Gallstones: Treatments, symptoms, and causes

Gallstones are stones or lumps that develop in the gallbladder or bile duct when certain substances harden.

The gallbladder is a small sac located on the right-hand side of the body, on the underside of the liver. Some of the chemicals that exist in the gallbladder can solidify into either one large stone or several small ones.

There are approximately 20 million Americans with gallstones. A study revealed that the prevalence of gallstones in adults in industrialized countries is around 10 percent and appears to be rising.

Fast facts on gallstones

Here are some key points about gallstones. More detail and supporting information is in the main article.

The gallbladder is a small organ located on the underside of the liver.

Stones can form when there is a chemical imbalance in the gallbladder.

People with overweight and obesity are more likely to develop gallstones.

Experts believe a low-fat, high-fiber diet may help prevent gallstones.

Symptoms

Gallstone pain
Symptoms of gallstones may include pain on the right-hand side of the body.

The majority of people with gallstones experience no symptoms at all. This is because the stones stay in the gallbladder and cause no problems.

Sometimes, however, gallstones may lead to cholecystitis, or an inflamed gallbladder.

The primary symptom is pain that comes on suddenly and quickly gets worse. This pain can occur on the right side of the body, just below the ribs, between the shoulder blades, or in the right shoulder.

Other symptoms include:

pain on the right-hand side of the body, just below the ribs

back pain between the shoulder blades

pain in the right shoulder

nausea

vomiting

sweating

restlessness

Treatment

Gallstones are only treated if they have caused gallbladder inflammation, blockage of the bile ducts, or if they have moved from the bile ducts into the intestines.

Cholecystectomy

Cholecystectomy means the surgical removal of the gallbladder. This is usually performed with keyhole surgery. Keyhole surgery is not possible for about 10 percent of people who need open cholecystectomy. They will have open surgery instead.

With open cholecystectomy, a large cut is made in the abdomen. People who undergo open surgery require a longer hospital stay and recovery time. If a gallbladder is severely inflamed, open surgery will be needed.

For a large proportion of those who undergo a cholecystectomy, gallstones come back within a year. To help prevent this, many people with gallstones are given ursosdeoxycholic acid, which is the acid found in bile.

Ursosdeoxycholic acid lowers the cholesterol content of bile, making it less likely that stones will form.

Ursodeoxycholic acid

If the gallstone is made of cholesterol, it can sometimes be slowly dissolved with ursodeoxycholic acid. This type of treatment, known as dissolution, may take up to 24 months to be effective. It is not as effective as surgery but is sometimes the only choice for people who cannot have a general anesthetic.

Endoscopic retrograde cholangiopancreatolography

When a person with gallstones cannot have surgery or ursodeoxycholic acid, they may undergo endoscopic retrograde cholangiopancreatolography (ERCP), which requires a local anesthetic. A flexible fiber-optic camera, or endoscope, goes into mouth, through the digestive system, and into the gallbladder.

An electrically heated wire widens the opening of the bile duct. The stones are then removed or left to pass into the intestine.

Lithotripsy

Ultrasonic shock waves are aimed at the gallstones, which break them up. If gallstones become small enough, they can then pass safely in the stools. This type of treatment is uncommon and is only used when there are few gallstones present.

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Diagnosis

In many cases, gallstones are discovered by accident when an individual is being treated for a different condition. A doctor may suspect gallstones after a cholesterol test, an ultrasound scan, a blood test, or even an X-ray.

Blood tests may be used to look for signs of infection, obstruction, pancreatitis, or jaundice.

Cholangiography

A dye is either injected into the blood stream so that it concentrates into the bile ducts or gallbladder, or it is inserted straight into the bile ducts using an ERCP. The dye shows up on X-rays. ERCP is also used to locate and remove stones in the bile duct.

The doctor will then be able to look at the X-rays and identify possible gallbladder or bile duct disorders, such as pancreatitis, cancer of the pancreas, or gallstones. The X-rays will indicate to the doctor whether the dye is reaching the liver, bile ducts, intestines, and gallbladder.

If the dye does not move into one of these areas, it generally means that the gallstone is causing a blockage. An expert will have a better idea of where the gallstone is located.

CT scan

This is a non-invasive X-ray that produces cross-section pictures of the inside of the human body.

Cholescintigraphy (HIDA scan)

A small amount of harmless radioactive material is injected into the patient. This is absorbed by the gallbladder, which is then stimulated to contract. This test may diagnose abnormal contractions of the gallbladder or an obstruction of the bile duct.

Diet

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