Definition of Gallstones
Gallstones are usually made of cholesterol or bilirubin that are formed in the gallbladder or within the bile ducts of the liver. Gallstones size can range from a grain of sand to a golf ball. In the United States, the most common type of gallstones are made of cholesterol. Cholesterol stones are formed due to an imbalance in the production of cholesterol and/or the secretion of bile. Pigment stones are composed of bilirubin which is a product of the normal breakdown of red blood cells. Gallstones are CommonGallstones affect 10-155 of the United States population. Not everyone needs treatment for gallstones. However, about 25% of the people with gallstones each year are treated.
Risk Factors for Developing Gallstones
Family history of gallstones
American Indians, Mexican Americans
Certain health conditions
High blood cholesterol levels (high triglyceride levels, low HDL level)
Those taking birth-control pills or on estrogen replacement therapy
Rapid weight loss
Diabetes and insulin resistance
Sickle cell anemia
When do gallstones become a problem?
Gallstones can block bile ducts, which normally drain bile from the gallbladder and liver. The gallstones can also block the pancreas ducts because both the bile ducts and pancreas ducts drain through the opening called Ampulla of Vater. This Ampulla of Vater is tightened by the Sphincter of Oddi, which is a circular muscle.
Gallbladder attack or biliary colic
When gallstones block the bile ducts and cause sudden, severe pain in the upper right abdomen
Gallstone pancreatitis: gallstones block the pancreas duct and cause inflammation
Cholangitis: infection of the common bile duct
Cholecystitis: inflamed gallbladder
Symptoms of Gallstones
Gallstones without symptoms are called silent gallstones.
Most people with gallstones don’t have symptoms.
Silent gallstones don’t need treatment
Gallbladder Attacks or Biliary Colic
Cause pain in the upper right abdomen that is sudden and severe and can last from couple minutes to several hours
Often happen after heavy anr rich meal with lots of fat (i.e. fried foods, barbeque)
Gallbladder attacks are usually resolved when gallstones move around and do not block the bile ducts.
When to see a doctor?
Gallbladder attack cause pain to last several hours
Fever or chills
Nausea and vomiting
Jaundice, yellowing of skin or whites of eyes
These are serious signs of infection or inflammation of the gallbladder, liver or pancreas.
Diagnosis of Gallstones
Physical examinations of abdomen
Lab tests : liver function tests
Best initial imaging test for finding gallstones
Can show gallstones of infection or blockage
However, can miss detecting gallstones
HIDA scan, hepatobiliary scan
Uses radioactive material to take picture of biliary tract when gallbladder contract
MRI : MRCP
Endoscopic retrograde cholangiopancreatography (ERCP)
More invasive method
Upper gastroendoscopy visualize the affected bile duct and gallstones.
This allows doctors to remove gallstones that is stuck in the common bile duct.
Treatment of Gallstones
Cholecystectomy: surgical removal of the gallbladder.
Gallbladder is not an essential organ, so people can live without gallbladder.
Perform cholecystectomies with laparoscopy
Only make couple, small entries for the ports and camera
For severely, inflamed or infected gallbladder
Ursodiol (Actigal) and chenodiol (Chenix)
Bile acid medicines that break up gallstones.
Best for breaking up small cholesterol stones
Shock wave breaks down gallstones into smaller pieces
Eating, Diet, Nutrition
Healthy eating plans
Eat foods high in fiber
Fruits, vegetables, beans, peas
Eat healthy fats
Fish oil, olive oil
Avoid refined carbohydrates and sugar
Avoid unhealthy fats
Obesity or overweight increase risk of developing gallstones
Fast weight loss after bariatric surgery or very low calorie diet increases the risk as liver releases extra cholesterol into the bile
Avoid crash dieting
Regular physical activity
At least 150 minutes a week of moderate intensity physical activity
Muscle strengthening activity
Dieting & Gallstones. National Institute of Diabetes and Digestive and Kidney Diseases.
Gallstones. National Institute of Diabetes and Digestive and Kidney Diseases.
Biliary Tract Disorders, Gallbladder Disorders, and Gallstone Pancreatitis. American College of Gastroenterology.