventions associated with a decrease in the volume of the stomach, as well as the presence of parasites in the intestines and biliary tract also contribute.

Scientists believe that the predisposition to gallstone disease is about 25% genetic in nature – and more than a dozen genes are involved in this.

Women are more likely to develop gallstone disease than men – as a rule, they begin to detect it at the age of about 40 years, and the peak of detection of the disease occurs at about 55 years. In men, gallstone disease is usually detected after 50 years, and the peak of detection falls on 60-65 years.

To avoid illness, it is important to check the body in a timely manner. Then you can diagnose gallstone disease in time and avoid complications: pancreatitis (inflammation of the pancreas), cholangitis (inflammation of the bile ducts), cholecystitis (inflammation of the gallbladder).

In addition to blood tests and ultrasound, a genetic test can help. For example, the Atlas Genetic Test will analyze information about genes responsible for the transport and metabolism of cholesterol and bile acids. This, together with the results of the lifestyle survey, will allow to calculate the individual risks of developing gallstone disease.

How to understand that you have gallstone disease?

Gallstone disease may not manifest itself for years. However, if a gallstone gets stuck in the duct, it can cause the following symptoms:

1. Sudden and rapidly worsening pain in the upper right corner of the abdomen
2. Sudden and rapidly worsening pain in the center of the abdomen, just below the sternum
3. Back pain between the shoulder blades
4. Pain in the right shoulder
5. Nausea or vomiting

Another symptom of gallstone disease is yellowing of the skin or whites of the eyes – in this case, you should also see a doctor.

A gastroenterologist is engaged in the diagnosis and treatment of gallstone disease, and a blood test and ultrasound will help him diagnose. In difficult cases where the stones are in the bile ducts, a test called magnetic resonance cholangiography or endoscopic retrograde cholangiopancreatography is used.

How to treat gallstone disease?

The treatment plan for gallstone disease depends on how severe the symptoms are. If they are not there, or they do not greatly affect the quality of your life, then you can limit yourself to observation, proper diet and – if necessary – pain relievers.

Choleretic drugs should not be taken – they can be prescribed by a doctor for cholangitis or cholecystitis, but do not try to use them to “expel” stones from the ducts or gallbladder.

These drugs, firstly, increase the production of bile, thereby increasing the load on the liver, and secondly, stones can simply get stuck in the ducts and block them.

If you are experiencing severe pain and there are many stones in your cholagogue system, an operation to remove the gallbladder is recommended.It is not a vital organ, which means you can lead a normal life without it.

Notes

• Gallstone disease – the formation of stones in the gallbladder and bile ducts. In the vast majority of cases, stones are high in cholesterol.
• Stones usually form due to a chemical imbalance in the composition or stagnation of bile.
• Risk factors for the development of gallstone disease include the consumption of fatty foods and the presence of excess weight, sudden weight loss, insufficient exercise, taking certain medications or the presence of diseases.
• The predisposition to gallstone disease is approximately 25% due to genes. The genetic test will help you calculate your individual risks.
• Symptoms of gallstone disease may be pain or yellowing of the skin, but the disease may not manifest itself for years.
• To avoid complications, it is important to be regularly examined by a specialist – to do a blood test and ultrasound.
• A plan for the treatment of gallstone disease must be developed by a doctor. Treatment is very individual: from observation and taking painkillers to removing the gallbladder.

90,000 Where do gallstones come from

The appearance of stones in the gallbladder is an urgent problem for many people. Therapist Galina Rodchenkova in an interview with 5-tv.ru told how they are formed. She explained how the gallbladder functions and what causes it to become blocked.

“The gallbladder is a baggy, pear-shaped organ. It is located under the liver, connected to it and the intestines by thin tubes – the bile ducts.It performs a reservoir function, that is, it accumulates and concentrates bile, which the liver produces continuously, ” – the doctor explained.

The therapist noted that bile is responsible for the breakdown of fats and caffeine. As an alkaline liquid, it neutralizes gastric juice before it enters the intestines. Rodchenkova explained that if the outflow of bile is impaired, then its concentration and crystallization occurs. As a result, stones can form.

Causes of stone formation

The expert named the possible risks of the formation of stones in the gallbladder.The physician noted that most often this problem occurs in women, regardless of age. Nevertheless, in the elderly, the pathogenic condition occurs more often than in the young.

“The problem also occurs in people with diabetes and high cholesterol. Pregnant women are susceptible to this problem, as well as people who are fond of diets, that is, those who have been on hunger strike for a long time, ” – the therapist said.

According to Rodchenkova, a genetic predisposition also affects the appearance of stones.Another risk factor is the use of drugs such as fibrates (drugs that lower bad cholesterol), ceftriaxone (a broad-spectrum antibiotic), and estrogen analogs in oral contraceptives.

Manifestation of disease and treatment of gallstones

Treatment of stones in the gallbladder, can be both operational and non-surgical. So, with an asymptomatic course of the disease, you do not need to lie down on the surgical table and get rid of the organ.According to the therapist, in this case, you need to monitor your condition.

“We must try a wait and see tactic. Then you will already clearly understand what manifestations should alert you. Then you can already discuss drug therapy with your doctor, ” – the doctor said.

The specialist also noted that people with cholesterol stones are subject to such treatment. According to the doctor, it must be borne in mind that only two-thirds of patients will achieve the desired effect over a long period of time.

The second variant of the manifestation of the disease is biliary colic. The doctor explained that these are recurrent attacks of pain in the right hypochondrium, which can radiate to the right shoulder, arm.

“Such conditions can be accompanied by bitterness, sometimes vomiting and even jaundice. With such symptoms, a planned removal of the bladder is necessary ”, – said the expert.

The third condition – a complicated course of the disease, indicating the presence of stones in the gallbladder – is the occurrence of other diseases.For example, acute cholecystitis, pancreatitis, that is, inflammation of the pancreas. The expert noted that in extremely rare cases, gallbladder cancer is possible. Patients with a third condition should seek immediate medical attention.

Earlier 5-tv.ru told why cellulite appears even in thin girls and children.

Where do stones come from in the gallbladder? Symptoms, diagnosis, treatment.

The gallbladder is an organ that looks like a small sac located under the liver.It accumulates and concentrates bile. After a person takes food, the gallbladder pushes bile into the lumen of the duodenum. This process is called bile secretion, or cholekinesis.

Our expert in this field:

Allakhverdyan Alexander Sergeevich

Surgeon-oncologist, professor, d.M.Sc. Leader of the ROC expert group. International expert

If the concentration of cholesterol, bilirubin (a substance that is formed during the breakdown of hemoglobin) rises in bile, or the gallbladder is incompletely emptied, and bile stagnates in it, stones are formed – cholelithiasis develops.

In addition to the gallbladder, stones can be found in the bile ducts.The condition when stones are found in the common bile duct (common bile duct) is called choledocholithiasis.

What symptoms do gallstones cause?

At the earliest stages of the disease, there are no stones in the bile yet, but it is in a lithogenic state, that is, there are already disturbances in it, which in the future will lead to the formation of a stone. At the second stage, a stone appears, but often it does not bother for a long time, for many years. The person does not know that he is sick.

In some patients, the stone eventually makes itself felt in the form of biliary colic.Pain occurs, usually after eating, in the stomach or in the upper abdomen, and may radiate to the right shoulder blade, shoulder. Sometimes vomiting occurs, but after it the pain does not decrease, it does not get better. The change in body position does not help either. The attack lasts from 15 minutes to several hours. Biliary colic occurs when a stone blocks the flow of bile.

A second attack may occur the next day, a week, a month, a year, or several years.

If, in parallel with pain, fever, jaundice, sweating occurs, the pulse quickens, most likely it is a gallstone disease complicated by acute cholecystitis (inflammation of the gallbladder), cholangitis (inflammation of the bile ducts) or pancreatitis (inflammation of the pancreas).

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How are gallstones diagnosed?

Stones in the gallbladder can be found during ultrasound.Sometimes they resort to endoscopic ultrasound examination – Endo-ultrasound. The procedure resembles FGDS, only, in addition to a video camera, there is an ultrasonic sensor at the end of the endoscope.

Stones can also be seen on conventional X-rays of the abdomen. A more informative X-ray examination is endoscopic retrograde cholangiopancreatography (ERCP). The doctor inserts the endoscope into the duodenum, locates the confluence of the bile duct, and injects a radiopaque contrast agent into it.It stains the gallbladder and bile ducts, as a result, their contours become clearly visible on X-rays. During ERCP, the stone can be removed.

Sometimes they resort to MRI – magnetic resonance cholangiopancreatography is performed. Computed tomography can also be used, but this method is more expensive and less accurate than ultrasound.

General and biochemical blood tests help in the diagnosis of inflammation, infection, disorders of the liver, pancreas, metabolism.

Review of the treatment of urolithiasis and cholelithiasis

The patient suffered from pain in the lower abdomen. She went to various medical institutions. The pain syndrome was removed there, after which they were sent home. In the international clinic Medica24 she underwent an examination, which showed the presence of stones in the kidneys and gallbladder. Two operations were performed. The problem has been resolved.

Read full review

Review of the treatment of gallstone disease

Feedback on treatment in the international clinic Medica24.Patient Nina Iosifovna was taken to the clinic in a critical condition. After stabilizing her condition in the intensive care unit, the patient underwent an operation to remove stones in the bile duct. Thanks to the efforts of resuscitators and surgeons, Nina Iosifovna feels well, moves independently and takes care of herself, her vital signs …

Read full review

How is the disease treated?

If a gallstone is not causing any symptoms and is discovered incidentally, treatment is usually not required.

If you experience symptoms that resemble biliary colic, you should immediately consult a doctor. If the diagnosis is confirmed, and stones are found in the gallbladder, surgery will be performed – removal of the gallbladder (cholecystectomy). The operation is most often performed laparoscopically, through punctures in the abdominal wall.

Are there medications that dissolve gallstones? Yes, there are such drugs. But they will take a very long time, and there is no guarantee that the stone will dissolve.Therefore, drug treatment is prescribed only to patients who have contraindications for surgery, or who themselves have refused surgery.

The material was prepared by the deputy director for surgery and oncology of the international clinic Medica24 Allakhverdyan Alexander Sergeevich.

If you experience symptoms resembling biliary colic, see your doctor. Stones in the gallbladder can be combined with acute cholecystitis, pancreatitis, such patients should be hospitalized immediately.Call: +7 (495) 230-00-01

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Choledocholithiasis: stones in the bile ducts operation

Choledocholithiasis is one of the forms of manifestation of gallstone disease, in which calculi are found not in the gallbladder, but in the bile ducts. Most often – in the common bile duct, common bile duct.

Moreover, they either get there from the gallbladder, or are formed directly in the common bile duct.As a rule, the treatment of such a disease is prompt. Note that the disease is quite serious, especially in cases where severe complications develop in the form of blockage of the duct, then the patient’s life is threatened.

How do stones appear in the bile duct?

They usually form in the gallbladder and travel with the flow of bile through the cystic duct. At the same time, the general appearance of stones in the bladder and in the ducts, their microstructure and chemical composition are identical.Evidence of the gallbladder origin of calculi is the presence of edges on their surface, which are formed as a result of the contact of several stones in the gallbladder. The wider the diameter of the cystic duct, the greater the likelihood of stones moving into the common bile duct. In some cases, stone formation can occur directly in the lumen of the common bile duct itself. This occurs when the outflow of bile through the ducts is difficult.

The reasons for the formation of stones in the biliary tract can be:

• Stenosis of the terminal (end) part of the common bile duct.
• Penetration from the duodenum of some helminths (roundworm, cat’s fluke).
• Production of bile with particularly high lithogenic properties in some geographic regions (the so-called Far Eastern choledocholithiasis). The mechanism for the formation of such bile is still unknown. In these cases, choledocholithiasis is considered primary.
• Sometimes stones in the bile ducts are detected some time later (several months, sometimes several years) after the cholecystectomy performed earlier.These can be stones not detected before the operation and during its execution (“residual” or “forgotten”), and newly formed (“recurrent” choledocholithiasis), which formed in the bile ducts after surgery due to metabolic disorders, stagnation of bile or the presence of infection.

Diagnosis of choledocholithiasis (stones in the bile ducts)

Diagnosis of choledocholithiasis cannot be based only on the clinic. Vesiculate stones in the common bile duct are not always clinically detected, and may be asymptomatic for a long time.Only the appearance of an attack of hepatic colic followed by jaundice suggests a possible problem in the biliary tract. The nature of hepatic colic in choledocholithiasis is no different from that emanating from the gallbladder. Although sometimes pain can be localized somewhat higher and more medial than with cholecystolithiasis, in the epigastric region. Even less often, unbearable pain is observed with a sudden blockage of the duodenal papilla with a stone (the so-called “papillary ileus”).

In the presence of small (less than 5-7 mm) stones in the gallbladder in any patient with gallstone disease, the presence of stones in the common bile duct should be suspected, since such sizes allow them to migrate freely through the cystic duct.You should especially be on your guard with bilirubinemia (even a slight increase in serum bilirubin). Usually, the level of alkaline phosphatase rises at the same time, an increase in the level of aminotransferases is likely. However, after the obstruction (blockage) has been removed, aminotransferase levels usually return to normal quickly. While bilirubin levels often remain elevated for 2 weeks, elevated alkaline phosphatase levels remain even longer.

Laboratory diagnostics.

Asymptomatic choledocholithiasis may not be accompanied by changes in laboratory tests. With the development of inflammation in the blood, the level of leukocytes and ESR increases. If the outflow of bile is disturbed, an increase in the concentration of bilirubin (due to the direct fraction), an increase in the level of aminotransferases (transaminases) and alkaline phosphatase in the biochemical analysis of blood are observed, and the content of bile pigments in urine increases. Stercobilin may be absent in the feces. A very formidable laboratory symptom is an increase in blood amylase, as this indicates damage to the pancreas.

Instrumental diagnostics.

Ultrasound examination of the abdominal organs (ultrasound) is the most accessible method for examining the biliary tract, in fact a screening method. Its sensitivity for detecting the expansion of the common bile duct is up to 90%. However, it is not always possible for a specialist in ultrasound diagnostics to examine the terminal section of the common bile duct (the zone of confluence of the common bile and pancreatic ducts, and their confluence into the duodenum), i.e.That is, the department is very important for making the correct diagnosis. The examination can interfere with gas or liquid (even in small quantities) in the intestine.

Therefore, in many cases it is necessary to resort to additional methods:

• Endoscopic ultrasound (endosonography). Examination is carried out with a special endosonographic probe through the lumen of the stomach and duodenum. With such an examination, the efficiency of correct diagnosis increases to 85-100%.

• MPT cholangiography. The accuracy of this research method is up to 97%. When performing MRI cholangiography, an image of the gallbladder and cystic duct, segmental, lobar bile ducts, common hepatic duct, common bile duct and pancreatic duct is obtained. It becomes possible to accurately visualize stones in the lumen of the ducts, their narrowing or expansion. The great advantages of MRI cholangiography include its non-invasiveness and the absence of the need for the use of contrast agents.

The following two diagnostic methods are invasive, therefore, they can be used only when the patient is in the hospital. We are talking about endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PCCG).

• ERCP is a standard method for diagnosing choledocholithiasis; in the hands of an experienced endoscopist, it is effective in 90 – 95% of cases. However, this method is associated with the possible development of serious complications: hyperamilasemia, cholangitis, pancreatitis, retroperitoneal perforation of the duodenum, bleeding.Therefore, its use must be justified.
• Percutaneous transhepatic cholangiography is used in patients with obstructive jaundice when it is impossible to perform retrograde cholangiopancreatography. In this case, under the control of an ultrasound or X-ray unit, an expanded duct of the right or left lobe of the liver is punctured through the skin. After evacuation of bile, a contrast agent is injected into the lumen of the bile duct and a series of images is taken. This allows you to get a clear image of the biliary tract, determine the cause of obstructive jaundice and the level of obstruction.

Additional methods of examination include computed tomography and video duodenoscopy.

• Computed tomography (CT) of the abdominal cavity is used if there is a suspicion of external compression of the bile ducts, or the presence of a neoplasm in their lumen.
• Videoduodenoscopy – endoscopic examination, in which a special endoscope with lateral optics is used, which allows a good examination of the area of ​​the large duodenal papilla or “papilla of Vater” (the place where the bile ducts enter the duodenum).This is a very important study, since sometimes the cause of choledocholithiasis is the pathology of the Vater papilla (inflammation, cicatricial stricture, tumor, or wedged calculus).

Main manifestations of choledocholithiasis

• Attack of biliary colic.
  Concrements in hepaticoholedochus injure its wall. Damage to the mucosa occurs especially easily in the narrowest part – in the area of ​​the large duodenal papilla.Therefore, the main and most striking symptom of hepatic colic is pain. The sensation of pain in choledocholithiasis practically does not differ from colic in cholecystolithiasis. Its irradiation to the back or lower back is characteristic. The pain can become shingles in the event that the overlap with calculus occurred in the area of ​​the Vater papilla, located in the duodenum 12. In this case, there is a violation of the outflow of bile and pancreatic juice, as a result, the pancreas suffers.

• Mechanical (subhepatic) jaundice.
  When the stones obstruct the duct, the pressure rises in the biliary tract, the latter expand, but the blockage of the stone prevents the flow of bile into the intestinal tube, the so-called acholic stool (clarification of feces) and dark urine (beer-colored) appear.
  Thus, obstructive jaundice develops. Difficulty in the outflow of bile through the biliary tract leads to the fact that bilirubin appears in the blood – a bile pigment with which the tissues of a sick person are saturated.Human skin, sclera, mucous membranes become yellow.

• However, complete blockage and persistent jaundice with choledocholithiasis are not so common. At the same time, any obstacle to the outflow of bile creates favorable conditions for the development of infection and inflammation in the ducts. There is cholangitis , which easily develops against the background of damage to the mucous membrane. As a result of repeated trauma and inflammation, narrowing of the lumen of the duct along its length and in the region of the large duodenal papilla can form – stenosing cholangitis and papillitis.The spread of the inflammatory process up, towards the liver, can lead to a serious complication: cholangiogenic liver abscess. It should also be noted that the diameter of the common bile duct, of course, reflects the state of hypertension in it, but this is not always the case – with narrow ducts, choledocholithiasis can also form. The inflammatory process is manifested by an increase in body temperature, chills, and itchy skin. Cholangitis is typically accompanied by septic fever.Less typical for choledocholithiasis are small temperature peaks accompanying attacks of pain.

• At latent choledocholithiasis is characterized by a complaint of dull pain under the right costal arch.

• At dyspeptic form of choledocholithiasis the patient complains of uncharacteristic pressing pain under the right costal arch or in the epigastric region, dyspepsia, nausea, belching, gas and intolerance to fatty foods.

More about complications of choledocholithiasis

1. 1. Cholangitis. As mentioned earlier, in the presence of stones in the bile ducts, the infection has the conditions for its development, this leads to inflammation – cholangitis. When this complication occurs, a high temperature appears with chills and torrential sweats, severe pain in the right hypochondrium, nausea, vomiting. severe general weakness. The danger of this complication is associated with the fact that against the background of the developing infection, liver function is impaired.In addition, if treatment is not carried out in a timely manner, there is a danger of the formation of a liver abscess, as mentioned above, and in the future – the development of general sepsis and liver failure.

2. 2. Jaundice . Always stagnant. The blockage is usually incomplete and the intensity of the increase in bilirubin fluctuates. Suspicious of choledocholithiasis should be not only any jaundice against the background of hepatic colic, but also fleeting subicterus, especially if it is often repeated.However, even severe choledocholithiasis does not always manifest itself as jaundice. Kehr also noted that sometimes when stones are piled up, bile, “like a mountain stream, freely pours over the stones.” More than 1/3 of patients with choledocholithiasis do not have jaundice. Much less often there is a manifestation of jaundice without accompanying biliary colic.

3. 3. Acute pancreatitis. The common bile duct and the pancreatic duct in humans in 70% of cases merge into one channel and together flow into the duodenum.When this common canal is blocked by a stone (this usually happens at the site of exit into the duodenum), then both bile and pancreatic enzymes lose the ability to be secreted into the intestines. There is an increase in pressure in the bile and pancreatic ducts, which leads to a serious complication – acute pancreatitis. Acute inflammation of the pancreas is a very serious illness, often fatal. Immediate surgical treatment is required in order to remove this obstacle, as well as other therapeutic measures.

Stones in the bile ducts – operation

Treatment of choledocholithiasis can only be surgical. However, this does not mean that a large operation with a large incision in the abdomen must be performed.
Most often, with choledocholithiasis, the removal of calculi of the bile ducts is carried out endoscopically.

In the hospital, the patient undergoes ERCP to clarify the presence of a stone, its localization and other parameters.If the diagnosis of choledocholithiasis is confirmed, this study turns from diagnostic to therapeutic. Dissection of the narrowed zone of the Vater’s papilla (papillosphincterotomy), crushing of stones (lithotripsy) or their removal (extraction) is performed. The surgeon’s tactics depend on the size of the stone. Stones more than 2 cm are usually crushed, less than 1 cm more often go away on their own within 2 days. But as practice shows, in most cases, in order to remove or ensure the independent passage of stones, one has to resort to endoscopic papillosphincterotomy.This is rarely avoided.

When it is impossible to remove the stone endoscopically, they resort to surgery. The operation is performed by the classical method or by laparoscopy. During the operation, the common bile duct is dissected (choledochotomy) with a special instrument and the stones are removed. In all cases of choledocholithiasis treatment, the gallbladder is removed at the same time (if it has not been removed earlier). In the future, after surgical treatment, it is necessary to undergo a postoperative examination, follow the recommendations on the regimen, nutrition and medication, which will be prescribed by the attending physician in the hospital.

In any case, the tactics of examination and treatment should be determined by a specialist and directed from simple methods of diagnosis and treatment to more complex ones.