A gallstone is a lump of hard material usually ranging in size from a grain of sand to 3-4 cms. They are formed inside the gall bladder as a result of precipitation of cholesterol and bile salts from the bile.
Types of gallstones and causes
- Cholesterol stones
- Pigment stones
- Mixed stones – the most common type. They are comprised of cholesterol and salts
Cholesterol stones are usually yellow-green and are made primarily of hardened cholesterol. They account for about 80 percent of gallstones. Scientists believe cholesterol stones form when bile contains too much cholesterol, too much bilirubin, or not enough bile salts, or when the gallbladder does not empty as it should for some other reason.
Pigment stones are small, dark stones made of bilirubin. The exact cause is not known. They tend to develop in people who have cirrhosis, biliary tract infections, and hereditary blood disorders such as sickle cell anemia in which too much bilirubin is formed.
Other causes are related to excess excretion of cholesterol by liver through bile. They include the following.
- Gender. Women between 20 and 60 years of age are twice as likely to develop gallstones as men.
- Obesity. Obesity is a major risk factor for gallstones, especially in women.
- Estrogen. Excess estrogen from pregnancy, hormone replacement therapy, or birth control pills
- Cholesterol-lowering drugs.
- Diabetes. People with diabetes generally have high levels of fatty acids called triglycerides.
- Rapid weight loss. As the body metabolizes fat during rapid weight loss, it causes the liver to secrete extra cholesterol into bile, which can cause gallstones.
Many people with gallstones have no symptoms. These patients are said to be asymptomatic, and these stones are called “silent stones.” Gallstone symptoms are similar to those of heart attack, appendicitis, ulcers, irritable bowel syndrome, hiatal hernia, pancreatitis, and hepatitis. So accurate diagnosis is important.
Symptoms may vary and often follow fatty meals, and they may occur during the night.
- Abdominal bloating
- Recurring intolerance of fatty foods
- Steady pain in the upper abdomen that increases rapidly and lasts from 30 minutes to several hours
- Pain in the back between the shoulder blades
- Pain under the right shoulder
- Nausea or vomiting
- Indigestion & belching
Ultrasound is the most sensitive and specific test for gallstone diseases.
Surgery to remove the gallbladder is the most common way to treat symptomatic gallstones. The most common operation is called laparoscopic cholecystectomy.
For this operation, the surgeon makes few tiny incisions in the abdomen and inserts surgical instruments and a miniature video camera into the abdomen. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close up view of the organs and tissues. While watching the monitor, the surgeon uses the instruments to carefully separate the gallbladder from the liver, ducts, and other structures.
If gallstones are in the bile ducts, the physician (usually a gastroenterologist) may use endoscopic retrograde cholangiopancreatography (ERCP) to locate and remove them before or during the gallbladder surgery
Frequently Asked Questions
A: Removing the gallbladder does not lead to any serious consequence. The function of the gallbladder is to store bile. Without the gallbladder, bile is stored in the bile ducts. Removing the gallbladder does not interfere with the production of bile that occurs in the liver.
A: Common complications include:
- acute infection of the gallbladder leading to severe upper abdominal pain and fever (acute cholecystitis)
- pus formation in the gallbladder (empyema) leading to high fever and sepsis, a life threatening infection
- jaundice when the stone block the bile duct that connects the liver to the small intestine leading to yellow eyes and skin.This may damage the liver
- blockage of the pancreatic ducts leading to a severe, life-threatening infection of the pancreas(pancreatitis)