Your gallbladder is a small pear-shaped organ located in the abdomen, under the liver. It stores bile secreted by the liver, which is released when fat enters the digestive tract. The bile helps to emulsify fats of food and facilitate their digestion. Among some people, this process does not work properly as it should; the gallbladder cannot empty enough (obstruction of the biliary tract). Therefore, the bile promotes cholesterol crystallization resulting in gallstones formation.
What are the causes of gallstones?
Gallstones, also called Bile duct stones, are due to the retention of bile from the gallbladder for a long period of time. Gallstones can be also the result of clumping, in the gallbladder, of cholesterol and various other elements such calcium in large quantities. Gallstones formed of cholesterol are usually green, white or yellow (Cholesterol stones) and represent approximately 80% of gallstones. The same, they may be brown or dark (Pigment stones) and containing a high concentration of bile pigments.
What are the risk factors of gallstones?
Risk factors of gallstones may include:
- Age – the risk of gallstones increases beyond 40 years of age;
- Family history – There is also a genetic factor in developing gallstones;
- Chronic inflammatory disorders of the colon such as Crohn’s disease;
- Hemolysis – abnormal breakdown of red blood cells in the blood vessels;
- Unhealthy diet – A diet too rich in cholesterol and low in fiber increases the risk of gallstones;
- Obesity and diabetes – obesity and diabetes also increase the risk; people suffer from gallstones often have diabetes or obesity problem;
- Sex and pregnancy – Women are more frequently affected than men are becauses certains feminine hormones favor formation of calculations; pregnancy is particularly conducive to lithogenesis (formation of calculi or stones).
Gallstone Warning Signs and Symptoms
In the initial phase of gallstones, it is usually asymptomatic in most people. The stones present no clinical signs, but continue to multiply or increase in size silently. They are, most of times, discovered during medical exams (x-ray, abdominal surgery) performed for other reasons, and usually required no special treatment. The disease becomes problematic when large stones block the cystic duct, and provoke severe biliary colic. The pain may last for weeks or months, even years in some people. The attack can persist from 20 minutes to several hours. Usually, after an initial attack, recurrences are often more frequent.
Other common gallstones symptoms include:
- Pain in the upper abdominal
- Nausea and vomiting
- Pain in under the right shoulder
- Pain in the back between the shoulder blades
- Pain in the lower region of the abdomen
What is the diagnosis of gallstones?
When there are no symptoms at all, gallstones can be discovered during routine medical exams. In case there are symptoms and igns, your physician may recommend an ultrasound of the abdomen to examine the gallbladder and other internal organs of the abdomen: kidneys, liver, spleen, and pancreas. Your doctor can also recommend other tests such as
Radionuclide scan – right brfore the test, a specialist inject a radioactive chemical (gamma) in your bloodstream. And then, he uses a gamma camera to detrect signs of infection or bile duct obstruction. Usually, you should not eat or drink for at least four hours before the test
Abdominal x-ray – X–ray of the Abdomen allows your health care provider to picture the aspect of the gallbladder and detect certain disorders. Furthermore, abdominal x-ray is often performed to diagnose the problems of the urinary tract, gastrointestinal perforation (peptic ulcer, for example), constipation, bowel obstruction, etc.
Oral cholecystogram – using a fluoroscope, a health care specialist perfoms this radiographic exam to detect gallstones in your gallbladder or bile duct.
CT scan – CT scan is often included in the diagnosis of gallstones. CT-scan is a medical imaging technique which helps your doctor to create cross-sectional pictures of organs in your body including the gallbladder.
All those exams provide additional information needed for the diagnosis. In addition, blood tests can be done to check for excess bilirubin or abnormal liver enzymes, which indicate a biliary obstruction. The blood test is also performed to detect trace of infection.
Asymptomatic gallstones require no treatment most of times. In case there are complications or symptoms, medical treatment can be envisaged. Treatment may include medications, cholecystectomy (laparoscopic cholecystectomy, open cholecystectomy) or both.
Medications – Certain analgesic and antispasmodic medications can be used to relieve the symptoms of gallstones, mainly biliary colic. Antibiotics can be prescribed to patients who have infections. The dissolution of the stones can be done by ursodeoxycholic acid (ursodiol) taken orally. However, ursodeoxycholic acid is used when the stones are small, or when there are no complications. In addition, the treatment should be continued for up to two years, and its effectiveness is less than 60%. Another method of dissolving gallstones is contact dissolution therapy – injection of the organic solvent methyl tert-butyl ether (MTBE) into the gallbladder to dissolve the stones.
Cholecystectomy – is a surgical therapy used to remove the gallbladder. The surgery can be laparoscopic cholecystectomy or open cholecystectomy.
Laparoscopic cholecystectomy – in this method, the surgeon makes small incisions of 5 to 10 millimeters, which allow the insertion into the abdomen a surgical instrument called laparoscope. The optical system is connected to a computer monitor allowing the surgeon to reach the gallbladder. The manipulation of the laparoscope is done outside the abdomen, under the control of the computer picture. This method causes less postoperative pain and less or no scar. In case of difficulties, open cholecystectomy may be necessary.
Open cholecystectomy – this is a surgical procedure involving the opening of the abdomen by a large incision, leaving the direct passage to other surgical procedures in the abdominal and pelvic organs. The opening is often from the sternum to the pubis giving possibility to different cuts. The gallbladder is reached easily, but there is high risk of scars and post-surgical pain.
After cholecystectomy, it is recommended to eat a low-fat diet for at least one month following the surgery. As the “reservoir of bile” (gallbladder) does not exist anymore, the body will need a little time to adapt and transform the bile duct in a “pretend” gallbladder. You may have diarrhea or more bowel movements than usual.
To reduce the risk of gallstones, it is important to have a healthy and balanced diet. It is recommended to consume a lot of dietary fiber, cruciferous vegetables, and fruits. These foods play an important role in the elimination of cholesterol responsible for forming stones. Avoid eating too much unhealthy fats and foods rich in calories. Besides diet, regular physical exercise is also necessary.
What are the complications of gallstones?
The risk of gallstones to turn into other serious diseases cannot be ignored. It is essential to treat any gallbladder infection before complications. If left untreated, symptomatic gallstones can cause cirrhosis of the liver. There are also other complications such as cholecystitis, inflammation of the gallbladder; pancreatitis, inflammation of the pancreas; cholangitis, inflammation of the bile duct; jaundice and degeneration into gallbladder cancer.
Br Med J (Clin Res Ed). 1986 March 01; 292(6520): 628
Laboratory 38. Stomach, Spleen and Liver, Step 14. The Gallbladder and the Bile System. Human Anatomy (Laboratory Dissections). SUNY Downstate Medical Center, Brooklyn, NY (2003–11-17
Elsevier (2003). Dorland’s Illustrated Medical Dictionary, 30th ed, Philadelphia: Elsevier. ISBN 978-0-7216-0146-5
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