Gallstones

Gallstones 

Gallstones are the hardening and depositing of liver’s bile secretions, usually form in the gallbladder or the bile ducts. They can cause quite a range of symptoms that in some cases can be severe. The main form of treatment is removal surgery of these stones or even of the gallbladder, depending on certain factors.

In this article we will tackle down all about gallstones – what they are, how they form and why, what symptoms they cause, what are the treatment options, what health complications they can cause and what diet is best suited for them. But before we do dive in, let’s first see what the gallbladder is.  

 

The Gallbladder

Gallbladder Dysfunction – types and causes

There is a significant number of medical conditions associated with the gallbladder, such as:

• cholecystitis – this term refers to the inflammation of the gallbladder which can be acute or chronic, depending on the frequency of episodes; chronic cholecystitis is usually the result of multiple episodes of acute cholecystitis; in most cases the inflammation of the gallbladder is caused by pre-existent gallstones;
• acalculous gallbladder disease – this is also known as acute acalculous cholecystitis and is a condition in which the gallbladder can get inflamed without the presence of gallstones; the symptoms are very similar to the other conditions caused by gallstones and can be severe or chronic, but it usually appears in people who have some other underlying serious medical condition;
• gallstones – these stones will be discussed in detail later in this article, but it’s important to know that they are usually the root to a lot of the gallbladder conditions we highlight in this section;
• choledocholithiasis – before the bile is transferred to the small intestine, it spends some time in the common bile duct where sometimes gallstones can form; this is the condition known as choledocholithiasis; gallstones can form in the gallbladder and travel through the ducts in which case the condition is called secondary common bile duct stone; if the gallstone is formed in the common bile duct itself, the condition is called primary common bile duct stone which has a higher chance of causing an infection than the secondary one;
• cholangitis – this term is used to describe the condition in which the bile duct system becomes inflamed; this is usually caused either by the blockage of a duct because of a gallstone or as a result of an autoimmune disease (e.g. inflammatory bowel disease – ulcerative colitis or Crohn's disease);
• empyema – or suppurative cholecystitis is the presence of purulent material or pus in the gallbladder; the symptoms are usually very similar to the other gallbladder conditions and sometimes signs of sepsis can take longer to appear; it’s a serious medical condition because if it’s not diagnosed in time and treated in due time, the infection can start to spread in the body and become life-threatening;
• gallstone ileus – refers to a small bowel obstruction and is a very rare complication of cholecystitis; it’s caused by the passage of a gallstone into the intestine where it can cause a blockage; while it’s a rare condition, it’s more common in older people;
• perforation of the gallbladder – this is a serious medical condition in which the gallbladder ruptures causing the wall to leak; the perforation is usually caused by the inflammation of the organ which in turn can be the cause of gallstones that become stuck, infection or injury; it’s essential to diagnose and treat this condition because if it’s left untreated it can lead to systemic inflammatory response syndrome or sepsis, which are life-threatening conditions;
• polyps – these are tissue growths on the lining of the inside of the gallbladder; in approximately 95% of cases, these polyps are benign, but there is a small risk of them being cancerous; the size of the polyp is a very important indicator of the type of polyp (benign vs. malignant); the treatment option is total removal of the gallbladder in case the polyp's size is upper than 1 cm, but this can also be recommended in case of co-existing gallstones;
• porcelain gallbladder – this condition is caused by deposits of calcium on the inner walls of the gallbladder, making the walls stiff and rigid; people with porcelain gallbladder don’t typically exhibit any symptoms, this condition usually being discovered by accident during an abdominal ultrasound or CT scan; porcelain gallbladder also represents a risk factor for gallbladder cancer;
• cancer – gallbladder cancer is a very rare type of cancer in which abnormal cells start to grow into the gallbladder; unfortunately, most cases of gallbladder cancer are discovered and diagnosed in later stages of the evolution which makes this a type of cancer with a low chance of survival; some of the risk factors for gallbladder cancer are biological sex (it’s more prevalent in women), age (the bigger the age, the higher the risk for this type of cancer), presence of other gallbladder diseases (such as polyps or chronic cholecystitis).

 

Gallbladder Dysfunction Symptoms

Symptoms for gallbladder diseases are usually similar and include pain in the upper right region of the abdomen, nausea and vomiting, sometimes, fever and diarrhea. In the case of a bile duct blockage, additional symptoms can be light-colored stools, darker urine and coloration of the skin in a yellow tone.

 

Gallbladder tests

Some of the tests that can be performed in order to assess the state of the gallbladder or for diagnostic purposes are abdominal ultrasounds, cholescintigraphy or HIDA scan, endoscopy, MRI, endoscopic ultrasounds, X-ray of the abdominal region.

 

Gallstones – the reason behind most of the gallbladder diseases

Gallstones causes and types

There are a few types of gallstones that are formed from different substances in the body:

• cholesterol gallstones – these stones are made of cholesterol which is a fat substance in the blood; if there is too much cholesterol excreted by the liver and the bile is not enough to dissolve it, the excess of cholesterol can turn into crystals and then stones; cholesterol gallstones are the most prevalent type of gallstones and have a greenish color;
• pigment gallstones – the main pigment in cause is bilirubin which is a chemical released by the liver when it metabolizes old red blood cells; the cirrhosis, some blood diseases of biliary tract infections can cause an excess of bilirubin production by the liver which in turn will contribute to the formation of gallstones if the gallbladder can’t break it down; these stones are usually darker-colored, brown or black;
• gallstones caused by a full gallbladder – sometimes the gallbladder doesn’t empty itself properly which can leave residual bile into the organ that can later become very concentrated, contributing to the formation of gallstones.

There are also some other known causes for gallstones which can appear in people with cirrhosis or blood disorders, in pregnant women or in case of a quick weight loss.

 

Where do gallstones form?

The most typical place where gallstones form and can be found is in the gallbladder (gallstones in gallbladder), but they can also travel to the common bile duct in the liver. If they find themselves in the common bile duct they can become the cause of serious medical conditions such as cholangitis (infection of the bile duct system) or even pancreatitis (inflammation of the pancreas).

 

Gallstones risk factors

Some of the risk factors associated with occurrence of gallstones are biological sex (females are more at risk), having more than 40 years old, obesity and sedentary lifestyle, diabetes, pregnancy, a diet that is high in fat and cholesterol levels and low in fiber, family history of gallstones, blood disorders (such as leukemia), liver disease.

 

Gallstones in pregnancy

We’ve seen that women have a higher risk of getting gallstones and this risk increases during pregnancy. This is because during the time a woman is pregnant, the hormone levels can increase the level of cholesterol in the blood, making it harder for the gallbladder to empty itself and leading to the formation of stones in the gallbladder.

 

Gallstones symptoms 

The symptoms caused by gallstones depend very much on their size and location with most of them being asymptomatic (known as silent gallstones). However, when they do start to cause trouble, the symptoms are:

• pain – if you are asking yourself “is gallstones painful”, then the answer is yes, they are quite painful; the pain is experienced in the upper right and mid abdomen (gallstones pain location), but it can also be between the shoulder blades (gallstones back pain) or in the right shoulder;
• nausea and vomiting;
• jaundice – yellow coloration of the skin and eyes;
• darker urine and lighter stool;
• diarrhea;
• stomach pain.

Asymptomatic gallstones. These gallstones don’t cause any type of pain or discomfort and are usually detected during ultrasounds or X-rays for other purposes. Asymptomatic gallstones are quite common, with almost 80% of people having them without even knowing.

 

Gallstones in pancreas – gallstone pancreatitis

First of all, pancreatitis is the inflammation of the pancreas. The pancreas is the organ responsible for controlling sugar levels in the blood through secretion of the hormone insulin. In some cases, a gallstone can travel from the gallbladder and block the duodenum bulb which is also the opening from the pancreas to the small intestine. This determines fluid to travel back up to the bile and pancreatic duct. Some of the symptoms of gallstone pancreatitis can be severe pain, fever, chills, jaundice, nausea and vomiting, back pain. To diagnose gallstone pancreatitis, the doctor can order blood tests that can confirm inflammation in the pancreas, as well as MRI or CT scan. The treatment plan for this medical condition usually includes medication for nausea and pain, an intravenous infusion with fluids for hydration or even surgery, in the more severe cases. If left untreated, gallstone pancreatitis can become life-threatening, with some of the complications being cholangitis (infection of the bile duct system) or pancreatic necrosis (the tissues of the pancreas start to die).

 

Gallstones vs kidney stones

Even though these stones are formed in different parts of the body, they do share quite a few similarities. Kidney stones form in the urinary tract, they can grow in size, but not as much as a gallstone and they cause pain when they travel through into the ureter and block the urine flow. The pain symptom is common in both conditions, both stones causing severe pain. However, kidney stones cause pain especially in the lower back region that can eventually radiate to the lower abdomen, while gallstones cause pain in the mid-right abdomen region that can later radiate to the shoulder blades and shoulders. While nausea and vomiting is also common between the two, kidney stones also cause blood in the urine and a painful urination process with either incapacity to urinate or a very frequent urination. Kidney stones are usually prevalent in older adults, some of the risk factors being family history of kidney stones or low urination levels. As far as treatment goes, small kidney stones are usually eliminated without much discomfort, but in some cases medication or surgery can be recommended.

 

Gallstones diagnosis

First of all, the doctor will do a physical exam that also means checking for skin and eye changes in color (they will check for one of the typical symptoms of gallstones which is jaundice that is caused by excess of bilirubin in the blood). In addition to the physical examination, the doctor might order some tests that can help with the diagnostic, such as blood tests, ultrasound, endoscopy ultrasound, CT scan, X-rays, gallbladder radionuclide scan, endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography.

Blood tests. These tests are useful in detecting the levels of bilirubin in the blood. They can also check for some specific markers that can indicate the level of functionality of the liver.

Ultrasound. This test can give images of the insides of the abdomen, being a painless procedure. It is the most frequently used test for detecting gallstones. However, one weakness of this procedure is that it does not show a good image of the common bile duct and if gallstones are suspected to be present there, some of the more advanced tests are recommended.

Endoscopy ultrasound. As its name suggests, this test is a combination of an ultrasound and an endoscopy. Using a scope that travels through the mouth into the common bile duct, it can provide a good image of the common bile duct. This test is designed to purely identify and diagnose gallstones, without removing them in the process.

CT scan. A CT scan of the abdominal region can produce images of the organs in the area, including the gallbladder and the adjacent structures. It can be used to diagnose gallstones, polyps, acute gallbladder disease, gallbladder cancer or pancreatitis.

Abdominal X-ray. This test is particularly useful in identifying gallstones that have calcified, as well as diagnosing porcelain gallbladder.

Gallbladder radionuclide scan. This procedure is performed using a radioactive substance that is injected into the bloodstream and travels to the gallbladder and liver, making visible any signs of infection or blockages from gallstones.

Endoscopic retrograde cholangiopancreatography. This procedure is a combination of a test and treatment option for gallstones in the common bile duct. Using a flexible tube with a light and a camera, the doctor can travel all the way into the small intestine, releasing a dye that will make the bile ducts more visible. In case of gallstones in the common bile duct, the endoscope can remove them. However, if there are gallstones identified in the gallbladder, they cannot be removed via this procedure.

Magnetic resonance cholangiopancreatography. Magnets and radio waves are used to create clear images of the organs. This procedure is used only to diagnose gallstones, without having the possibility to remove them. It is a safer test than the endoscopic retrograde cholangiopancreatography which is why doctors usually go for this one initially.

 

Gallstones treatment – gallstones how to treat

Treatment for gallstones depends on the severity of the symptoms. Silent stones or asymptomatic stones don’t require any form of treatment; in fact, they may never even be discovered (unless the patient undergoes some imaging tests that discover the gallstones). However, if symptoms such as pain, nausea and vomit, fever and others are present and cause discomfort, a treatment plan is needed.

The most common and typical form of treatment for this medical condition is surgically removal of the gallbladder (gallstone removal surgery). Removing the gallbladder is a surgical procedure known as cholecystectomy. This procedure can eliminate the gallstones in the gallbladder, but it does not remove gallstones in the bile ducts. For these gallstones another previously discussed procedure is more appropriate and that is endoscopic retrograde cholangiopancreatography.

Laparoscopic cholecystectomy. The surgical procedure of removing the gallbladder can be performed laparoscopically, meaning that this procedure is a minimally invasive one with less pain and a faster recovery process than the classical cholecystectomy (gallstones surgery; gallstones laparoscopic surgery). This technique uses several small incisions on the right side of the abdomen in which a tube with a camera called laparoscope is inserted.

Gallstone removal without surgery. While there isn’t a miracle way in which gallstones can be removed without surgery, some nonsurgical treatment options can be acid pills (that can dissolve the gallstones), shock waves therapy or endoscopic drainage are reserved for special cases.

 

Gallstones what to eat

There are some dietary and lifestyle changes that someone with gallstones can make in order to ease the symptoms caused by these conditions. Some of the most important foods to eat (gallstones foods to eat) are fruits and vegetables such as citrus fruits, tomatoes, bell peppers – basically any fruit or vegetable that has vitamin C, vitamins B, calcium or fibers. A low-fat dairy diet can also help so consider replacing whole milk with almond, oat or soy milk. Some of the foods that are to be avoided in case of gallstones (gallstones foods to avoid) are pasta, bread, vegetable or peanut oil, sugar, alcohol, high-fat foods.

 

Conclusion

Gallstones are quite a common condition that sometimes can go unnoticed because it causes no symptoms. However, their main symptoms are pain and nausea can be debilitating and severely affect one’s quality of life.  If not treated, Gallstones can cause a series of complications that can rapidly escalate and even become life-threatening. Through dietary and lifestyle changes some improvements can be made, but the main treatment for this condition remains the surgical removal of the gallbladder.