Like many people, you may have gallstones and not know it. In fact, these solid deposits of cholesterol or calcium salts that form in your gallbladder or nearby bile ducts, often cause no symptoms and require no treatment. But about 20 percent of people effected will have a gallbladder attack that causes nausea and an intense, steady ache in their upper-right abdomen. In some cases the pain can be severe.
One in 10 people have gallstones, and an estimated 1 million new cases are diagnosed annually. You’re at greater risk of developing gallstones if you’re older, female or overweight. A diet high in fat and sugar along with a sedentary lifestyle also increases your risk. So does rapid weight loss or eating a very low-calorie diet.
Complications from gallstones can be serious, and even fatal, if left untreated. Fortunately, treatment is usually straightforward, and newer techniques often allow faster recovery time.
Signs and Symptoms of Gallstones
You may not know you have gallstones until they’re discovered during routine tests. But sometimes they may cause certain symptoms. These include:
- Chronic indigestion.
Symptoms of indigestion may include nausea, heartburn, bloating and sometimes abdominal pain. But even if you have gallstones, they often aren’t the cause of your digestive problems. A number of other conditions, including gastroesophageal reflux disease (GERD) and peptic ulcers of the stomach or duodenum, can also cause chronic indigestion. For that reason, it’s important to discuss your symptoms carefully with your doctor.
- Sudden, steady and moderate-to-intense pain in your upper abdomen.
This usually signals a gallbladder attack. The pain may begin after eating, but may also occur at other times — even at night. It can last from 15 minutes to several hours. Gallbladder pain starts in your upper-middle or upper-right abdomen and may shift to your back or right shoulder blade. After the pain subsides, you might have a mild aching or soreness in your upper abdomen that can last for up to a day. Gallbladder attacks occur infrequently weeks, months or even years apart. Daily abdominal pain is usually not a symptom of gallbladder disease.
- Nausea and vomiting.
These symptoms may accompany a gallbladder attack.
Sometimes gallstones escape the gallbladder and enter the duct leading from your liver and gallbladder to your small intestine (common bile duct). They may also occasionally enter the duct leading to your pancreas. In some cases, a stone may block one of these ducts, a condition that can be fatal if not treated. You’ll likely have pain and sometimes fever due to inflammation at or near the site of the blockage. Other symptoms of bile duct obstruction include:
- Yellowing of your skin and the whites of your eyes (jaundice)
- Clay-colored stools
- Tea- or coffee-colored urine
- A high fever with shaking chills if an infection develops as a result of the obstruction
If you experience any of these symptoms, seek medical treatment right away. Keep in mind that you may have jaundice and changes in the color of your urine or stools without also having pain or indigestion.
Causes of Gallstones
Your liver produces bile — a greenish-brown fluid made of bile salts, fatty compounds, cholesterol and other chemicals. This fluid is concentrated and stored in your gallbladder until it’s needed to help digest fats in your small intestine.
When you eat a meal containing fat or protein, your gallbladder contracts and empties bile through small tubes called bile ducts. These lead to the upper part of your small intestine (duodenum). But if bile within your gallbladder becomes chemically unbalanced, it can form into hardened particles that eventually grow into stones.
Gallstones can be as small as a grain of sand or as large as a golf ball and may be smooth and round or irregular with a number of edges. About 20 percent of people with stones have just one stone, but others may have hundreds, or even thousands, of stones.
No matter what their size, shape or number, gallstones fall into one of three categories:
- Cholesterol stones.
The most commonly occurring gallstone among Americans and Europeans, these are composed mainly of undissolved cholesterol, although most also have other components, such as calcium and bilirubin, the residue from the breakdown of red blood cells.
- Pigment stones.
These small, dark brown or black stones form when your bile contains too much bilirubin. It’s not always clear what causes them. The destruction of red blood cells in some types of anemia also may create excess bilirubin.
- Primary bile duct stones.
Unlike stones that form in your gallbladder but escape into your bile ducts, these stones form in the ducts themselves. They’re usually soft and brown and made of decomposed bile.
Factors that contribute
Many factors, some of which aren’t well understood, contribute to the formation of stones. They include:
- Too much cholesterol.
Normally, your bile contains enough bile salts and lecithin, a fatty compound, to dissolve the cholesterol excreted by your liver. But if your bile contains more cholesterol than can be dissolved, the cholesterol may form into crystals and eventually into stones. It’s important to know that cholesterol in your bile has no relation to the levels of cholesterol in your blood, and cholesterol-lowering drugs don’t help prevent stones.
- Incomplete or infrequent gallbladder emptying.
If your gallbladder doesn’t empty completely or often enough, bile may become too concentrated and contribute to the formation of stones. This especially tends to occur during pregnancy or prolonged fasting.
Although you can’t entirely prevent gallstones from forming, you can lower your risk by following these suggestions:
- Maintain a healthy body weight.
- Avoid crash diets or a very low intake of calories, less than 800 calories a day.
- Exercise regularly, at least 30 to 40 minutes on most days.
- Choose a low-fat, high-fiber diet that emphasizes fresh fruits, vegetables and whole grains. Reduce the amount of animal fat, butter, margarine, mayonnaise and fried foods you eat.
Treatment for Gallstones
Eighty percent of gallstones produce no symptoms and require no treatment. Doctors often discover these “silent stones” during routine medical checkups or exams for other illnesses and usually recommend taking a wait-and-see approach to treatment. If your stones cause symptoms, however, there are several possible treatments.
Removing the gallbladder is the preferred treatment for the majority of people who have gallstones that cause symptoms. In fact gallbladder surgery (cholecystectomy) is one of the most common surgeries performed in the United States today.
Most often gallbladder surgery is performed using a laparoscope, a pencil-thin tube with its own lighting system and miniature video camera. A surgeon inserts the laparoscope into your abdomen through a hollow instrument (cannula). Only small incisions are required. The video camera then produces a magnified view on a television monitor of the inside of your abdomen. This allows the surgeon to see the surgery in detail. To remove your gallbladder, he or she uses tiny instruments inserted through several other small abdominal incisions.
Because laparoscopic cholecystectomy uses smaller incisions, you’ll likely have less postoperative pain, less scarring and an earlier return to your normal activity — usually within just a few days.
Laparoscopic removal of the gallbladder is effective in the majority of cases. But occasionally a surgeon may choose to perform open surgery, in which the gallbladder is removed through a large abdominal incision. This surgery may be seen as the best option in severe cases. It may also be used when the gallbladder walls are thick and hard or there is scar tissue from earlier abdominal operations. Recovery from open surgery typically entails up to a week’s stay in the hospital, followed by about 3 weeks at home.
Following surgery your liver continues to produce enough bile to digest a normal diet. But you may notice you’re having more bowel movements than usual and that their consistency is less solid. For some people these changes can be quite significant. In most cases the symptoms usually lessen over time. When diarrhea remains a problem, avoiding dairy products, fats and spicy foods as well as adding more fiber to your diet may help.
If you have stones in the bile duct as well as your gallbladder, your doctor may recommend surgical removal of both the duct stones and your gallbladder. But in some cases your doctor may suggest an ERCP, a procedure in which stones in the bile duct are removed using an endoscope. Your gallbladder also may be removed at a later date. Often, a cutting instrument is inserted though the endoscope, and the entrance of the bile duct is enlarged so the stone can pass through it. The same procedure may be used to remove a stone from a blocked pancreatic duct.
When surgery isn’t the best option, your doctor may recommend one of the following treatments:
- Bile salt tablets.
These tablets dissolve cholesterol stones over a period of time. The treatment works best on small cholesterol stones. Many doctors prefer the medication ursodiol (Actigall) because it’s one of the safest and seems to have the fewest side effects. Unfortunately, ursodiol is expensive, and its effects aren’t permanent. Gallstones tend to recur within 10 years of treatment in half the people taking the drug. To prevent a recurrence, most people need to take ursodiol indefinitely.
- Sound wave therapy (extracorporeal shock wave lithotripsy).
This treatment uses high-frequency sound waves to break up stones. You then take ursodiol tablets to dissolve the fragments. Shock wave therapy works best on single stones that are less than a half-inch in diameter. If you have more than one stone, or your stone is large, you’re probably not a good candidate for this treatment. And, as with other nonsurgical therapies, your gallstones are likely to return unless you take ursodiol indefinitely.
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