What are gallstones and how do they form. Can gallstones go away on their own without surgical intervention. What symptoms indicate the presence of gallstones. When should you seek medical attention for gallstone-related issues. What are the potential complications of untreated gallstones.

Understanding Gallstones: Formation and Types

Gallstones are hardened deposits that form in the gallbladder, a small organ located in the upper right quadrant of the abdomen. These stones can vary in size, ranging from as small as a grain of rice to as large as a golf ball. The gallbladder’s primary function is to store bile, a digestive fluid produced by the liver. When gallstones develop, they can interfere with this process and cause various health issues.

There are two main types of gallstones:

• Cholesterol gallstones: These account for approximately 80% of all cases and are typically greenish-yellow in color. They consist primarily of hardened cholesterol and lipid-protein complexes.
• Pigment gallstones: These are smaller, black or brown stones formed due to an excess of bilirubin in the bile. Bilirubin is a byproduct of red blood cell breakdown.

Recognizing the Symptoms of Gallstones

Many people with gallstones may not experience any symptoms, a condition known as asymptomatic cholelithiasis. However, when gallstones cause blockages or irritation, they can lead to various symptoms:

• Sudden, intense pain in the upper right abdomen or center of the abdomen below the breastbone
• Pain that radiates to the back between the shoulder blades or the right shoulder
• Nausea and vomiting
• Fever and chills (in cases of infection)
• Jaundice (yellowing of the skin and eyes)
• Dark urine and light-colored stools

Do gallstone symptoms always indicate a medical emergency? While occasional mild discomfort may not require immediate attention, persistent or severe symptoms should prompt a visit to the doctor. Seek medical help if you experience intense abdominal pain lasting several hours, accompanied by fever or jaundice.

The Root Causes of Gallstone Formation

While the exact cause of gallstones remains unclear, several factors contribute to their formation:

1. Excess cholesterol in bile: When the liver produces more cholesterol than the bile can dissolve, the excess may crystallize and form stones.
2. High levels of bilirubin: Certain conditions like liver cirrhosis or blood disorders can lead to increased bilirubin production, promoting stone formation.
3. Incomplete gallbladder emptying: If the gallbladder doesn’t empty properly, bile can become concentrated, leading to stone formation.

Are certain individuals more prone to developing gallstones? Yes, several risk factors increase the likelihood of gallstone formation:

• Genetic predisposition
• Obesity
• Rapid weight loss
• Diabetes mellitus
• Liver cirrhosis
• Certain blood disorders (e.g., sickle cell anemia, leukemia)
• Pregnancy
• Use of estrogen-containing medications

Potential Complications of Untreated Gallstones

If left untreated, gallstones can lead to serious complications:

• Acute cholecystitis: Inflammation of the gallbladder due to stone blockage
• Acute cholangitis: Infection of the bile ducts, which can lead to sepsis if untreated
• Pancreatitis: Inflammation of the pancreas caused by gallstone blockage of the pancreatic duct
• Gallbladder cancer: While rare, chronic irritation from gallstones may increase the risk of gallbladder cancer

Can gallstone complications be life-threatening? In severe cases, untreated gallstone complications can indeed be life-threatening. Acute cholangitis, for example, can lead to sepsis, a potentially fatal systemic infection.

Diagnostic Approaches for Gallstones

To diagnose gallstones, healthcare providers typically use a combination of methods:

• Ultrasound: The most common and non-invasive method to visualize gallstones
• CT scan: Provides detailed images of the gallbladder and surrounding structures
• HIDA scan: A nuclear medicine test that evaluates gallbladder function
• Blood tests: To check for signs of infection or obstruction
• Endoscopic retrograde cholangiopancreatography (ERCP): A procedure that combines endoscopy and X-rays to diagnose and potentially treat gallstone-related issues

How accurate are these diagnostic methods? Ultrasound is highly accurate for detecting gallstones, with a sensitivity of about 95% for stones larger than 2mm. However, combining multiple diagnostic approaches can provide a more comprehensive assessment of gallstone-related issues.

Treatment Options: From Conservative Management to Surgery

The treatment for gallstones depends on the severity of symptoms and the patient’s overall health. Options include:

1. Watchful waiting: For asymptomatic gallstones, monitoring without intervention may be recommended.
2. Medications: Ursodeoxycholic acid can be used to dissolve small cholesterol stones over time.
3. Lithotripsy: Sound waves are used to break up stones, but this is only effective for certain types of stones.
4. Cholecystectomy: Surgical removal of the gallbladder, often performed laparoscopically.
5. ERCP: Can be used to remove stones from the bile duct.

Is surgery always necessary for gallstones? No, surgery is not always required. The decision depends on the frequency and severity of symptoms, the size and location of the stones, and the patient’s overall health. Asymptomatic gallstones may not require any treatment.

Can Gallstones Dissolve or Pass Naturally?

One of the most common questions patients ask is whether gallstones can go away on their own. While it’s possible for small gallstones to pass through the bile duct and out of the body naturally, this is not common and can be painful. In some cases, very small stones may dissolve over time with dietary changes and medication.

However, it’s important to note that once gallstones form, they typically don’t disappear without intervention. The likelihood of spontaneous resolution depends on several factors:

• Size of the stones: Smaller stones are more likely to pass or dissolve than larger ones.
• Composition of the stones: Cholesterol stones may be more responsive to dietary changes and medications than pigment stones.
• Location of the stones: Stones in the gallbladder are less likely to pass than those already in the bile duct.

What dietary changes can help manage gallstones? While diet alone cannot cure gallstones, certain changes may help prevent their formation or reduce symptoms:

• Maintain a healthy weight
• Eat a balanced diet rich in fiber
• Limit high-fat and high-cholesterol foods
• Stay hydrated
• Exercise regularly

Living with Gallstones: Lifestyle Modifications and Management

For individuals diagnosed with gallstones, especially those opting for conservative management, certain lifestyle modifications can help manage symptoms and potentially prevent complications:

1. Dietary adjustments: Adopting a low-fat diet can reduce the frequency of gallbladder attacks.
2. Weight management: Gradual weight loss can help prevent stone formation, but rapid weight loss should be avoided as it can increase the risk.
3. Regular exercise: Physical activity may help prevent gallstone formation by improving cholesterol metabolism.
4. Stress reduction: Some studies suggest that stress may contribute to gallstone formation, so stress management techniques may be beneficial.
5. Avoiding trigger foods: Identify and avoid foods that seem to trigger symptoms.

How effective are these lifestyle changes in managing gallstones? While lifestyle modifications can help manage symptoms and may prevent new stone formation, they are unlikely to dissolve existing large gallstones. These changes are most effective when combined with medical supervision and appropriate treatment.

Monitoring and Follow-up

For patients with asymptomatic gallstones or those managing symptoms conservatively, regular monitoring is crucial. This typically involves:

• Periodic ultrasound examinations to track stone size and number
• Regular check-ups to assess symptom progression
• Blood tests to monitor liver function and check for signs of complications

How often should follow-up appointments be scheduled? The frequency of follow-up appointments depends on individual circumstances but typically ranges from every 6 months to annually for asymptomatic cases. Symptomatic patients may require more frequent monitoring.

Emerging Treatments and Research in Gallstone Management

As medical science advances, new approaches to gallstone treatment are being explored:

• Improved lithotripsy techniques: More precise and effective methods of breaking up gallstones without surgery.
• Novel medications: Research into new drugs that can dissolve stones more effectively or prevent their formation.
• Minimally invasive procedures: Development of new techniques that can remove stones with less invasive methods than traditional surgery.
• Genetic research: Studies aimed at identifying genetic factors that contribute to gallstone formation, potentially leading to new preventive strategies.

What is the future of gallstone treatment? While surgery remains the gold standard for symptomatic gallstones, ongoing research may lead to more non-invasive options in the future, potentially allowing more patients to avoid surgery or manage their condition conservatively.

Personalized Treatment Approaches

The field of personalized medicine is also impacting gallstone management. Factors such as genetic predisposition, lifestyle, and specific stone composition are increasingly being considered to tailor treatment plans to individual patients. This approach may lead to more effective treatments with fewer side effects.

How does personalized medicine impact gallstone treatment? By considering individual factors, doctors can better predict which patients are likely to benefit from conservative management versus those who may need more aggressive treatment, leading to improved outcomes and patient satisfaction.

Prevention Strategies: Reducing Your Risk of Gallstones

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

1. Maintain a healthy weight: Obesity is a significant risk factor for gallstones.
2. Eat a balanced diet: Include plenty of fruits, vegetables, and whole grains.
3. Avoid rapid weight loss: Gradual weight loss is preferable to crash diets, which can increase stone formation.
4. Stay hydrated: Adequate fluid intake helps maintain proper bile composition.
5. Exercise regularly: Physical activity can help prevent gallstone formation.
6. Manage underlying conditions: Control diseases like diabetes that may increase gallstone risk.

Are there specific foods that can help prevent gallstones? While no single food can prevent gallstones, a diet rich in fiber, healthy fats (like those found in fish and nuts), and antioxidants may help reduce the risk. Some studies suggest that moderate coffee consumption may also have a protective effect.

The Role of Supplements

Some research suggests that certain supplements may help prevent gallstones or alleviate symptoms:

• Vitamin C: May help break down cholesterol in bile.
• Fish oil: Omega-3 fatty acids may help improve bile composition.
• Lecithin: May help dissolve cholesterol in bile.

However, it’s important to consult with a healthcare provider before starting any supplement regimen, as some supplements can interact with medications or have side effects.

How effective are supplements in preventing gallstones? While some studies show promising results, more research is needed to definitively prove the effectiveness of supplements in preventing or treating gallstones. They should not be considered a substitute for medical treatment or a healthy lifestyle.

Special Considerations: Gallstones in Specific Populations

Certain groups may have unique considerations when it comes to gallstone management:

Pregnant Women

Pregnancy increases the risk of gallstone formation due to hormonal changes. Management during pregnancy requires careful consideration of the risks and benefits of various treatments.

Elderly Patients

Older adults may have a higher risk of complications from both gallstones and their treatments. Conservative management may be preferred in some cases, depending on overall health status.

Patients with Chronic Conditions

Individuals with conditions like diabetes or liver disease may require specialized management strategies for their gallstones.

How does the approach to gallstone treatment differ in these populations? Treatment plans must be carefully tailored to account for the unique risks and needs of each group. For example, pregnant women may need to delay non-urgent treatments until after delivery, while elderly patients might benefit from less invasive approaches.

The Impact of Gallstones on Quality of Life

Living with gallstones can significantly affect a person’s quality of life, particularly if they experience frequent symptoms or complications. The impact may include:

• Dietary restrictions and changes in eating habits
• Chronic pain or discomfort
• Anxiety about potential attacks or complications
• Limitations on physical activities
• Frequent medical appointments and potential hospitalizations

How can patients cope with the psychological impact of gallstones? Support groups, counseling, and stress management techniques can be helpful for many patients dealing with chronic gallstone issues. Additionally, working closely with healthcare providers to develop an effective management plan can provide peace of mind and improve overall well-being.

Long-term Outlook

For many patients, the long-term outlook after gallstone treatment is positive. Those who undergo cholecystectomy often experience complete resolution of symptoms. However, a small percentage may experience post-cholecystectomy syndrome, which can include ongoing digestive issues.

What is the recurrence rate of gallstones after treatment? For patients who undergo cholecystectomy, gallstone recurrence is not possible since the gallbladder is removed. However, for those who opt for non-surgical treatments, there is a risk of recurrence, which varies depending on the specific treatment and individual factors.

In conclusion, while gallstones can be a challenging condition to manage, advances in medical understanding and treatment options have greatly improved outcomes for many patients. Whether through conservative management, medication, or surgical intervention, most individuals with gallstones can find relief and maintain a good quality of life with proper care and attention to their condition.

Can Gallbladder Stones Go Away Without Surgery?

The gallbladder is a small-sized organ located in the right upper quadrant of the abdomen,  below the liver. Its main function is to store bile juice that assists digestion. Gallbladder stones is a medical condition wherein hardened deposits of cholesterol and bilirubin develop and sometimes get lodged in the gallbladder or bile ducts. The size of these stones may vary from the size of a golf ball to a grain of rice. Many stones may develop simultaneously.  These stones can leave the gallbladder and get stuck along the way.

This is when a person may feel the first instance of abdominal pain and discomfort. Interestingly, large-sized gallbladder stones usually stay in the gallbladder and do not cause any discomfort. Depending on the size and discomfort caused, these stones can be removed surgically or via symptomatic care.

What are the types of gallbladder stones?

Depending on its composition, there are mainly two variants of gallbladder stones.

1. Cholesterol gallstones

These are the most common types. They account for almost 80% of all gallbladder stones. These stones are generally greenish-yellow in colour, constitute cholesterol and lipid-protein, and contain other components.

2. Pigmented gallstones

These are generally smaller in size and black or brown. These stones are formed due to the excess amount of bilirubin in the bile. Bilirubin is the byproduct of destroyed and fragmented red blood cells. This yellow coloured substance passes through the liver into the gallbladder and is then excreted.

What are the symptoms of gallbladder stones?

Usually, gallbladder stones do not exhibit any symptoms. However, if these stones lodge in the bile duct, it might lead to :

• Sudden and rapidly growing pain in the upper right part of your abdomen
• Sudden and rapidly increasing pain in the centre of your abdomen, just below your breastbone
• Back pain between your shoulder blades
• Pain in your right shoulder
• Nausea or vomiting

When do you need to visit the doctor?

Gallbladder stones may not show any signs or symptoms always. However, immediate medical help is required if constant, searing abdominal pain, nausea, and fever develop. Make a note of the symptoms and medical history. Gallbladder stones pain may last for several hours to a few minutes. If severe symptoms and inflammation like these mentioned below occur, it is advisable to seek professional help immediately.

1. Abdominal pain that lasts for several hours
2. Fever or body chills
3. Yellowish skin and eyes. This symptom may indicate jaundice.
4. Dark-coloured urine and light-colored stool

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What are the causes of gallbladder stones?

Researchers have not yet found the exact reason why gallbladder stones occur. These stones might be caused by:

1. Excess cholesterol in the bile: The body requires bile for digestion. It also dissolves cholesterol excreted by the liver. If the liver excretes more cholesterol than required,  the excess cholesterol may crystallize and eventually form gallbladder stones.
2. Excess bilirubin in the blood: Conditions like liver cirrhosis, biliary tract infections, and certain blood disorders can cause your liver to produce bilirubin in excess. This excess bilirubin can lead to the formation of gallbladder stones.
3. Incomplete emptying of the gallbladder: If it does not empty itself, there might be an accumulation of bile, causing gallbladder stones.

Several factors might put a person at risk of developing gallbladder stones. A few of them are:

1. Hereditary: If an immediate member of the patient’s family has a history of gallbladder stones, the chances of occurrence are higher.
2. Lifestyle: Some common reasons for developing gallbladder stones are obesity, rapid weight loss within a short period, and diabetes mellitus.
3. Medical: Suffering from liver cirrhosis, estrogen, blood disorders like sickle cell anaemia or leukaemia, and pregnancy are all risk factors associated with gallbladder stones.

What are the complications of gallbladder stones?

Several complications may occur due to the formation of gallbladder stones. The most common ones are:

1. Acute cholangitis: This condition refers to the infection of bile ducts due to blockage. Infected bile ducts may spread bacteria in the bloodstream, developing a severe health condition called sepsis.
2. Acute cholecystitis: When a gallbladder stone gets logged in the gallbladder’s neck causing intense pain and discomfort, it may lead to Acute Cholecystitis. In extreme cases, the gallbladder might get ruptured or burst.
3. Blockage of the pancreatic duct: The pancreatic duct facilitates the movement of pancreatic juices that aids digestion. With gallbladder stones blockage, inflammation in the pancreas may occur which causes intense excruciating abdominal pain
4. Cancer in the gallbladder: Gallbladder stones might cause gallbladder cancer in an extremely rare cases. History of gallbladder stones might increase the risk of cancer, though it is very rare.

What are the diagnostic procedures for gallbladder stones?

The doctor might perform the following diagnostic tests:

1. A blood test to check for infections
2. Abdominal ultrasound to check for gallbladder stones
3. CT scan is a specialized scan that enables the doctors to check for gallbladder stones.
4. Magnetic Resonance Cholangiopancreatography (MRCP) uses radio waves and magnetic pulses to check the liver and gallbladder functioning.
5. Cholescintigraphy (HIDA scan) involves the use of radioactive material. This scan allows the doctors to check whether the gallbladder contracts properly or not.
6. Endoscopic Retrograde Cholangiopancreatography (ERCP) involves the insertion of a  small tube, which will be passed through the endoscope to the biliary tree. A contrast dye would be injected through a small tube into the ducts, after which X-rays will be taken.
7. Endoscopic ultrasound is the combination of ultrasound and endoscopy conducted to check for gallbladder stones.

What are the treatment procedures for gallbladder stones?

Today, there are numerous treatments for gallbladder stones. The doctor might likely remove the gallbladder through surgical processes.. The removal of the gallbladder does not hinder the digestion process. The following are some of the surgical procedures used.

1. Laparoscopic cholecystectomy is the most common surgical process. It takes around 24 hours for the patient to get discharged after completing the procedure and about 2 to 3 days to recover fully.
2. Open cholecystectomy is a slightly longer procedure that involves removing the gallbladder through larger incisions in the belly. Undergoing this procedure might take a few days for the patient to get discharged and about 7 to 10 days for a full recovery.

Medications to dissolve gallstones: Medicines may help dissolve gallstones without surgery. However, in this way, it may take months or years of treatment to dissolve the gallstones. In addition, there are chances of the formation of gallstones again if treatment is stopped.

Medications for gallstones are not used commonly and are reserved for those who cannot undergo a surgery. Ursodiol  and chenodiol may be used to  dissolve cholesterol stones. They can cause mild diarrhea.

Shock wave therapy is another non-surgical technique, that uses high-frequency sound waves to break/fragment the stones. Afterwards, bile salt is administered to dissolve small ston pieces. This therapy is used rarely.

Doctors may also try to remove gallstones during an ERCP test. During this procedure, the physician inserts an instrument through the endoscope to attempt removing the stone.

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Can gallstones be prevented?

Since lifestyle is a significant contributor to gallbladder stones, a few preventive measures can be practised to lower the  risk.

1. Consumption of fiber-rich food. Fiber acts as a prebiotic that helps maintain the gut microbiota. It also helps facilitate proper digestion and overall health.
2. Maintaining a healthy weight decreases the chances of excess cholesterol in the bloodstream. Also, it also reduces the chances of being obese. 
3. A balanced diet helps facilitate better digestion, thus, reducing the chances of gallstones.
4. Slow and controlled weight loss reduces the risk of gallstones.
5. Women with high risk of gallstones should check with the doctor whether they should avoid the use of hormonal birth control.

Gallbladder stones are usually harmless and dissolve on their own. But, they may pose to be life-threatening if these stones block any duct or cause an infection. Hence, it is worthwhile to take preventive measures. Avoid processed food; instead, consume more fresh fruits, vegetables, legumes, grains, and nuts. Maintaining a healthy lifestyle reduces the chance of acquiring many diseases.

Frequently Asked Questions (FAQs)

1. Is it normal to have stones in the gallbladder?

Although a vast majority have gallbladder stones , symptoms or signs may not always occur. If, however, symptoms occur, seek medical help immediately.

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2. How much time is required to recover from passing a gallstone?

However, if one has undergone surgery, it might take up to a week of hospitalization, depending on the severity. Further, to resume daily work, it might take up to four to six weeks.

3. Does drinking water help with gallstones?

Yes, it does. Drinking adequate amounts of water helps the gallbladder and prevents the build-up of bile. This, in turn, prevents the formation of gallbladder stones.

4. Will the removal of the gallbladder hinder my digestion?

It is possible to live normally without the gallbladder. When your gallbladder is removed, bile flows directly from your liver into the small intestine, and this may sometimes cause diarrhoea. As bile does not accumulate in the gallbladder, the quantities of digestive fluid can’t be stored up and used to break down a meal, especially a fatty meal. But, this condition is not considered serious and can be corrected by simply limiting fat in the diet.

5. Will my gallbladder stones come back after they have been non-surgically regmoved?

There is a high probability that the gallbladder stones might recur. It is advisable to consume a healthy diet, exercise regularly, and increase water intake if one has suffered from gallbladder stones. Surgical intervention, however, makes sure that it does not recur in the future.

Gallstones – NHS

Your treatment plan for gallstones depends on how the symptoms are affecting your daily life.

If you don’t have any symptoms, active monitoring is often recommended. This means you won’t receive immediate treatment, but you should let your GP know if you notice any symptoms.

As a general rule, the longer you go without symptoms, the less likely it is that your condition will get worse.

You may need treatment if you have a condition that increases your risk of developing complications, such as:

• scarring of the liver (cirrhosis)
• high blood pressure inside the liver (this is known as portal hypertension and is often a complication of alcohol-related liver disease)
• diabetes

Treatment may also be recommended if a scan shows high levels of calcium inside your gallbladder, as this can lead to gallbladder cancer in later life.

If you have episodes of abdominal pain (biliary colic), treatment depends on how the pain affects your daily activities.

If the pain is mild and infrequent, you may be prescribed painkillers to control further episodes and be given advice about eating a healthy diet to help control the pain.

If your symptoms are more severe and frequent, surgery to remove the gallbladder is usually recommended.

The gallbladder isn’t an essential organ and you can lead a normal life without one.

Some people may experience symptoms of bloating and diarrhoea after eating fatty or spicy food. If certain foods trigger symptoms, you may wish to avoid them in the future.

Keyhole surgery to remove the gallbladder

If surgery is recommended, you’ll usually have keyhole surgery to remove your gallbladder. This is known as a laparoscopic cholecystectomy.

During a laparoscopic cholecystectomy, 3 or 4 small cuts are made in your abdomen.

One larger cut (about 2 to 3cm) is made by the belly button and the others (each 1cm or less) will be on the right side of your abdomen.

Your abdomen is temporarily inflated using carbon dioxide gas. This is harmless and makes it easier for the surgeon to see your organs.

A laparoscope (a long, thin telescope with a tiny light and video camera at the end) is inserted through one of the cuts in your abdomen.

This allows your surgeon to view the operation on a video monitor. They’ll remove your gallbladder using special surgical instruments.

If it’s thought there may be gallstones in the bile duct, an X-ray or ultrasound scan of the bile duct is also taken during the operation.

If gallstones are found, they may be removed during keyhole surgery. If the operation can’t be done this way, or an unexpected complication occurs, it may have to be converted to open surgery.

After the gallbladder has been removed, the gas in your abdomen escapes through the laparoscope and the cuts are closed with dissolvable stitches and covered with dressings.

Laparoscopic cholecystectomies are usually carried out under a general anaesthetic, which means you’ll be unconscious during the procedure and won’t feel any pain while it’s carried out.

The operation takes 60 to 90 minutes and you can usually go home the same day.

Full recovery typically takes around 10 days.

Single-incision keyhole surgery

Single-incision laparoscopic cholecystectomy is a newer type of keyhole surgery used to remove the gallbladder.

During this type of surgery, only 1 small cut is made, which means you’ll only have a single scar.

But as this type of cholecystectomy hasn’t been carried out as often as conventional cholecystectomies, there are still some uncertainties about it.

Access to single-incision laparoscopic cholecystectomies is also limited because it needs an experienced surgeon with specialist training.

Read more about single-incision laparoscopic cholecystectomy on the National Institute for Health and Care Excellence (NICE) website

Open surgery

A laparoscopic cholecystectomy may not be recommended if you:

• are in the third trimester (the last 3 months) of pregnancy
• are extremely overweight
• have an unusual gallbladder or bile duct structure that makes a keyhole procedure difficult and potentially dangerous

In these circumstances, an open cholecystectomy may be recommended.

A 10 to 15cm (4 to 6in) incision is made in the abdomen, underneath the ribs, so the gallbladder can be removed.

General anaesthetic is used, so you’ll be unconscious and won’t feel any pain.

Open surgery is just as effective as laparoscopic surgery, but it does have a longer recovery time and causes more visible scarring.

Most people have to stay in hospital for up to 5 days. It typically takes 6 weeks to fully recover.

Read more about recovering from gallbladder surgery.

Endoscopic retrograde cholangio-pancreatography (ERCP)

Endoscopic retrograde cholangio-pancreatography (ERCP) is a procedure that can be used to remove gallstones from the bile duct.

The gallbladder isn’t removed during this procedure, so any stones in the gallbladder will remain unless they’re removed using other surgical techniques.

ERCP is similar to a diagnostic cholangiography (see diagnosing gallstones for more information), where an endoscope (a long, thin flexible tube with a camera at the end) is passed through your mouth down to where the bile duct opens into the small intestine.

But during ERCP, the opening of the bile duct is widened with a small cut or an electrically heated wire.

The bile duct stones are then removed or left to pass into your intestine and out of your body.

Sometimes a small tube called a stent is permanently placed in the bile duct to help the bile and stones pass.

ERCP is usually carried out under sedation, which means you’ll be conscious throughout the procedure but won’t experience any pain.

The procedure lasts about 30 minutes on average, but can take from 15 minutes to over an hour.

Afterwards, you may need to stay in hospital overnight so you can be monitored.

Medicine to dissolve gallstones

If your gallstones are small and don’t contain calcium, it may be possible to take ursodeoxycholic acid tablets to dissolve them.

But these aren’t prescribed very often because:

• they’re rarely very effective
• they need to be taken for a long time (up to 2 years)
• you can get gallstones again after treatment is stopped

Side effects of ursodeoxycholic acid are uncommon and are usually mild. The most commonly reported side effects are feeling sick, being sick and itchy skin.

Ursodeoxycholic acid isn’t usually recommended for pregnant or breastfeeding women.

Sexually active women should either use a barrier method of contraception, such as a condom, or a low-dose oestrogen contraceptive pill while taking ursodeoxycholic acid, as it may affect other types of oral contraceptive pills.

Ursodeoxycholic acid tablets may occasionally be used to prevent gallstones if it’s thought you’re at risk of developing them.

For example, ursodeoxycholic acid may be prescribed if you have recently had weight loss surgery, as rapid weight loss can cause gallstones to grow.

Diet and gallstones

In the past, people with gallstones who weren’t suitable for surgery were sometimes advised to adopt a very low-fat diet to stop the gallstones growing.

But recent evidence suggests this isn’t helpful because rapid weight loss resulting from a very low-fat diet can actually cause gallstones to grow.

This means that if surgery isn’t recommended or you want to avoid having an operation, it’s advisable to adopt a healthy, balanced diet based on The Eatwell Guide.

This involves eating a variety of foods, including moderate amounts of fat, and having regular meals.

A healthy diet won’t cure gallstones or completely eliminate your symptoms, but it can improve your general health and help control pain caused by gallstones.

Read more about healthy eating.

Page last reviewed: 19 November 2021
Next review due: 19 November 2024

Gallstone disease (stones in the gallbladder)

Gallstone disease (cholelithiasis).

Z disease in which the formation and outflow of bile in the biliary system is disturbed, the exchange of cholesterol and bilirubin in the body changes. As a result of these factors, stones (calculi) form in the bile ducts and gallbladder. Gallstone disease is not dangerous in itself, but the possibility of developing severe complications that are likely to be fatal. Much more often, gallstones form in women.

Causes of stone formation

If the balance of bile components in the bile ducts is disturbed, solid formations (flakes) form, which eventually grow and merge into stones. Most often, stones are formed when cholesterol metabolism is disturbed (its excess content in bile). Cholesterol-rich bile is called lithogenic (leading to the formation of stones). Also, infections, inflammation of the organs of the biliary system, allergic reactions, and autoimmune diseases can lead to the development of gallstone disease.

Diagnosis of cholelithiasis

Ultrasound of the abdominal cavity is the most informative method of examination for cholelithiasis. Ultrasound examination accurately shows the presence of echo-impermeable formations – stones, changes in the walls of the bladder. An ultrasound clearly shows the presence of signs of inflammation of the gallbladder. Magnetic resonance and computed tomography of the liver and biliary tract are also used for diagnosis.

Complications of cholelithiasis

The most common complication of cholelithiasis is not just inflammation of the gallbladder (acute and chronic), called cholecystitis, but inflammation with blockage of the bile ducts by a calculus (stone). Blockage of the bile ducts in the pancreas (part of the tract passes through the pancreas) can cause acute pancreatitis. Another common complication of gallstone disease is cholangitis (inflammation of the bile ducts). When the bile ducts are blocked, the patient develops jaundice due to a violation of the outflow of bile pigments, the level of bilirubin in the blood test increases. With inflammation of the ducts and the gallbladder itself, the temperature rises and symptoms of inflammation appear, and with the addition of pathogenic microorganisms, symptoms of purulent inflammation appear. It is these conditions that greatly worsen the prognosis and can cause the most unfavorable outcome.

Treatment of cholelithiasis

If acute or chronic calculous cholecystitis develops, removal of the gallbladder is indicated as a source of stone formation. Surgical intervention is abdominal or laparoscopic, depending on the state of the body, pathological changes in the walls of the bladder and surrounding tissues, and the size of the stones. It is necessary to determine the feasibility of abdominal or laparoscopic intervention with a surgeon. Of course, laparoscopic surgery has a significant cosmetic advantage when there are no large scars left on the abdomen after surgery. But not always (despite modern equipment) it is possible to perform laparoscopic intervention. Therefore, the decision on the type of intervention for the removal of stones must be made in consultation with the surgeon. The surgical department of the Kirov Railway Hospital has accumulated a large successful experience in the removal of gallbladder stones by laparoscopic cholecystectomy.

Prognosis and prevention of cholelithiasis

Prevention of cholelithiasis consists in avoiding factors that contribute to increased cholesterolemia and bilirubinemia, bile stasis. A balanced diet, normalization of body weight, an active lifestyle with regular physical activity can avoid metabolic disorders, and timely detection and treatment of pathologies of the biliary system (dyskinesia, obstruction, inflammatory diseases) can reduce the likelihood of bile stasis and sedimentation in the gallbladder. Particular attention should be paid to the exchange of cholesterol and the state of the biliary system for persons who have a genetic predisposition to stone formation, those whose relatives already suffer from gallstone disease.

In the presence of stones in the gallbladder, prevention of attacks of biliary colic will be following a strict diet (exclusion from the diet of fatty, fried foods, muffins, confectionery creams, sweets, alcohol, carbonated drinks, etc.), normalization of body weight, consumption of a sufficient amount liquids (water). To reduce the likelihood of movement of calculi from the gallbladder through the ducts, work associated with a long stay in an inclined position is not recommended. Trips (business trips) on rough roads are strictly contraindicated.

The prognosis of the development of cholelithiasis directly depends on the rate of formation of stones, their size and mobility. In the vast majority of cases, the presence of stones in the gallbladder leads to the development of complications. With successful surgical removal of the gallbladder – a cure without pronounced consequences for the quality of life of patients.

Appointment for a consultation with a surgeon and ultrasound examination by phone:

(8332) 25-50-50

Some common misconceptions about gallstone disease

Misconception 1: Gallstones can spontaneously pass from the gallbladder Imagine the structure of bile leg bladder: it has a bottom, a body and a neck. The bubble at the transition to the neck narrows to 7-8 mm. The cervix passes into the cystic duct, which contains a complex valvular apparatus several millimeters in diameter. The neck of the bladder connects with the common bile duct, which then enters the duodenum in the form of a sphincter called the papilla of Vater. The sphincter has the ability to contract, it regulates the flow of bile into the intestines and has a clearance of only 1-1.5 mm! Thus, it is difficult to imagine that stones larger than one millimeter could pass through this powerful valvular apparatus. But they sometimes reach several centimeters in diameter. Most often, stones get stuck in the bile ducts, causing acute cholecystitis, jaundice. Perhaps this misconception is due to the confusion of gallstones and kidney stones. In the urinary system (kidneys), stones can sometimes pass on their own. In the case of the formation of stones in the gallbladder, their independent exit to the outside is unlikely.

Misconception 2: Gallbladder stones can be dissolved with medications and some herbs.

Let’s see what gallstones are. The main chemical compounds that make up their composition are cholesterol, bilirubin, calcium salts, proteins, as well as small amounts of iron, copper, magnesium, sulfur, manganese.

According to the existing classification, stones are divided into cholesterol, complex cholesterol-pigment-salt, pigment. Of all these varieties, only pure cholesterol stones can be dissolved. For this purpose, chenodeoxycholic acid and its preparations are used: chenosan, chenofalk, chenochol, as well as ursodeoxycholic acid and its preparations (ursofalk, ursosan). It should be borne in mind that such treatment is very long, expensive and, unfortunately, does not always lead to the desired results. As for the use of medicinal plants to dissolve stones, they simply do not exist. Phytotherapy (here we also include attempts to be treated with homemade preparations from natural bear bile) aims to improve the chemical composition of bile, accelerate its secretion by the liver, stimulate the emptying of the gallbladder, thereby preventing the formation of stones, but not the removal of stones.

Misconception 3: Stones can be removed from the gallbladder with olive oil

As we have already found out, stones cannot leave the gallbladder. Taking a significant amount of any vegetable oil sharply stimulates bile secretion, contraction of the muscles of the bladder and ducts, as well as the release of pancreatic juice. As a result, it is possible to provoke an exacerbation of chronic cholecystitis, pancreatitis, cause the movement of calculi and infringement of one of them in the neck of the bladder, which leads to the need for urgent surgical treatment.

Delusion 4: If you use olive oil and lemon or apple juice, you can get the desired result.

This “treatment” has a long history. It is known that for the first time vegetable oil (olive or turpentine) alone or in combination with lemon juice for the expulsion of so-called stones from the gallbladder began to be used by North American healers in the early fifties of the last century. Subsequently, doctors began to use this method. But already in 1891 year, the American doctor Winston in his article showed that the stones found in the feces after taking oil and lemon juice have nothing to do with the gallbladder. Later, scientists found that with the simultaneous ingestion of any of the vegetable oils and acids, in particular lemon juice, special chemical compounds called soaps are formed in the intestines. Passing through the intestines, they acquire a rounded shape. That is why there has been a misconception that softened gallstones come out. Unfortunately, even now you can still find recommendations to use olive oil with lemon juice to remove stones, to lie with your right side on a heating pad. Some so-called folk healers sometimes do it out of ignorance, sometimes deliberately for selfish purposes. Unfortunately, this leads to the opposite goal – the stones do not come out, and the person ends up in the surgical department.

IF STONES ARE ALREADY FORMED, THEN THEY CAN ONLY BE GET RID OF THEM WITH THE HELP OF SURGICAL INTERVENTION. USUALLY IN SUCH CASES, THE GALLBLADER IS REMOVED – CHOLECYSTECTOMY. RECENTLY, LAPAROSCOPIC CHOLECYSTECTOMY IS MORE COMMONLY PERFORMED.

Good to know about laparoscopic cholecystectomy

In order to remove the gallbladder with the formed stones, the surgeon makes 4 punctures of the abdominal wall, each of which requires a miniature skin incision. Unlike the approximately 20 cm incision that is made during open surgery, the 4 punctures in the abdominal wall do not injure muscle tissue, so patients experience much less pain after surgery and can usually return to normal activities within one week. The abdominal wall is punctured with a thin tube called a trocar. Through a trocar inserted in the navel, the surgeon inserts a laparoscope into the abdominal cavity, to which a small video camera and a light source are connected. The video camera transmits the image from the endoscope to a video monitor, and the surgeon can see the organs from inside the body. Trocar punctures are also made at three other points. Through these trocars, the surgeon introduces the special instruments needed to perform the operation. For example, to hold the gallbladder in a fixed position, a gripping clamp is used – a grasper. Instruments that allow the use of a laser beam or a low voltage electric current are used to separate the gallbladder from the liver while sealing the wound surface and stopping bleeding. Ultimately, the gallbladder is removed from the abdominal cavity through a trocar in the navel. The operation is performed under general anesthesia, takes about an hour and requires the patient to stay in the hospital for another 3-6 days, although, of course, in each individual case, these terms are individual.

In the recovery period, immediately after surgery, nausea and discomfort may sometimes occur. In the first week after surgery, a diet with the exclusion of fatty foods is recommended. During the week, you should also be observed by the surgeon. You can return to a full life activity as soon as you feel comfortable.

Appointment for a consultation with a surgeon and ultrasound examination by phone:

(8332) 25-50-50

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Cholelithiasis: to operate or not?

Most patients who are aware of the presence of gallstones prefer to coexist peacefully with them. About what are the indications for the removal of the gallbladder, and in what cases it is possible to refrain from the operation, says the head. Department of Emergency and General Surgery EMC Vladimir Kan.

Calculous cholecystitis, cholelithiasis, or, as it is more commonly called, cholelithiasis, is a chronic inflammatory disease of the biliary tract, accompanied by the formation of gallstones.

With prolonged stagnation of bile in the gallbladder, which is facilitated by various metabolic disorders and a decrease in the contractility of the gallbladder, bile components (most often cholesterol) begin to crystallize and precipitate. Microscopic crystals – microlites – increase in size over time, merge with each other and form large stones.

What symptoms indicate the possible presence of gallstones?

The first warning signs are heaviness in the right hypochondrium, bitterness in the mouth and nausea after eating, which are common signs of biliary tract disease. Often a person is unaware of the existence of gallstones until the moment when they are detected by ultrasound of the abdominal organs, and in the worst case, when biliary colic and other symptoms develop due to the ingress of stones from the gallbladder into the common bile duct and its blockage.

Gallbladder colic is pain in the right hypochondrium or “under the pit of the stomach”, in the epigastric region, due to the contraction of the walls of the gallbladder, which tends to push out the “cork” that clogged it. The intensity of the pain increases, then the pain becomes constant (up to several hours), after which it gradually decreases and disappears when the moving stone returns to the gallbladder cavity. There is no pain between attacks. But if the stone remains in the bile duct, then complications such as acute cholecystitis, obstructive jaundice, perforation of the gallbladder and the development of peritonitis can develop, which require emergency surgical care.

Is it necessary to remove the gallbladder if the stone does not bother?

Patients suffering from cholelithiasis are divided into two groups: patients with symptoms of biliary colic and a picture of acute cholecystitis, and patients in whom the presence of stones does not manifest itself in any way.

Currently, the vast majority of surgeons agree that patients with asymptomatic cholelithiasis with a first discovered small stone should not immediately undergo prophylactic cholecystectomy (gallbladder removal). The risk of developing severe complications with small single stones is estimated to be low, therefore, such patients should undergo regular abdominal ultrasound examinations and follow lifestyle and nutrition recommendations.

The long-term presence of stones is always accompanied by the addition of a secondary infection and the development of chronic cholecystitis, which entails various diseases of neighboring organs – the liver and pancreas. Long-term inflammation also increases the risk of developing gallbladder cancer. Therefore, the doctors of the EMC Surgical Clinic recommend that after observing asymptomatic stones for 2 years, nevertheless, contact the surgeon for advice. With some concomitant diseases (for example, diabetes mellitus), with large stones, with pathological changes in the gallbladder itself, the doctor may recommend removing the gallbladder in the “quiet period” of the disease after a comprehensive examination and preparation of the patient.

In the case of calculous cholecystitis, when the patient has intermittent attacks of biliary colic, surgeons recommend cholecystectomy, which should be performed in a planned manner. Each subsequent attack can cause the development of acute cholecystitis, which, as already noted, can be accompanied by severe complications from the liver and pancreas. If a picture of acute cholecystitis develops – biliary colic lasts more than 3 hours, pain is localized in the right upper quadrant of the abdomen, is not relieved by antispasmodic drugs, the temperature rises, nausea and vomiting occur – an ambulance should be called.

Doctors of the EMC Surgical Clinic are ready around the clock to perform surgery for calculous cholecystitis using the least traumatic and safest method – using laparoscopic access. Regardless of how many stones are found in the gallbladder – one large or many small – the gallbladder is removed completely. There are contraindications to laparoscopic cholecystectomy – in this case, the surgeon may decide to perform an open, laparotomy operation.