Definition & Overview

The gallbladder is found right under the liver. It is a small sac that processes bile, which in turn helps the body to digest fats. Gallstones are formed when bile fails to properly process the cholesterol and other substances that enter your body. This usually happens when you have too much toxins in your system, and your gallbladder is no longer emptying properly. Gallstones, compared to kidney stones, are believed to be harmful regardless of their size. They can be smaller than grains of sand or as big as golf balls. Individually, they can block the ducts that transport the bile from the gallbladder to the intestines, and they can cause a lot of pain. Some doctors believe that even microscopic gallstones cause a lot of harm if they produce a buildup of “sludge” in your intestine that prevents the proper digestion of the food you eat.

Cause of the Condition

Gallstones form when cholesterol and other undigested substances in your gallbladder crystalize and block bile ducts. This can cause a lot of abdominal pain, and in certain cases, even impede urination. Aside from high amount of cholesterol in the body, the other reason for gallstone formation is abnormal high level of bilirubin in the gallbladder. This is a substance that is produced during the breaking down of red blood cells.

These crystals could be very small—smaller than grains of sand. However, over the years, they can build up into bigger stones that block your bile ducts. Most of the time, only one stone forms and will need to be surgically removed. Sometimes, though, multiple stones form simultaneously. People who are at most risk include women who have had children, those who are obese, and those who are at least 40 years old.

Other factors that could lead to the formation of gallstones are the following:

  • Liver cirrhosis or scarring of the liver tissues
  • Digestive disorders like IBS (irritable bowel syndrome) or Crohn’s disease
  • Genes (those who have a family history of gallstones are at a higher risk of getting gallstones themselves).
  • Abrupt weight loss due to dieting or cosmetic surgery
  • Medications like ceftriaxone (this is an antibiotic, usually used to treat gonorrhea, meningitis or pneumonia).
  • Combined oral contraceptive pills
  • Oestrogen therapy

Key Symptoms

The most common symptom of gallstone formation is abdominal pain. This abdominal pain usually starts close to the stomach area, right below your ribs, and spread to the upper right portion of your chest close to your shoulder blades. The pain does not subside when you move around, and it usually lasts for 15 minutes up to 24 hours. This pain is sharp enough to wake you up at night, and it is usually very hard to attempt to be comfortable once you feel this jabbing pain.

You may also experience nausea or vomiting, fever and chills, jaundice, dark (brownish) urine, and a noticeable lightening of your stool. It is important to consult a general practitioner first (or an ER doctor if the pain is severe) for immediate assessment. You might be suffering from gallstone formation, or you could also be suffering from other conditions with similar symptoms like a heart attack (for chest pains). Some of these symptoms may also signal an inflammation in your liver, pancreas, or gallbladder.

Who to See and Types of Treatments Available

If you find yourself experiencing the symptoms above, see your family doctor or go directly to the emergency room if the pain and discomfort are severe. Seeing a general practitioner first is necessary because they will have to zero in on your pain, and assess if you are indeed suffering from gallstones.

Some of the diagnostic tools that will be used to assess your condition include:

  • Ultrasound examination
  • Computerized tomography (CT) scan
  • Magnetic resonance imaging (MRI)
  • Cholescintigraphy
  • Endoscopic retrograde cholangiopancreatography (ERCP)

There are also “silent” gallstones or gallstones that have already formed without displaying symptoms. Usually, these are detected when an ultrasound is done for another reason. This type of gallstone typically does not require treatment.

A gallstone formation that causes pain and other symptoms is usually referred to as a “gallbladder attack”. When the condition is confirmed through tests, the patient is referred to a gastroenterologist. Patients who experienced a gallbladder attack once are most likely to experience it again.

The most common treatment for gallstones is the surgical removal of the gallbladder. Surgical treatments for this condition include:

  • Laparoscopic cholecystectomy - tiny incisions are made in the abdomen so that a laparoscope or a tiny tube with a camera could be inserted. The surgeon, with the enlarged image from the camera as a guide, carefully separates the gallbladder from the liver and other structures. Usually, the patient can go home on the same day of the operation.

  • Open cholecystectomy - this is a more invasive surgical procedure, which is only performed when there is a severe inflammation of the gallbladder. A longer incision (usually 4 to 6 inches long) is made to remove the gallbladder properly. There are cases when the surgery starts off as laparoscopic, but the surgeon needs to switch to this surgery because the inflammation on the gallbladder, via a more close up view, is too severe.

Oral dissolution therapy and shock wave lithotripsy are given to those who suffer from gallbladder attacks but are not well enough to undergo surgery.

References:

  • “Gallstones” http://www.nhs.uk/Conditions/Gallstones/Pages/Symptoms.aspx
  • “Digestive diseases” http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/gallstones/Pages/facts.aspx
  • “Treating gallstones” http://www.nhs.uk/Conditions/Gallstones/Pages/Treatment.aspx
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