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Gallstones: Causes, Symptoms, Diagnosis, Treatment, and Prevention

A gallstone is a solid deposit of digestive fluid that forms in the gallbladder, a small organ responsible for storing bile and assisting digestion. Based on their size, number, and how they affect bile flow, gallstones can cause different problems.

Causes of Gallstones

Gallstones are thought to form as a result of an imbalance of the substances that make up bile, such as cholesterol, bilirubin, and bile salts. Some factors that may contribute to this imbalance include:

  • Having too much cholesterol in the bile, which can lead to the formation of cholesterol stones, the most common type of gallstones.

  • Having too much bilirubin in the bile, which can result from certain blood disorders, liver diseases, or infections. Bilirubin is a waste product that is normally eliminated by the liver. Excess bilirubin can form pigment stones, which are dark and hard.

  • Having a low concentration of bile salts in the bile, which can be caused by genetic factors, certain medications, or rapid weight loss. Bile salts help dissolve cholesterol and keep it in liquid form. Without enough bile salts, cholesterol can crystallize and form stones.

  • Having a reduced or irregular emptying of the gallbladder, which can be due to pregnancy, fasting, aging, or certain diseases. This can cause bile to become more concentrated and prone to forming stones.

Symptoms of Gallstones

In many cases, people who have gallstones do not experience any symptoms and are unaware they have them. This is because the stones do not cause any problems unless they block the flow of bile from the gallbladder into the small intestine. It is possible for this to cause a sudden and severe pain in the upper right or middle part of the abdomen, commonly known as biliary colic. The pain may last for a few minutes to several hours and may radiate to the back, shoulder, or chest. There may also be nausea, vomiting, sweating, or fever associated with it.

Some complications that can arise from gallstones are:

  • As a result of a stone blocking the cystic duct that connects the gallbladder to the common bile duct, cholecystitis is an inflammation or infection of the gallbladder. In addition to persistent pain, jaundice (yellow skin and eyes), and tenderness in the upper right abdomen, cholecystitis can cause fever.

  • Symptoms of choledocholithiasis include jaundice, dark urine, light-colored stools, itching, and abdominal pain when a stone moves from the gallbladder to the common bile duct and blocks it.

  • When a stone blocks the pancreatic duct, which joins with the common bile duct before entering the small intestine, pancreatictitis occurs. In addition to severe abdominal pain that spreads to the back, pancreatitis can cause nausea, vomiting, fever, and elevated blood sugar.

  • An obstruction of the small intestine caused by a gallstone passes from the gallbladder to the small intestine, resulting in abdominal pain, bloating, constipation, diarrhea, vomiting, and weight loss.

Diagnosis of Gallstones

To diagnose gallstones and their complications, your doctor may perform various tests and procedures such as:

  • A blood test can check for signs of infection, inflammation, jaundice, pancreatitis, or other gallstone-related conditions.

  • An abdominal ultrasound is a noninvasive procedure that uses sound waves to create images of your abdominal organs. It can detect gallstones in your gallbladder or bile ducts.

  • Ultrasound endoscopy (EUS): It involves inserting a thin tube with a camera and an ultrasound device into your digestive tract. The tube is inserted through your mouth and into your digestive tract. With it, you can see the gallbladder and surrounding tissues in detail, and you can identify smaller stones that an abdominal ultrasound may miss.

  • Other imaging tests: These may include oral cholecystography (OCG), which involves swallowing a contrast dye that makes your gallbladder visible on X-rays; hepatobiliary iminodiacetic acid (HIDA) scan, which involves injecting a radioactive tracer into your vein that travels to your liver and gallbladder and shows how well they function; computed tomography (CT) scan, which uses X-rays to create cross-sectional images of your abdomen; magnetic resonance cholangiopancreatography (MRCP), which uses magnetic fields to create images of your bile ducts and pancreas; or endoscopic retrograde cholangiopancreatography (ERCP), which involves inserting a tube with a camera and a dye through your mouth and into your bile ducts and pancreas. Stones can also be removed or stents can be placed to relieve blockages using ERCP.

Treatment of Gallstones

The treatment of gallstones depends on whether they cause symptoms or complications, and on your overall health and preferences. The main options are:

  • An effective treatment for gallstones that are symptomatic or complicated is surgery. In this procedure, your gallbladder is removed (cholecystectomy), which is not essential for digestion or does not affect your quality of life. You can undergo surgery by either making a large incision in your abdomen (open cholecystectomy) or by using a camera and special instruments (laparoscopic cholecystectomy). While laparoscopic surgery is less invasive and has a shorter recovery time, it may not be suitable for everyone.

  • The medications are less effective than surgery in dissolving gallstones, and they take longer to dissolve. They are usually reserved for those who can't undergo surgery or who have small cholesterol stones. If the treatment is stopped, the stones may recur. They work by reducing the amount of cholesterol in your bile. It can take months or years for the stones to dissolve, and if they stop, the stones may recur.

  • Other procedures: These are used to break up or remove gallstones without removing the gallbladder, but they are rarely performed and have limited success. In addition to extracorporeal shock wave lithotripsy (ESWL), which uses sound waves to smash the stones, percutaneous cholecystostomy, which drains the gallbladder through a tube inserted into your skin, and contact dissolution therapy, which dissolves stones through the injection of a solvent into your gallbladder.

Prevention of Gallstones

There is no sure way to prevent gallstones, but you can reduce your risk by making some lifestyle changes such as:

  • Eating a healthy diet that is low in fat and cholesterol and high in fiber, fruits, vegetables, and whole grains.

  • Maintaining a healthy weight and avoiding rapid weight loss or gain.

  • Drinking plenty of water and staying hydrated.

  • Exercising regularly and staying physically active.

  • Avoiding smoking and excessive alcohol consumption.

  • Taking medications as prescribed and avoiding unnecessary use of drugs that may affect your bile composition.

In most cases, gallstones are harmless, but if they block the flow of bile from your gallbladder or small intestine, they can cause serious problems. When you experience gallstone symptoms or complications, it is important to seek medical attention immediately. If you have gallstones, you will usually need surgery to remove your gallbladder, which will not affect your digestion or quality of life. The risk of gallstones can be reduced or prevented by following a healthy lifestyle and taking care of your liver and gallbladder.

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