How to prevent gallstones: symptoms, causes, treatment, diet


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

  • Certain populations:

  • Female

  • Older age

  • Family history of gallstones

  • American Indians, Mexican Americans

  • Pregnant female

  • Certain health conditions

  • Obesity

  • 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

  • Cirrhosis

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

Silent 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

  • Tea-colored urine

  • Light-colored stools

  • 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

  • Imaging tests

  • Ultrasounds

  • Best initial imaging test for finding gallstones

  • CT scan

  • 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

Surgery

  • Cholecystectomy: surgical removal of the gallbladder.

  • Gallbladder is not an essential organ, so people can live without gallbladder.

  • Laparoscopic cholecystectomy

  • Perform cholecystectomies with laparoscopy

  • Only make couple, small entries for the ports and camera

  • Open cholecystectomy

  • For severely, inflamed or infected gallbladder


Nonsurgical treatments

  • Ursodiol (Actigal) and chenodiol (Chenix)

  • Bile acid medicines that break up gallstones.

  • Best for breaking up small cholesterol stones

  • Lithotripsy

  • Shock wave breaks down gallstones into smaller pieces

  • Rarely used

Eating, Diet, Nutrition

Preventing Gallstones

  • Healthy eating plans

  • Eat foods high in fiber

  • Fruits, vegetables, beans, peas

  • Whole grains

  • Eat healthy fats

  • Fish oil, olive oil

  • Avoid refined carbohydrates and sugar

  • Avoid unhealthy fats

  • Desserts

  • Fried foods


Weight

  • 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



References

  1. Dieting & Gallstones. National Institute of Diabetes and Digestive and Kidney Diseases.

  2. Gallstones. National Institute of Diabetes and Digestive and Kidney Diseases.

  3. Biliary Tract Disorders, Gallbladder Disorders, and Gallstone Pancreatitis. American College of Gastroenterology.