What are gallstones?
Gallstones are hard substances formed from the digestive juices present in the gallbladder (an organ situated below the liver wherein a digestive juice called bile is stored, which is released into the small intestine for digestion of food).
There are two types of gallstones:
- Cholesterol gallstones: These are yellow in color and are made up of undissolved cholesterol along with other components.
- Pigment gallstones: These are dark brown or black stones formed due to excessive bile pigment in the bile.
What causes gallstones?
The main cause is unknown but is believed to be due to high cholesterol in the bile juice (seen due to an unhealthy diet, obesity, hereditary factors, and smoking).
Others occur because of increased levels of a pigment called bilirubin (that increases in blood and liver diseases) and other ailments that affect the gallbladder.
Who is more likely to develop Gallstones?
Gallstones are more common among:
- Women, especially those who are undergoing hormone replacement therapy or pregnant
- People with high triglyceride and low HDL cholesterol levels
- People who are obese, have lost weight quickly, or have had weight loss surgery previously
- Those who eat a low fiber diet
- Old age men and women
- Smokers
- Individuals with a family history of gallstones
Other conditions that increase the risk are cirrhosis (causing impaired liver function), intestinal diseases (such as inflammatory bowel disease), infections in the bile duct, hemolytic anemias, and diabetes mellitus.
What are the Symptoms of Gallstones?
- Intense pain in the upper abdomen (on the right side) may spread to the back, which may radiate to the and shoulder on the same side.
- Nausea
- Vomiting
- Flatulence (gas) and indigestion
- Diarrhea
- Darker colored feces and urine
At times, you may not even experience any symptoms, and these may be found on the x-rays or during surgery in the surrounding area.
Diagnosis for Gallstones
The doctor starts with history taking, followed by clinical or physical examination. This will be followed by blood investigations and imaging techniques that the doctor feels appropriate.
The blood tests may include complete blood count, liver function tests (which will reveal levels of bilirubin which is important in the diagnosis of Gallstones), Lipid profile which reveals levels of cholesterol, HDL good cholesterol which may be causative for the formation of the gallstones.
Other tests may be imaging techniques such as
- Abdominal Ultrasound,
- EUS (endoscopic ultrasound),
- Oral Cholecystography,
- Hepatobiliary Iminodiacetic acid (HIDA) scan,
- Computerized Tomography (CT),
- Magnetic Resonance Cholangiopancreatography (MRCP) or
- Endoscopic Retrograde Cholangiopancreatography (ERCP).
How to Treat Gallstones?
If the gallstones are present with no symptoms, the patient is advised to maintain a healthy diet with plenty of fluids, take supplements, and light exercises directed by the doctor.
If the patient is symptomatic there are non-invasive treatments, surgical treatment both open and minimally invasive, or laparoscopic surgery.
Non-invasive Treatments:
In non-invasive techniques depending on the type of gallstone, bile salts can be used to dissolve stones formed due to cholesterol but this cannot be used for gallstones formed due to bile pigments.
This treatment duration may take longer as some of the stones may be calcified.
Sometimes shock wave therapy (where shock waves are used to break the stones down into finer pieces) is used to break down the stones followed by administration of bile salts.
ERCP(Endoscopic retrograde cholangiopancreatography) - This is a kind of endoscopy through which an instrument is inserted through the endoscope to remove the stones.
In most of these non-invasive procedures, recurrence is common and hence not successful long term. Gall bladder serves an important function but it is not required for a healthy life.
Surgical Treatment for Gallstones (Gallbladder Removal)
When the symptoms of gallstones are persistent then surgery to remove the Gallbladder should be considered. There are two types of surgeries open and laparoscopic cholecystectomy.
Laparoscopic Cholecystectomy: In a Laparoscopic Cholecystectomy, the surgeon will make four small incisions in your abdomen. Then a tube that has a tiny video camera is inserted into your abdomen through one of the incisions.
The surgeon with the help of a video monitor sees and inserts the other surgical tools through the other incisions in the abdomen and removes the gallbladder. Later these small incisions are sutured. This takes about 1-2 hours.
Laparoscopic cholecystectomy may not be advisable for all patients, it is for the treating surgeon to decide whether the patient should undergo laparoscopic or open.
What are the Complications of Gallstones Untreated?
Untreated gallstones may lead to complications such as:
- Jaundice (yellowish skin and eyes)
- Pancreatitis – Inflammation of the pancreas
- Acute cholecystitis -the stone blocks the bile duct and causes infection in the gallbladder
- A complication of infection leading to sepsis
- Acute cholangitis –bile ducts become blocked and infected
- Cancer of the gallbladder
Are you suited for Gallbladder Removal Surgery?
You may have to undergo the tests as prescribed by the doctor to evaluate the type, size, and location of the gallstone for surgery.
Patients with other ailments like allergies, liver, and blood disorders are approached in a slightly different manner as compared to those without them. Hence, one must visit the doctor for the best treatment option.
