Gallstones

The gallbladder is a pear-shaped organ located on the right side of the abdomen, just below the liver. It stores bile fluid which is produced in the liver. Bile fluid contains water, proteins, fats, cholesterol, bile salts and bile pigments, which aid in the digestion of food. The gall bladder releases bile fluid into the intestine through the common bile duct following ingestion of food.

An imbalance in the components that form bile can lead to the formation of gallstones. Gallstones are small, hard deposits that form inside the gallbladder. The size of the gallstone can range from a small grain of sand to a large golf ball.

Gallstones are of two types:

Cholesterol stones: These are yellowish-green in colour and chiefly made up of hardened cholesterol.
Pigment stones: These are dark and small, usually present in numbers and primarily made of bilirubin, a yellowish bile pigment.

In some cases, a mix of both gallstone types can be seen.

Causes of Gallstones

The exact cause of gallstones is not clear. However, gallstones can form due to increased amounts of cholesterol or bilirubin; or inadequate emptying of the gallbladder.

The risk factors that increase the chance of having gallstones include:

Pregnant women and women taking birth control pills or hormone replacement therapy
Elderly people (>60 years)
Genetic factors & family history of gallstones
Ethnic background, esp. native Americans and Mexican-Americans
Diabetes
Obesity
Rapid weight loss
Use of cholesterol-lowering drugs

Signs and Symptoms of Gallstones

Gallstones do not always cause symptoms and are sometimes called ‘silent stones’. These are often detected by your physician while diagnosing another condition. However, when the gallstone moves and lodges itself in the bile ducts, it causes signs and symptoms such as:

Pain in the upper abdomen, upper back, and between the shoulder blades; lasting for several hours
Nausea & Vomiting
High fever with chills
Yellowing of skin and eyes
Other gastrointestinal problems such as bloating, indigestion, and heartburn

Complications Associated with Gallstones

The complications of gallstones include:

Blockage of the common bile duct leading to jaundice and infection
Blockage of the pancreatic duct leading to pancreatitis
Gallbladder inflammation (cholecystitis)
Increased risk of gallbladder cancer

Diagnosis of Gallstones

Your physician diagnoses gallstones based on your symptoms, medical history, and physical examination. The diagnosis is confirmed based on findings from imaging studies such as ultrasound, CT (Contrast Tomography), MRI (Magnetic Resonance Imaging), and ERCP (Endoscopic Retrograde Cholangio- Pancreatography) which helps to locate gallstones in the gallbladder as well as bile ducts. Your doctor may also request blood tests to any complications of gallstones.

Treatment of Gallstones

Gallstones without symptoms do not require treatment. Treatment for symptomatic gallstones and its complications includes medications to dissolve the gallstones, and surgery to remove the gall bladder (cholecystectomy).

Medications can help dissolve gallstones but may take several months to years, so this option is reserved only for patients contraindicated to surgery.