What are gallstones and how do they form. What symptoms indicate a gallbladder attack. How are gallstones diagnosed and treated. Can gallstones be prevented through lifestyle changes. Who is at higher risk of developing gallstones.

Understanding Gallstones: Formation and Composition

Gallstones are hard deposits that form inside the gallbladder, a small, pear-shaped organ located beneath the liver. These stones can vary in size, ranging from tiny grains of sand to golf ball-sized formations. But what exactly are they made of?

The majority of gallstones (about 80%) are composed of cholesterol. Under normal circumstances, bile acids break down cholesterol. However, when the liver produces an excess of cholesterol that overwhelms the bile’s capacity to dissolve it, the surplus solidifies into stones. The remaining gallstones are primarily made of bilirubin, a yellowish pigment resulting from the breakdown of red blood cells.

Do certain factors contribute to gallstone formation? Indeed, several conditions can increase the likelihood of developing gallstones:

• Imbalances in bile composition
• Incomplete emptying of the gallbladder
• High-fat diets leading to increased cholesterol production
• Rapid weight loss, which can alter bile chemistry

Recognizing the Signs: Symptoms of Gallstones

Many individuals with gallstones remain asymptomatic, a condition referred to as “silent gallstones.” However, when symptoms do manifest, they can be quite severe and alarming. What should you watch out for?

A gallbladder attack, typically triggered when a stone becomes lodged in a bile duct, can cause:

• Intense pain in the upper right abdomen
• Discomfort radiating to the upper back
• Nausea and vomiting
• Fever
• Jaundice (yellowing of the skin)

These attacks often occur after heavy meals, particularly in the evening or during the night. They generally subside once the stone dislodges, but prolonged blockages can lead to complications. Is immediate medical attention necessary? If a gallbladder attack persists for several hours, it’s crucial to seek medical help promptly.

Risk Factors: Who’s More Likely to Develop Gallstones?

While gallstones can affect anyone, certain demographic groups and lifestyle factors are associated with an increased risk. Understanding these risk factors can help individuals take preventive measures or seek early diagnosis.

Who falls into the high-risk categories for gallstone formation?

• Women, especially those who are pregnant or taking birth control pills
• Individuals over 60 years of age
• People with diabetes
• Those with a family history of gallstones
• Individuals following high-fat diets
• People who are overweight or obese
• Those experiencing rapid weight loss

Does this mean that individuals in these categories are destined to develop gallstones? Not necessarily. While these factors increase the risk, many people in high-risk groups never develop gallstones, and conversely, some without risk factors may still be affected.

Diagnostic Approaches: Identifying Gallstones

Diagnosing gallstones can be challenging due to the similarity of symptoms with other conditions. How do medical professionals confirm the presence of gallstones?

The diagnostic process typically involves a combination of methods:

1. Physical examination: Doctors check for signs such as abdominal tenderness and jaundice.
2. Blood tests: These can help identify signs of infection or obstruction.
3. Imaging tests: Ultrasounds and CT scans provide visual confirmation of gallstones and their location.

In cases where a gallstone is suspected to be lodged in a bile duct, additional procedures may be necessary for both diagnosis and potential stone removal. How accurate are these diagnostic methods? While no single test is 100% definitive, the combination of clinical evaluation and imaging studies provides a high degree of accuracy in diagnosing gallstones.

Treatment Options: Managing Gallstone-Related Issues

The approach to treating gallstones depends on the severity of symptoms and the results of diagnostic tests. What are the primary treatment options available?

1. Watchful Waiting

For asymptomatic gallstones or after a single mild attack, doctors may recommend a “wait and see” approach. This involves monitoring the condition without immediate intervention, as some cases may resolve on their own.

2. Surgical Intervention

Cholecystectomy, or surgical removal of the gallbladder, is the most common and effective treatment for symptomatic gallstones. Why is surgery often recommended? Once an individual experiences a gallbladder attack, the likelihood of recurrence is high (up to 70%). Surgery prevents future attacks and potential complications.

Laparoscopic cholecystectomy is the preferred surgical method, involving small incisions and specialized tools. This minimally invasive approach typically results in a shorter hospital stay (usually about one day) and faster recovery compared to traditional open surgery.

3. Alternative Treatments

For individuals who are not suitable candidates for surgery due to health concerns, alternative treatments may be considered:

• Sound wave therapy (lithotripsy): This non-invasive method uses sound waves to break up gallstones, allowing them to pass through the digestive system naturally.
• Medications: Certain drugs can help dissolve gallstones over time, though this approach is not effective for everyone and may take months or years to show results.

Are these alternative treatments as effective as surgery? While they can be beneficial in specific cases, they generally have lower success rates and a higher risk of gallstone recurrence compared to surgical removal of the gallbladder.

Prevention Strategies: Reducing the Risk of Gallstone Formation

While it’s not always possible to prevent gallstones, certain lifestyle modifications may help reduce the risk of their formation. What steps can individuals take to minimize their chances of developing gallstones?

• Maintain a healthy diet: Focus on balanced nutrition with moderate fat intake.
• Achieve and maintain a healthy weight: Obesity is a significant risk factor for gallstones.
• Avoid rapid weight loss: Crash diets can increase the risk of gallstone formation.
• Stay hydrated: Adequate fluid intake may help prevent bile from becoming too concentrated.
• Exercise regularly: Physical activity can help maintain a healthy weight and may improve gallbladder function.

Can these preventive measures guarantee freedom from gallstones? While they can significantly reduce the risk, it’s important to note that some factors, such as age, gender, and genetic predisposition, are beyond individual control.

Living Without a Gallbladder: Post-Surgery Considerations

For many individuals who undergo gallbladder removal, a common concern is how life will change without this organ. How does the body adapt to the absence of a gallbladder?

The gallbladder’s primary function is to store and concentrate bile, releasing it when needed for digestion. After its removal:

• The liver continues to produce bile, which flows directly into the small intestine.
• Most people can resume a normal diet and lifestyle after recovery.
• Some individuals may experience temporary changes in bowel habits, which typically resolve over time.

Are there long-term dietary restrictions after gallbladder removal? In most cases, no specific diet is required long-term. However, some people find that gradually reintroducing fatty foods and increasing fiber intake helps manage any digestive changes.

Complications and When to Seek Help: Recognizing Serious Gallstone Issues

While many cases of gallstones can be managed effectively, certain situations require immediate medical attention. What complications can arise from untreated gallstones?

• Cholecystitis: Inflammation of the gallbladder
• Choledocholithiasis: Blockage of the common bile duct
• Cholangitis: Infection of the bile duct system
• Pancreatitis: Inflammation of the pancreas due to gallstone blockage

When should you seek emergency medical care? If you experience severe abdominal pain lasting more than a few hours, especially if accompanied by fever, chills, or jaundice, it’s crucial to seek immediate medical attention. These symptoms could indicate a serious complication that requires prompt treatment.

Understanding gallstones, from their formation to treatment options, empowers individuals to make informed decisions about their health. While gallstones can be a painful and concerning condition, modern medical approaches offer effective solutions for managing and treating this common digestive issue. By recognizing the symptoms, understanding risk factors, and adopting healthy lifestyle practices, individuals can take proactive steps towards maintaining gallbladder health and overall well-being.

Gallstones – familydoctor.org

What are gallstones?

Gallstones are hard deposits that can form inside the gallbladder. The gallbladder is a small, pear-shaped organ just under your liver. It stores bile, the digestive fluid that is made by the liver. Sometimes the bile becomes solid and forms stones. Some are as small as a grain of sand. Others can be the size of a golf ball.

Symptoms of gallstones

Most people who have gallstones never experience symptoms. These are called silent gallstones. Sometimes, a gallstone can leave your gallbladder and go into a bile duct. If a gallstone gets stuck in that passageway and blocks it completely, you may experience:

• Severe pain in the right upper part of your belly.
• Pain in your upper back.

This is known as a gallbladder attack. The pain usually starts suddenly and lasts for several hours. Complete or partial blockage can also cause your gallbladder to get irritated and inflamed. If this happens, you may:

• Have pain that lasts several hours.
• Develop a fever.
• Vomit or feel nauseated.

In addition, your skin may turn a yellowish color, known as jaundice.

Gallbladder attacks tend to happen after heavy meals. They’re more likely to happen in the evening or during the night. They stop when the gallstones move and are no longer lodged in the duct. If the duct remains blocked for more than a few hours, complications can occur. Call your doctor right away if you’re experiencing a gall bladder attack that lasts more than several hours.

What causes gallstones?

Gallstones are causes by imbalances in the substances that make up bile.

Most gallstones (80%) are made of cholesterol. Normally, acids in the bile break down cholesterol. But a high-fat diet can lead the liver to produce extra cholesterol that the acids can’t break down. This leads the excess cholesterol to solidify. Other gallstones are made of bilirubin. Bilirubin is a yellowish pigment in bile that is produced when red blood cells break down. These stones are formed when there is too much bilirubin in the bile.

Gallstones may also form if the gallbladder doesn’t empty itself completely.

You’re more likely to get gallstones if you:

• Are a woman.
• Are more than 60 years of age.
• Have diabetes.
• Have a family history of gallstones.
• Are pregnant.
• Take birth control pills.
• Eat a diet high in fat.
• Are overweight or obese.
• Are on a low-calorie diet and have recently lost weight very quickly.

How are gallstones diagnosed?

Gallstones can be hard to diagnose because they share symptoms with other conditions. Your doctor will do a physical exam to look for signs of gallstones. This will include looking for yellowing of the skin and tenderness in the abdomen. He or she may order blood tests. They may also order imaging tests. These could include an ultrasound or CT scan, which will make pictures of your gallbladder and bile ducts. If your doctor thinks you have a gallstone stuck in a bile duct, they could try to remove the stone.

Can gallstones be prevented or avoided?

In most cases, gallstones can’t be prevented or avoided. Eating a healthy diet, maintaining a healthy weight, and avoiding rapid weight loss could reduce your risk.

Gallstones treatment

Your treatment depends on the severity of your symptoms and what the doctor finds from the tests.

• No treatment.If the gallstones are floating free and you have no pain, you won’t need treatment.
• Wait and see.If you have one gallbladder attack, your doctor may want to take a wait-and-see approach. The problem may solve itself. Then if you have more attacks, your doctor may recommend surgery.
• Surgery. Once you have one gallbladder attack, the chance of having another one is high (up to 70%). Many doctors will suggest surgery to remove your gallbladder to prevent a future attack. If your gallbladder is irritated or inflamed, most doctors will want to take it out right away. The surgery is most often done with laparoscopic surgery. This means that small tools are inserted into small incisions in your abdomen to remove your gallbladder. The surgery is safe and effective. It limits your hospital stay to about 1 day. Without surgery, the gallbladder can get infected. It might even burst, causing further problems.

Are there other treatments?

Other treatments are available for people who would have a high risk in surgery. This could be because they are elderly, or have heart problems or lung disease. However, gallstones usually return when they aren’t treated with surgery. Other options include:

• Sound wave therapy.This can break up the stones so they can move into the intestine without problem. But not everyone can receive this treatment. If you have more than 1 gallstone, if your gallstone is large, or if you have other medical conditions, you may not be able to receive sound wave therapy.
• Medicine. You might be able to take a pill to dissolve the stones. This pill doesn’t work for everyone and can be expensive. It can take 2 years or longer to work, and gallstones could return after you finish treatment.

Surgery is the best way to cure symptomatic gallstones. Talk with your doctor about what is right for you.

Living with gallstones

If your gallstones aren’t causing symptoms, you may live the rest of your life without any problems. If you do experience symptoms, your doctor may want to remove your gallbladder. You don’t need your gallbladder to live. So when it’s removed, you won’t notice much difference. You may have diarrhea at first. If you have diarrhea that lasts more than 3 months after surgery, talk to your doctor. Some people may find they need to eat a lower-fat diet.

Questions to ask your doctor

• Are there lifestyle changes I can make to prevent gallstones?
• Am I at risk of having another gallstone?
• What should I do if I have a gallbladder attack?
• Is there any kind of medicine that will make a gallbladder attack less painful?
• Will I need surgery to remove my gallbladder? Are there other options?
• Is having a gallstone a sign of another condition?

Resources

National Institutes of Health, MedlinePlus: Gallstones

National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases: Gallstones

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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90,000 symptoms, treatment. What causes stones in the gallbladder?

The disease ranks third in prevalence after cardiovascular and endocrine pathologies. The disease is more often diagnosed in women.

Gallbladder stones: causes and mechanism of disease development

Stones in the gallbladder and bile ducts are formed due to a violation of the process of metabolism of bile components. Pathology develops with the simultaneous presence of the following factors: the production of lithogenic bile (oversaturated with cholesterol), an imbalance between the activity of pronucleating and antinucleating components, and a decrease in the contractile function of the gallbladder.

Among the main causes of gallstone disease are:

• hereditary factor;
• overweight;
• dramatic weight loss;
• eating foods high in cholesterol and low in fiber;
• inflammatory processes and biliary dyskinesia;
• taking oral contraceptives;
• malabsorption syndrome;
• disorders in the work of the endocrine system;
• Crohn’s disease;
• liver disease.

Also, the disease can develop during pregnancy.

There are 2 main mechanisms for the development of the process of formation of stones in the gallbladder: vesicoinflammatory and hepatometabolic. The first variant develops against the background of an inflammatory process, leading to a violation of the acid-base balance of bile and a decrease in the protection of protein fractions, which causes crystallization of bilirubin. Further, the epithelium and mucus join it, which causes the formation of a calculus. In the second case, the disease develops against the background of a violation of the metabolic processes of the liver, which is often the result of existing liver diseases, unbalanced nutrition, endocrine disorders, hypothyroidism.

Symptoms of cholelithiasis

The disease develops gradually and may not manifest itself in the early stages. The average growth rate of stones is 3-5 mm per year, so the first symptoms often appear only after a few years.

Symptoms of gallstone disease are varied and depend on the location of the stones, their size, etc. You can suspect stones in the gallbladder by the following signs:

• pain and heaviness in the right hypochondrium;
• taste of bitterness in the mouth;
• nausea;
• flatulence and other bowel disorders;
• belching of air;
• yellowing of the skin and mucous membranes.

Many of these symptoms may indicate other diseases, so for an accurate diagnosis, you need to see a doctor. You can contact a general practitioner or go directly to a gastroenterologist. The main method for diagnosing cholelithiasis is ultrasound, it allows not only to confirm the diagnosis, but also to determine the exact localization of stones and their size.

Treatment of cholelithiasis

If stones are found in the gallbladder, treatment should be started immediately. Otherwise, the disease will progress and lead to complications, including: acute cholecystitis, pancreatitis, perforation of the gallbladder, stones in the intestines and the formation of intestinal obstruction. Also, over time, the disease can provoke the development of an oncological process in the gallbladder.

The possibilities of modern medicine make it possible to successfully treat gallstone disease. The main thing is to choose the right tactics. There are 2 main options here:

• conservative treatment;
• surgery.

Conservative treatment is aimed at dissolving stones with the help of special preparations and crushing them with the help of a laser or ultrasound. There are a number of contraindications to these methods of treatment, besides, it does not always completely solve the problem, therefore, an operation is often prescribed for stones in the gallbladder – cholecystectomy, which involves the removal of the gallbladder.

To date, most often the removal of the gallbladder is carried out by the modern laparoscopic method, since the strip operation requires a longer rehabilitation. Laparoscopy is performed under general anesthesia: the surgeon makes 2-4 punctures of the abdominal wall. A video endoscope with a light source is inserted into one puncture, and manipulators into the others. The whole process usually takes 1-2 hours. After that, the patient is sent to the hospital. In the absence of complications, in most cases, the patient is discharged after one or two days.

Laparoscopic cholecystectomy can be done at the DIALINE Surgery Center. The operation is carried out using advanced high-precision equipment, which, combined with the extensive experience of our specialists, allows us to solve the problem quickly and without consequences.

You can make an appointment with a gastroenterologist either on your own in your DIALINE personal account or by ordering a call back.

Do not delay treatment, see a doctor right now:

Gallstone disease – causes, symptoms, diagnosis, complications, treatment of gallstones

Gallstone disease is a chronic disease of the organs of the hepatobiliary system, characterized by a violation of the synthesis and circulation of bile, the formation of stones in the gallbladder or bile ducts. Most often, the pathology is manifested by paroxysmal pain in the right hypochondrium – biliary colic, jaundice. A complete cure is possible only by surgery. Without removal of calculi, the development of severe, including life-threatening, complications is possible – cholecystitis, peritonitis and others.

According to the clinical recommendations of the Russian Federation, the prevalence of gallstone disease in developed countries reaches 10-15%, which is explained by the nature of the diet of their inhabitants. In Africa and Asia, this figure is much lower and is about 3.5-5%. Mostly people aged 40 to 69 are ill. In women, the risk of developing gallstone disease is 2-3 times higher than in men.

Causes

The main cause of stone formation in the gallbladder and ducts is an increased concentration of bile. When it is oversaturated with cholesterol, large calculi of a yellowish-white color are formed. If there is an inflammatory process in the bile ducts, as well as with hemolysis and cirrhosis of the liver, pigmented brown or black stones are formed.

The following factors contribute to the development of gallstone disease:

• genetic predisposition;
• high-calorie diet with excessive intake of fatty foods and simple carbohydrates;
• sedentary lifestyle;
• obesity;
• taking hormonal contraceptives;
• pregnancy;
• rapid weight loss, low-calorie diet;
• helminthiasis;
• alcohol abuse;
• chronic liver pathology, diabetes mellitus, Crohn’s disease, anemia, cystic fibrosis, infectious process in the biliary tract;
• certain medications, eg octreotide, clofibrate.

Symptoms

Pathology for a long time may not have clinical manifestations. Symptoms of gallstone disease appear with inflammation or obstruction in the biliary tract, when stones from the cavity of the gallbladder move into its neck or ducts and clog them. This process may be accompanied by an attack of biliary colic, symptoms of acute calculous cholecystitis, as well as chronic cholecystitis, cholangitis, biliary pancreatitis.

Biliary colic has the following symptoms:

• Severe pain in the projection of the gallbladder. It starts in the right hypochondrium, suddenly and can give in the back, under the right shoulder blade, in the neck, in the right shoulder. In rare cases, its migration to the region of the heart causes angina pectoris. The duration of such an attack in cholelithiasis is from a couple of minutes to several days. The nature of pain is first acute, then constant, aching.
• Taste of bitterness in the mouth, loss of appetite.
• Dyspeptic manifestations. Nausea, vomiting with an admixture of bile, not leading to relief, frequent and loud belching of air or food eaten.
• Increased body temperature. With purulent cholecystitis, fever can reach 39 ° C and above.
• Indigestion. Often the patient has bloating, constipation of the atonic type.

An exacerbation of gallstone disease can be triggered by a violation of the diet. The movement of calculi can also be caused by shaking riding, torso tilts. With the development of choledocholithiasis – the entry of stones into the bile ducts and their blockage – mechanical jaundice develops. With it, the skin, sclera of the eyes and mucous membranes become icteric, there is itching of the skin, darkening of the urine and discoloration of the feces.

Often cholelithiasis appears together with hiatal hernia, peptic ulcer of the stomach or duodenum, diverticulosis of the colon. This is due to the common innervation of the affected organs and similar predisposing factors for these pathologies. In such a situation, the clinical picture of the disease may not be entirely characteristic.

Diagnostics

The diagnosis of gallstone disease is handled by a gastroenterologist, a surgeon, a general practitioner and a general practitioner. In a conversation with the patient, he finds out the duration and nature of the symptoms, the presence of predisposing factors. An important place in the examination is occupied by palpation of the right upper quadrant of the abdomen, during which pain and other characteristic signs of acute cholecystitis are determined: a symptom of Zakharyin, Ortner, Murphy.

Further examination includes the use of laboratory and instrumental methods:
1. Complete blood count. Neutrophilic leukocytosis and accelerated ESR indicate inflammation in the gallbladder – acute cholecystitis.
2. Biochemical blood test. Allows you to identify a typical for cholelithiasis increase in cholesterol and bilirubin, alkaline phosphatase activity. Blockage of the bile ducts and bile stasis often lead to liver damage, so indicators such as alanine aminotransferase, aspartate aminotransferase, gamma-glutamyltranspeptidase, total and C-reactive protein are also important in cholelithiasis.
3. Tumor markers in serum. Their determination is aimed at identifying signs of cancer of the hepatobiliary system.
4. General analysis of urine. Particular attention is paid to the level of bilirubin metabolic products.
5. Ultrasound of the liver and biliary tract. Method of choice in the diagnosis of gallstone disease. During the examination, the so-called “non-functioning” gallbladder can be determined, containing a small amount of bile or, on the contrary, an organ stretched and not contracting in response to choleretic food. There is also severe pain in the right hypochondrium when pressed by the probe (“Murphy’s ultrasound symptom”), the presence of fluid around the gallbladder, thickening of its wall more than 4 mm. Despite the high sensitivity of ultrasound, with choledocholithiasis, it is not sufficiently informative.
6. Plain radiography of the abdominal cavity. The method allows to detect gallstones with a sufficient content of calcium in them and complications of cholelithiasis. The method is also used to recognize emphysematous cholecystitis, porcelain gallbladder, lime bile.
7. X-ray studies with contrast. During execution, a “disabled”, non-staining gallbladder can be determined. Endoscopic retrograde cholangiography is an invasive method that includes cannulation of the major papilla with the introduction of contrast through the choledochus. Percutaneous transhepatic cholangiography is performed if other contrast methods cannot be performed. Oral contrast-enhanced cholecystography and intravenous dye cholangiography are rarely performed.
8. Esophagastroduodenoscopy. A method of visualization of the duodenum with a mandatory examination of the major duodenal papilla.
9. Magnetic resonance cholangiopancreatography. It has high accuracy in detecting small calculi from 2 mm in size, including those in the area of ​​the bile ducts (situations where ultrasound capabilities are insufficient).
10. Endoscopic ultrasound examination of the pancreatic-biliary zone. This study allows you to recognize even very small stones, sludge, strictures of the terminal part of the common bile duct. However, the invasiveness of the procedure and the ability to assess the ductal system only in the area where it enters the duodenum impose restrictions on its implementation.
11. Bilioscintigraphy. This is a radioisotope study with 99mTc labeled iminodiacetic acids. Gallstone disease is indicated by the absence of visualization of the gallbladder, accompanying not only the obstruction of the cystic duct, but also acute or chronic cholecystitis or previous cholecystectomy.

Complications

In cholelithiasis, the walls of organs are traumatized by a stone with the development of inflammation in them, so the pathology can be complicated by cholangitis, cicatricial fusion of the major duodenal papilla, the formation of fistulous tracts between the biliary tract and neighboring organs or the abdominal cavity.

Untimely detection and treatment of acute cholecystitis is dangerous for the development of such fatal complications of cholelithiasis as empyema, gangrene and perforation of the gallbladder, peritonitis.

Treatment

When cholelithiasis is established, the patient is prescribed a diet, he is also recommended lifestyle correction and weight loss. Meals should be frequent and in small portions, with the exception of fried and fatty foods, every 3-4 hours, balanced, contain proteins, carbohydrates, and dietary fiber.

Drug therapy is effective only at the initial stage of gallstone disease, before the formation of calculi. In this case, the treatment is aimed at normalizing the composition of bile and preventing its stagnation. Ursodeoxycholic acid preparations are used, which reduces the saturation of bile with cholesterol and partially extracts it from stones. To alleviate the symptoms of acute calculous cholecystitis, patients are prescribed antispasmodics.