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Gallstones

Alternative names: Cholelithiasis

What are gallstones?
What are the signs of gallstones?
What causes gallstones?
How does my doctor tell if I have gallstones?
How are gallstones treated?

What are gallstones?

The main job of the pear-shaped gallbladder is to store bile, a brown liquid that is made by the liver and used to digest food. Gallstones are pieces of solid matter that form in the gallbladder. They can be made of cholesterol, bile pigment (bilirubin), or a combination of the two. Gallstones range in size from a grain of sand to a large marble, and the gallbladder can contain hundreds of these stones

What are the signs of gallstones?

Many times gallstones are found by chance on an unrelated X-ray or ultrasound. These "silent" gallstones create no symptoms, and need no treatment. But when a gallstone blocks the flow of bile through or out of the gallbladder, a patient may have:

  • Intense pain in the upper abdomen, perhaps spreading into the right shoulder
  • Chest pain similar to a heart attack
  • Sweating
  • Feeling like you have indigestion or "gas"
  • Nausea and vomiting
  • Fever
  • Chills
  • Jaundice (yellowing of the skin)

A stone that sticks in the main bile duct (which carries bile from the gallbladder to the small intestine), can lead to a serious infection, or inflammation of the pancreas. Both of these conditions require immediate medical attention.

What causes gallstones?

Gallstones form much in the way that sugar collects in the bottom of a jug of maple syrup. Cholesterol and bile pigment - two parts of what makes up bile - settle out from the bile solution and form crystals. The gallbladder may contain many crystals and stones too small to see.

Pigment (bilirubin) gallstones are found most often in patients with:

  • Liver disease
  • Blood disorders like sickle cell anemia

Gallstones made of cholesterol are found most often in:

  • Women over 20 (especially if pregnant)
  • Men over 60
  • People who are overweight
  • People who lose a lot of weight quickly
  • Patients using certain medications like birth control pills and cholesterol-lowering agents
  • Native Americans and Mexican-Americans

A diet high in cholesterol and fat, and low in fiber may increase your risk of getting gallstones.

How does my doctor tell if I have gallstones?

A doctor can often tell if you have gallstones because of your symptoms. He or she may recommend any of these tests to make sure:

  • An abdominal ultrasound uses sound waves to examine the bile ducts, liver, and pancreas for gallstones
  • In an oral cholecystogram (OCG), the patient first swallows pills that have dye in them. This dye helps the gallbladder show up on a X-ray.

If your gallstones have entered the common bile duct, the above tests will not work as well. Your doctor might then recommend:

  • An endoscopic ultrasound allows your doctor to place an ultrasound probe inside the digestive (GI) tract, very close to an area where you might have problems. These images are far more detailed than those of a traditional ultrasound. You will be given medication to make you relaxed and drowsy, and will need someone to drive you home after the procedure.
  • Endoscopic retrograde cholangiopancreatography (ERCP) uses a thin, flexible tube with a tiny video camera on the end to find problems in the liver, bile ducts, and pancreas. The test uses X-rays and a liquid dye to locate gallstones, tumors, and other problems. In some cases, these problems can be treated at the same time.

How are gallstones treated?

"Silent" gallstones that cause no symptoms need no treatment. Surgery to remove the gallbladder is recommended for patients who have painful gallstones.

Non-surgical:

Medication

Ursodiol thins bile and can dissolve gallstones if an operation is not possible. However, the stones can take a while to dissolve, and they may return once treatment ends.

Minimally-invasive procedures

Endoscopic retrograde cholangiopancreatography (ERCP) uses a thin, flexible tube with a tiny video camera on the end to find problems in the liver, bile ducts, and pancreas. If the test shows that there are gallstones in the bile ducts, your doctor can use a special, tiny tool to remove them.

Surgery:

Stones in the gallbladder can't be removed by ERCP. Laparoscopic cholecystectomy uses small incisions and a tiny video camera to remove the gallbladder. The operation is common and straightforward. The patient can usually go home from the hospital in a day and return to normal activities in a few days.

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