Gallstone Disease

Overview

Gallbladder disease is characterized by inflammation, infection, stones, or gallbladder obstruction. The gallbladder is a pouch underneath the liver. It is responsible for storing and concentrating bile produced by the liver. Bile assists in fat digestion and is secreted by the gallbladder into the upper small intestine in response to meals (especially fats).

The most frequent condition affecting the biliary system, the body's mechanism for transferring bile, is gallstone disease. Gallstones are pebble-like solid masses that occur in the gallbladder or biliary system (the ducts leading from the liver to the small intestine). They occur as bile hardens because to an overabundance of cholesterol, bile salts, or bilirubin. 

Intermittent discomfort, known as biliary colic, is the most frequent and mild symptom of gallbladder stones. A patient often complains of a constant gripping or gnawing pain in the upper right abdomen near the rib cage, which can be severe and spread to the upper back. Some biliary colic sufferers have discomfort beneath the breastbone. It is possible to have nausea or vomiting.

If the patient has gallstones or the gallbladder is not working correctly, surgery to remove the gallbladder may be necessary. Most of the time, this may be done as an outpatient operation, either laparoscopically (via small incisions) or with robotic-assisted surgery.

What Are Gallstones Made of?

Gallstones are formed in your body from hardened minerals. Generally, there are two kinds:

1. Cholesterol: Cholesterol is a fatty substance present in the blood that is found throughout the body. Gallstones of this sort are the most prevalent.
2. Pigment Stones (mostly bilirubin-based): When red blood cells degrade in the liver, this chemical is formed. Too much bilirubin in the bloodstream can cause the skin and eyes to become yellow (jaundice).

Gallstones composed by cholesterol are often greenish in colour. Gallstones composed of cholesterol are more prevalent than other forms of stones.

Causes of Gallstone Disease

Although scientists aren't exactly sure why and how gallstones form, they appear to form when your bile has too much cholesterol, too much bilirubin, not enough bile salts, or your gallbladder is malfunctioning. Some persons are more prone to have gallstone risk factors, including as age, obesity, certain illnesses, and diets.

Gallstones form in the gallbladder, a pear-shaped organ on the right side of the belly under the liver. The gallbladder is approximately 3 inches long and 1 inch broad at its thickest point, and it stores and releases bile into the intestine to help digestion.

Bile is a digestive fluid produced by the liver. Bile includes bile salts, which function as natural detergents to break down lipids in the food we eat. The gallbladder discharges bile into the bile ducts when food moves from the stomach into the small intestine. These ducts, sometimes known as tubes, connect the liver to the gut. Bile also aids in the removal of excess cholesterol from the body. The liver secretes cholesterol into bile, which is ultimately excreted from the body through the digestive system.

Most studies believe that at least one of four factors must exist in order for gallstones to form:

• Excess cholesterol in your bile: Bile becomes cholesterol supersaturated, which means it contains more cholesterol than your bile can breakdown. This can cause the cholesterol to crystallize and finally form stones.
• Excess bilirubin in your bile: Certain health issues, such as liver cirrhosis, particular hereditary blood diseases, and biliary tract infection, might result in excessive bilirubin in your bile. Bilirubin excess can result in colored gallstones.
• Too few bile salts in your bile: This can create gallstones either because there aren't enough bile salts to break down the cholesterol in your bile or because there is too much cholesterol in your bile for the bile salts to dissolve.
• Gallbladder dysfunction: The gallbladder does not contract sufficiently to clear its bile on a regular or complete basis, causing your bile to become concentrated.

Risk Factors for Gallstone Disease

1. Genetics

Gallstones are more likely to form if you have a family history of them.Several studies, however, have found that genes only account for roughly 25% of the overall risk of having gallstones.

If you are Native American, you may have a hereditary propensity to secrete more cholesterol in your bile.

2. Lifestyle Risk Factors

There are a number of lifestyle risk factors that may contribute to gallstones, including obesity, rapid weight loss, and dieting:

• Obesity:

Obesity is a significant risk factor for gallstone formation. Obesity is frequently defined by scientists using a mathematical calculation known as body mass index (BMI) (BMI = weight in kilograms divided by height in meters squared). The more fatty you are, the more likely you are to get gallstones.

Several studies have found that women with a high BMI are nearly three times more likely than women with a healthy BMI to develop gallstones.

It is unknown why obesity is a risk factor for gallstones, but researchers have discovered that obese persons have greater levels of cholesterol in their bile, which can induce gallstones. Obese people may also have big gallbladders that do not function properly.

• Losing Weight Rapidly:

People who lose a lot of weight quickly are more likely to develop gallstones. Gallstones are, in fact, one of the most serious medical problems of dieting. The link between diets and gallstones has just lately come to light.

Very low-calorie diets are commonly classified as those that comprise 800 calories per day, are often consisting of liquid food, and are followed for an extended length of time, typically 12 to 16 weeks.

Gallstones that form in persons on very low-calorie diets are normally quiet and cause no symptoms. However, one research discovered that those on very low-calorie diets may be more likely to develop gallstones that necessitate hospitalization or cholecystectomy (surgical removal of the gallbladder).

Gallstones are also prevalent in obese people who lose weight quickly following gastric bypass surgery, which reduces the size of the stomach, reducing overeating. Gallstones are more likely to form in the first few months following surgery.

• Dieting:

Dieting, according to researchers, may produce a change in the equilibrium of bile salts and cholesterol in the gallbladder. The cholesterol level rises as the quantity of bile salts falls. Going without food for long periods of time (for example, skipping breakfast) is a typical diet habit that may reduce gallbladder contractions. Gallstones can develop if the gallbladder does not contract frequently enough to discharge the bile.

If rapid or significant weight loss increases the risk of developing gallstones, more gradual weight loss appears to reduce the risk of developing gallstones. However, further research is needed to put this notion to the test.

Some very low-calorie diets may lack enough fat to cause the gallbladder to constrict sufficiently to clear its bile.

However, no studies have directly connected the nutritional makeup of a diet to the development of gallstones.

Furthermore, no research on the impact of frequent dieting on gallstone development have been undertaken, despite the fact that a pattern of continuously losing and gaining weight has been demonstrated to possibly raise your odds of getting gallstones.

3. Other Risk Factors

Other risk factors for gallstones include:

• Age 40 or over.
• Gender (women are at higher risk than men).
• Ethnicity, especially Native American and Mexican American
• High triglyceride levels.
• Low high-density lipoprotein (HDL) cholesterol.
• Taking cholesterol-lowering drugs.
• Diabetes.
• Crohn's disease in the terminal ileum.
• High estrogen levels from pregnancy, hormone replacement therapy, or birth control pills.
• Liver disease.
• Bile duct infection.
• Cirrhosis.

Gallstones Symptoms & Signs

Gallstone symptoms can vary depending on the size of the gallstone. The majority of gallstones cause no symptoms at all. These gallstones are known as silent stones since they do not require treatment. Gallstones can produce a variety of symptoms, including:

• Pain in the upper mid abdomen or upper right abdomen.
• Associated pain in the right shoulder.
• Chest pain.
• Nausea and vomiting.
• Repeated similar episodes.
• Jaundice (a yellow tint to the skin and eyes).

Pain is the main symptom most people experience with gallstones. This pain is steady and can last from around 15 minutes to several hours. The episodes, which can be severe, generally subside after one to three hours or so. 

People who have these painful assaults, while uncomfortable, are not in any danger of harming themselves medically. Gallstones can induce acute cholecystitis, a more dangerous illness in which the gallbladder becomes inflamed. This occurs when a stone obstructs the cystic duct, increasing the pressure within the gallbladder. This illness may necessitate the use of antibiotics, hospitalization, and perhaps emergency surgery.

Stones that pass through the gallbladder and into the common bile duct can completely clog the duct, resulting in jaundice, infection, and pancreatitis.

You may experience discomfort in a variety of locations, including:

• Upper part of the abdomen, on the right side.
• Between the shoulder blades.
• Under the right shoulder.

When patients have gallstone discomfort, it is commonly referred to as a gallbladder attack or biliary colic. There are two conditions that might cause symptoms similar to gallstones. To begin, some gallbladders contain a thick sludge that has not yet hardened into stones. Sludge can sometimes be felt to induce sensations comparable to gallstone discomfort. Second, there is a rare disorder known as acalculous cholecystitis, which occurs when the gallbladder becomes inflamed but no stones are present. In most cases, the gallbladder is surgically removed.

Can Gallstones Be Prevented?

Gallstones are unavoidable. You may, however, reduce your risk factors by adopting a healthy lifestyle. Maintaining a healthy weight through exercise and a well-balanced diet is critical. Talking to your doctor about weight reduction and cholesterol management is also an important aspect of gallstone prevention.

What foods should I avoid if I have had gallstones in the past?

Cholesterol is the main component of many gallstones. Though you cannot avoid gallstones, you can try to minimize your intake of fatty foods. Among the many suggestions for lowering cholesterol in your diet are:

• Eating less meat.
• Adding fish.
• Limiting the amount of fried foods.
• Adding more whole grains.
• Choosing low-fat dairy products (cheese, milk).
• Adding fresh vegetables and fruit.

How Are Gallstones Diagnosed?

A health care provider will usually order an ultrasound exam to diagnose gallstones. Other imaging tests may also be used. 

1. Ultrasound exam: Ultrasound gives an image of organ anatomy by using a device called a transducer, which bounces safe, painless sound waves off organs. A professionally trained technician performs the operation in a health care provider's office, outpatient facility, or hospital, and the pictures are interpreted by a radiologist—a doctor who specializes in medical imaging. There is no need for anesthesia. Gallstones will be apparent in the image if they are present. The most accurate approach for detecting gallstones is ultrasound.
2. Computerized tomography (CT) scan:  A CT scan is a type of x-ray that provides images of the body. A CT scan may include the administration of a specific dye known as contrast medium. CT scans provide three-dimensional (3-D) pictures by combining x-rays and computer technologies. CT scans need the patient to lie on a table that slides into a tunnel-shaped equipment that takes x-rays. In an outpatient facility or hospital, an x-ray technician conducts the procedure, and a radiologist interprets the results. There is no need for anesthesia. CT scans can detect gallstones as well as problems such as infection and gallbladder or bile duct obstruction. CT scans, on the other hand, can overlook gallstones that are present.
3. Magnetic resonance imaging (MRI): MRI machines use radio waves and magnets to produce detailed pictures of the body’s internal organs and soft tissues without using x rays. MRIs can show gallstones in the ducts of the biliary system.
4. Cholescintigraphy: Cholescintigraphy, also known as a hydroxyl iminodiacetic acid scan, HIDA scan, or hepatobiliary scan, produces images of the biliary system using a non-harmful radioactive substance. A person rests on an exam table as a health care worker injects a small quantity of non-harmful radioactive material into a vein in the individual's arm. A chemical that causes the gallbladder to constrict may potentially be injected by the doctor. A unique camera records the radioactive substance as it passes through the biliary system. In an outpatient facility or hospital, the procedure is performed by a professionally trained technician, and the pictures are interpreted by a radiologist. There is no need for anesthesia. Cholescintigraphy is used to detect aberrant gallbladder contractions or bile duct blockage.
5. Endoscopic retrograde cholangiopancreatography (ERCP): ERCP uses an x ray to look into the bile and pancreatic ducts. After lightly sedating the person, the health care provider inserts an endoscope—a small, flexible tube with a light and a camera on the end—through the mouth into the duodenum and bile ducts. ERCP helps the health care provider locate the affected bile duct and the gallstone. The stone is captured in a tiny basket attached to the endoscope and removed. This test is more invasive than other tests and is used selectively. 

How Are Gallstones Treated?

Treatment is typically unnecessary if gallstones are not producing symptoms. A health care practitioner would normally prescribe treatment if a person has a gallbladder attack or other symptoms. For therapy, a person may be referred to a gastroenterologist (a specialist who specializes in digestive diseases). If a person has had one gallbladder attack, he or she is likely to have several.

Gallstones are often treated by surgery to remove the gallbladder. If a person is unable to have surgery, nonsurgical therapies to dissolve cholesterol gallstones may be employed. A health care professional may use ERCP to remove stones from the common bile duct in patients who are going to have gallbladder removal surgery or to remove stones from the common bile duct in persons who are unable to undergo surgery.

Nonsurgical Treatments for Cholesterol Gallstones:

Nonsurgical treatments are used only in special situations, such as when a person with cholesterol stones has a serious medical condition that prevents surgery. Gallstones often recur within 5 years after nonsurgical treatment.6

Two types of nonsurgical treatments can be used to dissolve cholesterol gallstones:

• Oral dissolving therapy: Ursodiol (Actigall) and chenodiol (Chenix) are bile acid-containing medicines that dissolve gallstones. These drugs work well for dissolving tiny cholesterol stones. It may take months or years of therapy to dissolve all stones.
• Shock wave lithotripsy: To crush the gallstone, a machine called a lithotripter is employed. The lithotripter sends shock waves through the person's body, shattering the gallstone into tiny fragments. This treatment is infrequently done and may be combined with ursodiol.

Surgical Treatment:

Cholecystectomy, or gallbladder removal surgery, is one of the most common surgeries performed on people in the United States.

The gallbladder is not a necessary organ, which implies that a person may live healthily without one. Instead of being held in the gallbladder, bile flows out of the liver via the hepatic and common bile ducts and straight into the duodenum after the gallbladder is removed.

Surgeons perform two types of cholecystectomy: 

Laparoscopic cholecystectomy: A laparoscopic cholecystectomy is performed by inserting a laparoscope—a thin tube with a tiny video camera attached—through many tiny incisions in the belly. The camera transmits a magnified image from inside the body to a television monitor, allowing the surgeon to see organs and tissues up close. 

While keeping an eye on the monitor, the surgeon skillfully separates the gallbladder from the liver, bile ducts, and other tissues. The gallbladder is then removed by the surgeon through one of the tiny incisions. Patients are frequently put under general anesthesia.

Laparoscopy is used for the majority of cholecystectomies. Many laparoscopic cholecystectomies are performed as outpatient procedures, which means the patient can go home the same day. In most cases, normal physical activity may be resumed within a week.

Open cholecystectomy: When the gallbladder is significantly inflamed, diseased, or scarred from previous surgeries, an open cholecystectomy is performed. In the majority of these situations, open cholecystectomy is planned from the beginning. When complications arise during a laparoscopic cholecystectomy, a surgeon may do an open cholecystectomy. As a precautionary step, the surgeon must do an open cholecystectomy in these circumstances.

To remove the gallbladder during an open cholecystectomy, the surgeon makes a 4 to 6 inch long incision in the abdomen. Patients are frequently put under general anesthesia. Some patients may need to stay in the hospital for up to a week after having an open cholecystectomy. After about a month, normal physical activity may normally be resumed.

Can I Digest Food Without a Gallbladder?

A gallbladder is not required for optimal digestion. If your gallbladder is removed, bile will travel directly from your liver to your small intestine via the hepatic duct and the common bile duct. You may have some softer stools after the procedure, which will usually go away within a few days.

Conclusion

Gallstones are small, hard particles that form in the gallbladder. The gallbladder is a tiny, pear-shaped organ under the liver in the upper right abdomen (between the chest and hips).

Gallstones can be as little as a grain of sand or as large as a golf ball. A single enormous gallstone, hundreds of smaller stones, or both small and large stones can form in the gallbladder. Gallstones are hypothesized to form as a result of an imbalance in the chemical composition of bile inside the gallbladder.

Complications from gallstones, such as gallbladder inflammation, might occur in certain persons (cholecystitis). This can result in chronic discomfort, skin and eye yellowing (jaundice), and a high fever.

Abdominal ultrasound, Endoscopic ultrasound (EUS), and blood tests are among the test used to identify gallstones and gallstone problems. hepatobiliary iminodiacetic acid (HIDA) scan, computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP), or endoscopic retrograde cholangiopancreatography(ERCP) are all possible further testing. Gallstones detected during an ERCP procedure can be removed.

If your gallstones aren't causing any symptoms, you generally don't require therapy. Contact your doctor if you are experiencing a gallbladder attack or other symptoms. Although your symptoms may go away, they may reappear, and you may require therapy. Your doctor may recommend you to a gastroenterologist or surgeon for therapy.

Gallstones are usually treated by surgery to remove the gallbladder. Nonsurgical therapies for cholesterol stones are occasionally used by doctors, however surgery is frequently required for pigment stones.