Gallstones - Symptoms, Risk factors and Treatment

The gallbladder is a small pouch located below the liver and stores a fluid called bile that helps in digestion. Gallstones refer to small stones of bile that can develop in the gallbladder.

What causes gallstones?

Gallstones are hardened deposits of bile. The bile contains bilirubin- a breakdown product of red blood cells, and cholesterol, bile salts, and phospholipids. Bilirubin and cholesterol play an important role in stone formation. It is believed that too much of either bilirubin or cholesterol can form crystals, and ultimately stones. The stones can be divided into two types depending upon the substance that caused their formation. There are two types of gallstones namely:

Cholesterol gallstones: They are the most common type of gallstones and are made up of cholesterol.

Pigment stones: They are made up of bilirubin.

Another reason for gallstone formation can be impaired gallbladder emptying. When the gallbladder does not empty properly, it can result in saturation of bile, giving rise to gallstones.

Symptoms of gallstones:

When in the gallbladder, gallstones may show no symptoms at all. Small gallstones may pass without causing any symptoms. However, when a gallstone gets stuck in the cystic duct- a tube that helps transport the bile out of the gallbladder, it may cause acute cholecystitis.

Acute cholecystitis is an inflammation of the gallbladder caused by the lodging of a stone in the cystic duct. It can show symptoms such as:

• Sudden, severe pain in the upper right side of the abdomen
• Sudden, severe pain in the center of the abdomen
• Pain after eating foods rich in fats
• Nausea
• Vomiting
• Fever
• chills

Risk factors for developing gallstones:

Certain factors increase the risk of developing gallstones such as:

• Female gender
• Obesity
• Age greater than 60
• Family history of gallstones
• Having diabetes mellitus
• Rapid weight loss
• Pregnancy
• Consuming a diet rich in fats and low in fiber
• Having a liver disease like cirrhosis
• Taking oral contraceptive drugs

Complications of gallstones:

The complications of gallstones include:

Jaundice: Jaundice is yellowing of the skin and eyes due to the accumulation of bilirubin. When a gallstone causes blockage of normal bile flow, the bile gets absorbed in the bloodstream giving rise to jaundice. The symptoms of jaundice include:

• Yellowing of the skin
• Yellowing of the eyes
• Dark-colored urine
• Clay-colored stools
• Nausea 
• Vomiting

Other complications of gallstones include:

• Infection of the gallbladder (cholecystitis)
• Infection of the bile duct (cholangitis)
• Spread of the infection to the whole body (sepsis)
• Inflammation of the pancreas (pancreatitis)

Diagnosis of gallstones:

Gallstones can be diagnosed by a history and physical exam. To confirm the diagnosis, your doctor may order blood tests and imaging tests like ultrasound and CT scans of the abdomen.

Treatment of gallstones:

Sometimes, gallstones may not need any treatment, and they may pass on their own. However, if they get stuck in the cystic duct, the treatment options can include:

Shockwave lithotripsy: It is a non-invasive procedure in which shock waves are passed through the patient. These shock waves break the stones into tiny, small pieces, and they can pass easily on their own.

Cholecystectomy: This refers to surgery to remove the gallbladder. It is now done laparoscopically in a minimally invasive manner and involves several small incisions instead of a big one. The surgeon then removes the gallbladder through an incision.

Conclusion:

Gallstones can be painful when they get lodged in the cystic duct and may become complicated. Fortunately, there are effective treatment options with very minimal risk of complications. To prevent gallstone formations, it is important to avoid modifiable risk factors like rapid weight loss, a diet low in fiber and high in fats, etc. If you notice any symptoms of acute cholecystitis, it is advisable to see your doctor.