Gall stones

Introduction

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

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 (sludge) to a large avocado stone size.

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

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 and 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

Gallstones do not always cause symptoms, and are sometimes called ‘silent stones’. Your physician in the course of diagnosing another condition often detects these incidentally. 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 and Vomiting.
• High fever with chills.
• Yellowing of skin and eyes. Dark urine and / or pale stool.
• Other gastrointestinal problems such as bloating, indigestion, and heartburn.

Complications

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

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 assess any complications of gallstones.

Treatment

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 in whom surgery is contraindicated. 

The surgical removal of the gallbladder does not cause any major impact on health as the gall bladder not essential for survival. Surgery is also recommended as gallstones can reoccur. Once the gall bladder is removed, the bile is directed from the liver into the intestine.