What are Gallstones?
The gallbladder, a small organ in the upper right of your abdomen, is located below your liver. It stores bile (a green-yellow liquid that aids in digestion). Problems with the gallbladder are usually caused by a blockage of its bile passages, such as a gallstone. Gallstones can be caused by substances found in bile, such as cholesterol.
Gallstones are common and often asymptomatic. About 10% of those diagnosed with gallstones will experience noticeable symptoms within five years. In this article, we are going to discuss gallstones, types of gallstones, symptoms, causes, and treatment. We are also going to discuss the diagnosis and preventional tips for the same.
Types of Gallstones
Gallstones can form in the gallbladder of several types:
- Cholesterol gallstones. A cholesterol gallstone is the most common type. It often looks yellow. These gallstones are mainly composed of undissolved cholesterol but can also contain other components.
- Pigment gallstones. These dark brown or black stone forms when there is too much bilirubin in your bile.
Gallstone Symptoms and Signs
Gallstones can cause pain in your upper right abdomen and the middle of your stomach. Gallbladder pain may occur from time to time if you eat a lot of fat-rich foods like fried foods. However, the pain can happen at any time. Gallstone pain is usually temporary but can be severe. Gallstones that are not treated or identified promptly can cause symptoms to worsen, including:
- High temperatures
- rapid heartbeat
- Jaundice is a yellowing of the skin or whites of your eyes.
- itchy skin
- diarrhoea
- Chills
- There is confusion
- A loss of appetite
These symptoms could be symptoms of gallbladder inflammation, liver disease, or gallbladder infection. Gallstone symptoms can mimic other serious conditions like pancreatitis and appendicitis. It is important to seek medical attention if you have any of these symptoms.
Gallstones that are Symptomatic
Gallstones don't cause pain. Pain is caused by gallstones blocking the flow of bile from your gallbladder. The American College of Gastroenterology states that about 80 percent of gallstone sufferers have silent gallstones. This means that they don't feel any pain or experience symptoms. These cases may be diagnosed by your doctor using X-rays or abdominal surgery.
Causes
Gallstones are thought to generally occur or develop by a chemical imbalance in the bile within the gallbladder. Although researchers aren't sure what causes this imbalance, there are some possible explanations:
Too Much Cholesterol In The Bile
Too much cholesterol in the bile can cause yellow cholesterol stones. These hard stones could form if your liver produces more cholesterol than your body can dissolve.
Too Much Bilirubin Is In Your Bile
Bilirubin is a chemical that occurs during normal red blood cell breakdown. It is then passed through the liver before being excreted from the body. Your liver may produce more bilirubin due to certain conditions such as liver disease and blood disorders. When your gallbladder is unable to break down excess bilirubin, pigment gallstones can form. These hard stones can be dark brown or black.
A Full Gallbladder Can Cause Concentrated Bile
To function properly, your gallbladder must be able empty its bile. It can become overly concentrated and cause stones to form if it does not empty its bile.
Complications
Gallstone complications can include:
- Inflammation of gallbladder. Cholecystitis is caused by a gallstone getting lodged in the neck. Cholecystitis may cause severe pain and fever.
- Blockage of common bile drain. Gallstones can cause obstruction of the tubes (ducts), through which bile flows to your small intestine from your liver or gallbladder. You may experience severe pain, jaundice, and bile-duct infection.
- Blockage of the pancreatic tube. The pancreatic tube runs from the pancreas to connect with the common bile conduit just before it enters the duodenum. The pancreatic juices which aid in digestion flow through this tube. A gallstone can block the pancreatic conduit, which can cause inflammation and pancreatitis. Pancreatitis is characterized by intense and constant abdominal pain that often requires hospitalization.
- Gallbladder cancer. Gallbladder cancer is more common in those who have had gallstones in the past. Gallbladder cancer can be very rare.
Treatment
You won't usually need treatment for gallstones unless they cause pain. Sometimes, gallstones can be passed without you even realizing it. Your doctor may recommend surgery if you are in pain. In very rare cases, medication might be prescribed. There are several non-surgical options to try to treat gallstones if you are at risk of complications from surgery. Your gallstones could return even with additional treatment if surgery is not performed. You may need to monitor your condition throughout your entire life.
Surgery
The most common operation on adults in America is cholecystectomy. This is a procedure to remove the gallbladder. It is possible to live a normal life with the gallbladder removed, as it is not an essential organ. There are two types:
- Laparoscopic cholecystectomy. This is a common procedure that requires general anaesthesia. The surgeon will typically make three to four incisions in the abdomen. The surgeon will then make incisions through your abdomen, insert a small, light-emitting device, check for stones and remove your gallbladder. If there are no complications, you can usually return home the same day or the next day.
- This surgery is performed when the gallbladder becomes inflamed, infected, or scarred. If problems arise during laparoscopic surgery, this surgery could also be performed.
After the gallbladder removal, you may feel loose or watery stool. The bile must be rerouted from the liver to reach the small intestine in order to remove a gallbladder. The gallbladder can no longer carry bile and becomes more concentrated. This can lead to diarrhoea and a laxative effect. However, most people will be able to resolve the issue on their own.
Nonsurgical Treatments
There are other options available if surgery is not possible, for example, if the patient has gallstones that are too large or if they are very old.
- To dissolve gallstones, oral dissolution therapy usually involves the use of Actigall and Chenodiol. These medications contain bile acid, which works to break down the stones. This treatment is most effective for breaking down cholesterol stones. It can take several months or even years to complete.
- Another option is shock wave lithotripsy. A lithotripter generates shock waves that pass through the body. These shock waves can cause gallstones to break into smaller pieces.
- To aspirate (draw out) the bile, percutaneous gallbladder drainage involves inserting a sterile needle in the gallbladder. To aid with drainage, a tube is inserted. This is not a common procedure and may not be the best option for everyone.
Gallstones: Risk Factors
While some risk factors for gallstones can be controlled through diet, others are more difficult to control. Things like race, gender, and family history are all risk factors that cannot be controlled.
Lifestyle Risk Factors
- Living with obesity
- A diet high in cholesterol or fat and low in fibre
- undergoing rapid weight loss
- Living with type 2 Diabetes
Genetic Risk Factors
- being born female
- Being of Native American or Mexican descent
- Gallstones in the family
- Being 60 or older
Factors That Could Pose A Medical Risk
- Living with cirrhosis
- being pregnant
- Certain medications can lower cholesterol
- High estrogen-content medications (such as certain birth control pills)
Some medications can increase your gallstone risk. However, you should not stop taking them without consulting your doctor and getting their approval.
Who Is At The Greatest Risk Of Gallstones?
Gallstones may be more likely if you are:
- Are you a woman?
- Are older than 40
- Gallstones are a common condition in the family.
- Are overweight.
- You have lost a lot of weight in a very short time.
- Do not have diabetes.
- Crohn's disease.
- Avoid eating a high-fat and cholesterol-rich diet.
- Use drugs that lower cholesterol
- Use oral contraceptives and other medications.
- Certain blood disorders
- Are either of Native American or Mexican heritage.
Diagnosis
A physical exam will be performed by your doctor. This includes checking your eyes for any visible changes in colour. Jaundice is a result of excessive bilirubin. A yellowish tint could be an indication of this condition.
Diagnostic tests may be used to help your doctor examine your body. These tests may include:
- Ultrasound. Ultrasound produces images of the abdomen. This is the best imaging method to determine if you have gallstone disease. It can also reveal abnormalities that are associated with acute cholecystitis.
- Abdominal CT scan. This imaging test captures images of your liver, abdominal region, and other areas.
- Scan of the gallbladder for radionuclides. The important scan takes approximately one hour. The specialist injects radioactive substances into your veins. The radioactive substance is injected into your bloodstream and travels to the liver, gallbladder, and other organs. It can be detected on a scan as evidence of infection or blockage in the bile drains.
- Blood tests. A doctor might order blood tests to measure your blood bilirubin levels. These tests can also be used to determine the health of your liver.
Moderation In Diet And Food
These tips can help you improve your health and decrease your chance of developing gallstones.
- Reduce refined carbs like white bread and cookies, and eat less sugar.
- Increase your intake of healthy fats like olive oil and fish oil. This may help your gallbladder contract.
- Consume the right amount of fibre each day. Women need approximately 25g per day, while men need around 38g.
- Do some form of exercise every day.
- Hydrate properly.
Slowly lose weight if you want to. Rapid weight loss can increase your chances of developing gallstones or other health problems.
Prevention
Although there is no way to prevent gallstones completely, cholesterol appears to play an important role in their formation. Your doctor might recommend that you limit the intake of foods high in saturated fat if you have a history of gallstones. These foods include:
- Fat meats, such as bacon and sausage
- Cookies and cakes
- Lard and cream
- certain cheeses
Gallstones are more common in obese people. To limit their chances of developing, it is important to keep your weight in a healthy range.
Gallstones can be reduced by following these steps:
- Don't skip meals. Stick to your regular meal times each day. Avoiding meals or fasting may increase your risk of developing gallstones.
- Lose weight slowly. Slowly lose weight if you are desperate to. Rapid weight loss can increase your risk of developing gallstones. You should aim to lose between 0.5 and 1 kilogram per week.
- Eat more high-fibre foods. Increase the intake of fibre-rich foods like fruits, vegetables, and whole grains in your diet.
- Keep your weight under control. Gallstones are more common in overweight and obese people. You can achieve a healthy weight by reducing your calorie intake and increasing your physical activity. You can maintain a healthy weight once you have achieved it.
Long-term Outlook
The outlook for gallstones is usually positive if your doctor diagnoses them and recommends surgery to remove them. Most stones that are removed do not return. You can have surgery if you're unable to and take medication to dissolve the gallstones. Your doctor will monitor your progress. You don't need to do much if your gallstones are not causing any symptoms. You may still want to change your lifestyle to stop them from growing and causing more problems.
Is My Weight Or Diet Putting Me At Risk Of Gallstones?
Gallstones are more common in overweight people or those who plan to lose weight, whether through surgery or a diet. There are several reasons why the risk is greater.
- High levels of cholesterol may lead to overweight people. Although your bile already contains cholesterol, a high-cholesterol diet can increase the likelihood that it will build up and cause a cholesterol gallstone.
- Rapid weight loss can also be a concern. The digestive process includes the gallbladder. The gallbladder holds the bile in place, much like a tank. The bile is then released by the gallbladder through the ducts into the intestine. This helps to break down food. Your liver releases extra cholesterol to the bile if you follow a diet that drastically reduces calories or undergo weight loss surgery. Gallstone formation can also occur when the gallbladder is unable to contract vigorously due to being 'lazy'. Gallstone formation is possible in patients who have undergone a gastric bypass, or any other surgery that results in rapid weight loss. The surgeon may prophylactically remove the gallbladder (a preventative measure) during weight loss surgery.
It is important to talk with your doctor about the risks associated with any weight loss or surgery you are considering. If you have ever had stones, this could be particularly important. Gallstones can occur more than once.
Can Children Get Gallstones?
Gallstones can occur in both children and adults. Gallstones are most common in middle-aged people. Gallstones can also occur in adults. Gallstones in children can be difficult to identify. Young children might have trouble identifying the location of the pain. Call your doctor if you notice any unusual symptoms in your child's abdomen or if they are experiencing abdominal pain.
What Is A Laparoscopic Surgery For Cholecystectomy (also Known As Laparoscopic Cholecystectomy)?
Laparoscopic cholecystectomy can be described as minimally invasive because it makes several smaller incisions than one. A laparoscope, a small tube equipped with a camera, is an instrument that allows you to see inside the body. The laparoscope is inserted through a single incision. Your doctor can view your gallbladder through the camera on a TV screen. The surgeon then removes the gallbladder through a small incision.
What Happens If Laparoscopic Cholecystectomy Fails Or There Are Complications?
The surgeon may have to perform an open cholecystectomy if there are complications with gallstones. This procedure involves an abdominal incision and can require a longer stay in the hospital (three to five nights). Open cholecystectomy could be due to the following medical issues:
- Severe inflammation of the gallbladder.
- Experiencing difficulties during an attempted laparoscopic surgery.
- Severe respiratory and cardiac problems.
- A late-term pregnancy.
- Major scarring after a previous operation.
- A bleeding disorder or liver disease.
- Gallbladder cancer is a rare but serious condition.
What Is An Endoscopic Retrograde Cholangiopancreatography (ercp) Procedure?
An endoscopic retrograde cholangiopancreatography (ERCP) procedure helps for removing gallstones. The endoscope looks like a tube. During treatment, your doctor will need it to be moved through your digestive system. The endoscope's path is:
- In the mouth.
- The throat.
- Through the stomach.
- Into the duodenum, the beginning of the small intestine, where the common bile duct empties its bile.
Once the patient is there, the endoscope can be used to clear any obstructions in the bile drain.
Can I Digest Food With Or Without A Gallbladder?
To properly digest food, you don't require a gallbladder. Your liver will carry bile directly through your gallbladder, the hepatic drain, and the common bile duct to your small intestine. You may feel softer stool after the surgery. These usually resolve in a few days.
Is There A Non-surgical Treatment For Gallstones?
Your healthcare provider will usually use minimally invasive techniques to remove gallstones. You can dissolve stones with medications. These drugs aren't as commonly used because of the advancements in minimally invasive techniques. It can take several months or even years to dissolve medications. A procedure, on the other hand, can resolve the problem quickly. These medications could be used to treat gallstones if you cannot have surgery due to another condition. Discuss all options with your doctor to determine which is best for you.
What Are The Complications Associated With Gallstones?
A gallstone attack can cause many complications, such as:
- Bloating.
- Nausea and vomiting.
- Abdominal pain
- Shoulder pain
- Pain in the back
- Chest pain.
Gallstones can also lead to infection of the gallbladder and bile ducts. A blockage of the common bile drain can lead to jaundice, yellowing of the skin and eyes, or irritation to the pancreas.
Is It Possible To Prevent Gallstones?
Gallstones can't be avoided. You can reduce your risk factors by living a healthy lifestyle. You can maintain a healthy weight by exercising and eating a balanced diet. A key part of gallstone prevention is talking to your doctor about cholesterol management and weight loss.
If I Have Gallstones, What Foods Should I Avoid?
Cholesterol is a major component of gallstones. Although you cannot prevent gallstones from forming, you can reduce the intake of fatty foods. Several tips for limiting cholesterol in your diet include:
- Reduce your meat intake
- Adding fish.
- Reduce the consumption of fried foods.
- Increase your intake of whole grains
- Low-fat dairy products (cheese and milk)
- Fresh vegetables and fruits can be added.
Are There Any Gallstones That Can Be Re-infected?
Yes. It is much more likely that you will experience a gallstone attack again if you have already had one. Because gallstones can be attacked multiple times, your doctor may recommend that you have the gallbladder removed.
When Is It Best To Call My Doctor?
Call your doctor if you feel pain in your abdomen. This is especially important if it gets worse over time or is associated with nausea, fever, or vomiting. There are many reasons for abdominal pain. Your doctor will carefully examine your symptoms to determine the cause. You may need to be referred to the emergency department if your symptoms are severe.
Are Gallstones Considered Fatal?
Gallstones aren't necessarily fatal. They can lead to serious complications. This is rare. A large stone could block your bile passages. This can cause severe pain and infection. This is an urgent medical situation that needs prompt treatment. Of course, all medical procedures--such as ERCP and cholecystectomy--have risks.
Conclusion
Gallbladder diseases are most commonly secondary to cholelithiasis. While most cases of gallstones are asymptomatic, a few cases may advance to symptomatic disease. Factors that may increase the risk of gallbladder disease incorporate gender, identity, medical history, family history, and diet and nourishment. Gallbladder disease is diagnosed primarily via imaging procedures. These diagnostic procedures have their pros and cons, and, most importantly, their accuracy varies.
Asymptomatic patients generally don't need treatment. The medical procedure is the most well-known treatment, yet nonsurgical alternatives are available for patients who cannot or are reluctant to go through a medical procedure. Pharmacists can play a job in the treatment of gallbladder disease by educating patients about the risk factors for gallbladder disease — particularly cholelithiasis.
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