GALLSTONES

Gallstones are hard solid matter usually formed inside the gallbladder. The gallbladder is a small saclike organ in the upper right part of the abdomen. It is located under the liver, (just below the front rib cage on the right side). It stores bile, which helps to digest fatty foods. Bile contains several different substances, including cholesterol and bilirubin; it is stored in the gallbladder until needed. When we eat a high-fat meal the gallbladder contracts and injects bile into the small intestine.

Gallstones are thought to develop because of an imbalance in the chemical make-up of bile, (they may also form if the gallbladder doesn’t empty itself completely). There are two main types of gallstones: Cholesterol stones and Pigment stones. Cholesterol stones are more common (80%) and they are made up of cholesterol; pigment stones are made of bilirubin (which is a waste product of the breakdown of red blood cells).  Some persons have a single stone while others have multiple. Some stones are as small as a grain of sand and others can be the size of a golf ball.


SYMPTOMS

Most persons who have gallstones never experience any symptoms (up to 70% of persons). Gallstones usually cause symptoms when they move from the gall bladder into the bile ducts (the tubes that lead from the gall bladder to the intestine). (See image below)

Biliary colic is the most common symptom of gallstones. It occurs when gallstones get stuck in the narrow neck of the gall bladder, which can cause severe pain. The pain is felt at the top of the abdomen, either in the middle or just under the ribs on the right hand side. The pain may spread to the right side or behind to the right shoulder blade. It is generally a continuous pain but may come in waves; the pain could last for minutes to hours and then goes away. Some persons may experience sweating and vomiting as well. Biliary colic may occur at any time, but some persons notice it more at evening time and after having a “fatty meal”. The pain may be so severe that it sometimes wakes persons out of their sleep at night. Some persons with gallstones may develop fever, jaundice (yellowing of the skin and whites of the eyes), cholecystitis (inflammation of the gall bladder) and pancreatitis (inflammation of the pancreas).


RISK FACTORS

You’re more likely to get gallstones if you:

• Are a woman (particularly if you've had children)
• Are overweight or obese
• Are over 40 years
• Have a family history of gallstones
• Are pregnant
• Have diabetes
• Take birth control pills
• Eat a diet high in fat

TESTS

Your doctor may recommend blood tests to look for signs of infection and to check if the liver is working normally. Gallstones are confirmed using an abdominal ultrasound scan. This can give the location, number and size of the stones, which will determine the best kind of treatment.


TREATMENT

Treatment for gallstones is usually only necessary if they are causing symptoms.

Surgery

Most cases of gallstone disease are easily treated with surgery. Once you have one “gallbladder attack”, the chance of having another one is high (up to 70%). You can wait to see if the problem resolves itself, but it may be best to remove the gallbladder to prevent future attacks. You can lead a perfectly normal life without a gallbladder. Your liver would still produce bile to digest food, but the bile would drip continuously into the small intestine (rather than build up in the gallbladder).

If your gallbladder is irritated or inflamed, most doctors will want to take it out right away. The surgery is most often laparoscopic surgery. This means that small tools are inserted into small incisions in the abdomen to remove the gallbladder. The surgery is safe and effective and it limits your hospital stay to about 1 day. Without surgery, the gallbladder could get infected; it might even burst open, causing further problems. Very severe cases can be life threatening; however, deaths from gallstone disease are generally rare.


Endoscopic Retrograde Cholangiopancreatography (ERCP)

This is a procedure that can be used to find and remove stones in the common bile duct.
(Click the link below to learn more)

https://www.sages.org/publications/patient-information/patient-information-for-ercp-endoscopic-retrograde-cholangio-pancreatography-from-sages/

Dissolving Stones

Gallbladder stones can sometimes be dissolved by a chemical (Ursodiol or Chenodiol), which comes in pill form.
(Click the link below to learn more)
https://medlineplus.gov/druginfo/meds/a699047.html

 
Tip#1:

Maintain a healthy weight. Obesity increases the risk of gallstones. Work to achieve a healthy weight, and then try to maintain that weight by continuing a healthy diet and continuing to exercise.


Tip#2:
Lose weight slowly. There's evidence that rapid weight loss can disrupt your bile chemistry and increase your risk of developing gallstones. A more gradual weight loss plan is recommended.


Tip#3:
Reduce your intake of fats. Avoid greasy and fried foods. Choose low-fat foods whenever possible, but do not avoid fats completely.


Tip#4:
Ensure a Healthy Diet. Your diet should contain lots of fruits, vegetables, whole grains and nuts (including peanuts and cashews); this may reduce the chances of getting gallstones.

 
I hope these tips on GALLSTONES were helpful; Remember YOUR HEALTH IS INVALUABLE.

By Dr. J. Lawarna Matthew
 
Acknowledgements
American Gastroenterological Association
Medicine.net (For image)
Visit https://www.gastro.org/practice-guidance/gi-patient-center/topic/gallstones for more information.