Gallstones

What is it

A hardened mass formed unusually in the gallbladder by bile pigments, cholesterol, and calcium salts. The gallbladder is pear-shaped and located on the right side of the abdomen underneath the liver. This organ produces bile, the digestive fluid created by the liver and stored in the gallbladder to provide an emulsifier of fats to the small intestine. The size and number of gallstones vary. The term “cholelithiasis” is sometimes used to describe having gallstones. When one of the ingredients to make bile is produced excessively, the sediment collects more and chrysalis into gallstones.

Severity/complications

Up to 20% of those who have gallstones experience symptoms, requiring gallstone treatment. They are not always serious, as some people have gallstones without ever knowing.

However, they become hazardous when the gallstones pass through the bile duct and become lodged, leading to a blockage in the digestive tract, discomfort, and potentially life-threatening consequences. At this point, the pain is referred to as a gallbladder attack because it is frequently abrupt and intense. Conversely, biliary colic is a type of pain that peaks and then gradually subsides; episodes can last anywhere from minutes to hours. The pain is characterized as sharp, stabbing, squeezing, or intestinal, and it only goes away when the stones shift or the pressure decreases.

Sometimes the pain is felt beneath the right rib cage, but it can also radiate in other directions. These can be disorienting symptoms, extending from the right shoulder, the back between the shoulder blades, and into the middle of the chest, as they mimic ailments like heartburn, indigestion, or a heart attack.

Affected organ systems including the gallbladder's system are among the complications. Life-threatening bacterial infections can be brought on by more acute inflammation. Gallstones can cause infection, resist bile in the bloodstream, increase inflammation of the accessory organs, and cause cholecystitis, pancreatitis, cholangitis, hepatitis, jaundice, and septicemia.

Tresca , Amber J. An Overview of Cholecystitis. 30 May 2024. Verywellhealth, https://www.verywellhealth.com/cholecystitis-overview-4588159. Accessed 25 June 2024.

Symptoms:

Sudden and intense pain in upper right of abdomen
Sudden and intense pain in center of abdomen
Pain between shoulder blades
Pain in right shoulder
Nausea
Vomiting
Jaundice
Cramping
Discomfort

What causes it?

Excessive cholesterol, bile salts, or bile pigment can cause gallstones. However, researchers do not entirely understand the reason for the changes in bile to occur. Sometimes, the gallbladder's inability to empty the gallbladder can also cause abnormal amounts of bile.

Excess estrogen occurs from pregnancy or birth control pills and is found to increase cholesterol levels and decrease movement in the gallbladder, creating gallstones. People over age 60 are more prone to developing gallstones than younger people. A popular phrase, called the 5 F’s, “fair, fat, female, fertile, and forty” is often used by doctors to identify patients with cholelithiasis.

Rapid weight loss disrupts the normal balance of the bile composition and can lead to an increase in cholesterol levels, increasing gallstone risk. On the contrary, a lack of physical activity slows down bile flow and provides an environment in which gallstones can thrive, increasing the likelihood of gallstones increase. In addition, obesity, cholesterol-lowering drugs, diabetes, and fasting are risk factors and increase the risk for gallstones.

Treatment

Treatment is different for everyone, depending on the pain, symptoms, and previous surgery or genetic factors.

A low-fat diet restricts fat, such as saturated fat and cholesterol. It can improve the bile composition, decreasing the risks of developing further gallstones. A diet low in saturated and trans fat lowers blood cholesterol, reducing the amount of cholesterol that would otherwise be crystallized and form stones in the gallbladder. A balanced exercise routine is also highly recommended, in which weight is lost through low-fat and low-calorie diets, making it less likely to trigger gallstone formation compared to rapid weight changes.

When possible, Laparoscopic surgery is conducted, in which a video camera along with thin tubes are inserted into small cuts on the body, to repair/remove tissue. But sometimes, even if gallstones are removed from the bile duct, others might remain and new ones can form. These cases required gallbladder removal, called cholecystectomy.

Medicines such as Ursodiol link (Actigall) and chenodiol link (Chenix) breaks down gallstones to make them easier to pass through and minimize scar tissue. However, months and years may be required to break all gallstones.

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