Gallstones

Symptoms: extreme discomfort and pain in the abdomen, right shoulder pain, vomiting or nausea and pain between shoulder blades

Causes: Excessive amount of cholesterol in the bile, high levels of bilirubin in the bile, infrequent emptying of the gallbladder, increased concentration of bile, family history or genetics, consuming a high-fat diet, inactive lifestyle

Risk Factors: Being female and over 40 years, pregnancy, obesity, consumption of high cholesterol diet, diabetes, blood disorders like leukaemia or anaemia, liver diseases, and insulin resistance

Prevalence: The prevalence of gallstones in the general population is estimated to be between 10% and 15%; however, there is some variation across countries.

Severity: Mild to severe

Which doctor to consult: Gastroenterologist, General Surgeon or Laparoscopy Surgeon

Overview

Gallstones are solidified deposits found in your gallbladder, where bile is produced. The bile fluid is released into the small intestine from the gallbladder. The fluid comprises other substances like bilirubin, bile salts, cholesterol and lecithin.

Gallstones are pebble-shaped deposits that contain cholesterol and bilirubin and are found at the bottom region of the gallbladder. A patient might develop one or multiple gallstones.

Gallbladder stones can be the size of a grain or even a golf ball. Their size might increase gradually as the stones continue collecting deposits from the bile juice as the fluid washes over them. That's why, in most cases, these stones do not initially cause symptoms and stay in the gallbladder.

Most gallstones occur due to high levels of cholesterol in the body. These high cholesterol levels may be due to conditions like diabetes, obesity and a sedentary lifestyle. Consumption of high-fat and high-cholesterol foods can also lead to gallstones.

If the cholesterol level is high, the bile cannot dissolve it. As a result, the extra cholesterol remnants gradually develop into stones that cause the issue. Moreover, excessive bilirubin can also cause these stones to develop.

Gallstones can cause a wide variety of complications, including liver blockage, liver cirrhosis, cholangitis, jaundice, malabsorption, and gallbladder inflammation. So, these stones must not be left untreated and should be immediately examined by a specialist doctor.

Types of Gallstones:

Gallstones are small, hard deposits that form in the gallbladder, and there are two main types:

Cholesterol Gallstones are the most common type, accounting for about 75% of gallstones. They are primarily made of cholesterol and are usually yellow-green in colour.
Pigment Gallstones: These account for 20% to 25% of gallstones and are composed of bilirubin, a pigment formed from the breakdown of red blood cells. Pigment gallstones are usually smaller and darker, ranging from brown to black.
Sometimes, people may have a mixture of both types of stones. The type of gallstone can influence the treatment approach.

Symptoms:

Gallstones often don’t cause symptoms, but when they do, the symptoms can be quite noticeable. Common symptoms include:

Sudden and severe pain in the upper right abdomen or the centre of the abdomen, just below the breastbone
Back pain between the shoulder blades
Pain in the right shoulder
Nausea or vomiting
Fever and chills
Jaundice (yellowing of the skin and eyes)
Lightheadedness
These symptoms can occur a few hours after eating, especially fatty foods, and may last from several minutes to a few hours. If you experience such symptoms, it’s important to seek medical attention.

Causes:

Gallstones are formed due to an imbalance in the substances that make up bile in the gallbladder. The main causes include:

Excess cholesterol: If your liver excretes more cholesterol than your bile can dissolve, the excess may form into crystals and, eventually, stones.
Excess bilirubin: Conditions like liver cirrhosis, biliary tract infections, and certain blood disorders can cause your liver to produce too much bilirubin, leading to pigment gallstones.
Concentration of bile: If your gallbladder doesn’t empty properly, bile may become very concentrated, which can lead to stone formation.
Metabolic disorders: These can affect the way your body processes and stores substances like cholesterol, increasing the risk of gallstones.
Other factors: Obesity, rapid weight loss, pregnancy, fasting, and certain medications can also increase the risk of developing gallstones.
Consulting with a healthcare professional is the best way to understand your risk factors and prevention strategies better.

Risk Factors:

Risk factors for gallstones include conditions and lifestyle choices that increase the likelihood of stone formation in the gallbladder. These risk factors are:

Gender and age: Women, especially those over 40, are more likely to develop gallstones.
Obesity: Higher body mass index (BMI) increases the risk.
Diet: High in cholesterol, refined carbohydrates, and saturated fats.
Rapid weight loss: This can lead to imbalances that promote stone formation.
Pregnancy: Hormonal changes can affect bile composition.
Metabolic disorders: Such as diabetes.
Medications: Certain cholesterol-lowering drugs can contribute to gallstone formation.
Fasting: Can decrease gallbladder movement, leading to concentrated bile.
Spinal cord injury: May affect gallbladder function.
Maintaining a healthy weight, a balanced diet and regular physical activity can help reduce the risk of gallstones.

Possible Complications:

Acute Cholangitis: It is a type of infection caused when the bile duct gets blocked due to gallstone formation. The affected person might experience symptoms like upper abdomen pain, chills, itchy skin, confusion and jaundice.
While antibiotics can address the symptoms, these might not be enough to prevent complications of the bile draining properly. The infection can worsen if the condition is left untreated.

Pancreatitis: Unchecked gallstones increase the risk of developing pancreatitis, a condition in which the stone blocks the pancreas opening. The patient might feel a sudden pain in the upper abdomen that slowly intensifies. The pain might spread to the back, and the affected individual might feel uncomfortable after eating a meal.

Diarrhoea, loss of appetite, sickness, and abdomen tenderness are other symptoms a patient might experience. Hospitalisation and constant medical supervision might be required to address these issues. People getting their gallstones checked may cure acute pancreatitis faster.

Jaundice: This is a very common complication of gallbladder stones. It occurs when a gallstone is released into the bile duct from the gallbladder. Symptoms include itching, dark-coloured urine, yellow skin, and pale stools.

Jaundice can get worse if a patient neglects the initial symptoms of gallbladder stones. Prompt medical supervision will enable the doctor to analyse the condition of the stones. It will help them develop the necessary treatment plan.        
Gallbladder Cancer: It is a rare condition, but untreated gallstones might increase the chances of this disease. A family history of gallbladder cancer and high calcium levels inside the gallbladder increases the risks. Even though gallbladder cancer is a complicated condition, patients might witness common symptoms like fever and abdominal pain.

In this case, the doctor might suggest gallbladder removal. On the other hand, a patient might also undergo surgical methods, chemotherapy and radiation to treat cancer.

Bile Duct Blockage: It is a very common complication that a patient might suffer from if the gallstones are untreated. The stones in the gallbladder can prevent the bile from being released into the small intestine.

It happens when gallbladder stones block the bile ducts, leading to severe pain. Moreover, a patient might experience bile duct infection and jaundice.   

Prevention:

Preventing gallstones involves several lifestyle and dietary adjustments to reduce the risk factors associated with their formation. Here are some strategies that may help:

Maintain a healthy weight: Obesity can increase the risk of gallstones. Aim for a gradual weight loss if you’re overweight.
Balanced diet: Eat a diet high in fibre and low in refined carbohydrates and fats. Include plenty of fruits, vegetables, and whole grains.
Regular meals: Don’t skip meals, which can lead to bile concentration and gallstone formation.
Physical activity: Regular exercise helps maintain a healthy weight and may reduce the risk of gallstones.
Moderate fat intake: While a low-fat diet is often recommended, very low-fat diets can also contribute to gallstone formation. Include healthy fats like olive oil in moderation.
Hydration: Drink plenty of water throughout the day to help flush out your system.
Coffee: Some studies suggest that moderate coffee consumption may lower the risk of gallstone formation.
Avoid rapid weight loss: Crash diets or very low-calorie diets can increase the risk of gallstones.

When to Consult a Doctor?

On Symptoms Occurrence: Visiting a specialist doctor as soon as the patient experiences the symptoms is essential. The signs include intense abdominal pain that prevents you from sitting comfortably. The patient might experience severe shoulder pain with high fever and chills. Yellowing of the skin or jaundice is a common symptom. 
If the gallstone causes an infection or blockage, the patient may experience abdominal pain and increased heart rate.   
Inability to Digest Fats: If an individual has been experiencing trouble digesting fats, the gallbladder might have complications, as the organ plays a vital role in fat digestion. Symptoms like excessive bloating, chest pain, clay-coloured stools, and dark-coloured urine also need medical supervision.

Annual Screening or Health Checkup: Most gallbladder stones do not depict any initial symptoms even after formation. When the stones get stuck and create a blockage, patients start experiencing abdominal pain. The discomfort might be less due to a partial blockage. However, an annual screening or checkup can detect and address these issues appropriately.

Diagnosis

Preliminary Examination: The initial diagnosis of gallstones depends on analysing symptoms. The patient can visit a general physician to explain his/her symptoms and problems. If the doctor understands that the patient has gallstones, he/she may refer the patient to a gastroenterologist for expert advice and treatment.

During any appointment, the patient must discuss his/her medical history, current medications, and health complications.

Diagnostic Tests

Blood Tests: The doctor might recommend blood tests to detect problems caused by gallbladder stones. The tests can also diagnose gallbladder infections, jaundice, and any underlying pancreatic complications.

Abdominal Ultrasound: It is a common non-invasive diagnostic test to identify gallbladder stones. In this, a device called a transducer is moved around on the patient’s stomach or abdominal region to create internal imagery of the stomach to diagnose gallstones.

Endoscopic Ultrasound: This test helps detect smaller gallstones that may not be detected through an abdominal ultrasound. The doctor passes a thin tube into the digestive tract through the patient’s mouth. Then, the transducer sends signals to the connected computer to develop images of the surrounding tissues. Thus, it helps detect gallstones conveniently.

MRCP: Magnetic resonance cholangiopancreatography is an imaging test used to examine bile ducts. It enables the doctor to create clear images of the biliary system to find gallstones. Doctors might also conduct additional imaging tests, such as a hepatobiliary iminodiacetic acid scan, endoscopic retrograde cholangiopancreatography, or computerized tomography test.

Treatment

Home Treatment and Lifestyle Changes: Doctors might suggest some changes to prevent gallstones from growing. These recommendations might apply to people who are not suitable for surgeries.

So, a patient must follow a low-fat and low-cholesterol diet, including fruits, vegetables and whole grains. Avoiding foods like cakes, biscuits, butter, sausages, cream pastries, and junk food is essential. It is also important for the patient to engage in some form of physical activity and control his/her weight.

Medication: Medications for gallstones are primarily used to dissolve cholesterol stones and are most effective when the stones are small and cholesterol-based. Here are some examples:

Ursodiol: A bile acid that can dissolve gallstones.
Chenodiol: Similar to ursodiol, it helps dissolve cholesterol stones.
These medications can take months or even years to dissolve gallstones, and not all types of gallstones will respond to medication. Surgery is often required for gallstones that cause symptoms or complications. It’s important to consult with a healthcare professional to determine the best treatment option for your specific situation.

Surgical Treatment and Alternative Management: The most effective method of removing gallstones is surgical treatment. A patient might undergo an endoscopy, where doctors will remove the gallstones through a long tube. They will pass the tube through the patient’s mouth, which is a noninvasive process.

Another technique is cholecystectomy, in which the doctor surgically removes the gallbladder. This technique prevents gallstone growth and related complications. Further, the process does not affect a patient’s digestion.

If the gallstone situation is complicated, the doctor might opt for open surgery. It involves an extended hospitalisation and a larger incision. Specific laparoscopic cholecystectomy may be performed as an open surgery to prevent further complications.

Additionally, there are alternative techniques to remove gallstones. Consuming foods like apple juice with apple cider vinegar, milk thistle, and Artichoke might remove gallstones naturally. However, seeking medical advice before opting for these foods is crucial.
 

Additional Information

Women and Their Risks of Developing Gallstones

Progesterone secretion in women might slow down the gallbladder contractions, while oestrogen secretion can increase the cholesterol levels in a woman's body. Both these situations put women at risk of developing gallstones.

Most women experience weight gain or loss due to pregnancy. Excessive fat due to obesity can elevate cholesterol levels and also increase oestrogen levels. However, sudden weight loss is also a risk.

When a woman loses a lot of fat, the liver must process much cholesterol. If the liver fails to handle the cholesterol processing, the excess gets deposited in bile, leading to cholesterol gallstones.