What Are Gallstones?
Gallstones are pieces of solid material that form in the gallbladder. These stones develop because cholesterol and pigments in bile sometimes form hard particles.
Gallstones are hardened deposits of digestive fluid that can form in your gallbladder. Your gallbladder is a small, pear-shaped organ on the right side of your abdomen, just beneath your liver. The gallbladder holds a digestive fluid called bile that's released into your small intestine.
Gallstones range in size from as small as a grain of sand to as large as a golf ball. Some people develop just one gallstone, while others develop many gallstones at the same time.
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The two main types of gallstones are:
Cholesterol stones: Usually yellow-green in color, approximately 80% of gallstones are cholesterol stones. The most common type of gallstone, called a cholesterol gallstone, often appears yellow in color. These gallstones are composed mainly of undissolved cholesterol, but may contain other components.
Pigment stones: These dark brown or black stones form when your bile contains too much bilirubin.
What Causes Gallstones?
Several factors may come together to create gallstones, including:
Genetics
Body weight
Decreased motility (movement) of the gallbladder
Diet
Gallstones can form when there is an imbalance in the substances that make up bile. For instance, cholesterol stones may develop as a result of too much cholesterol in the bile. Another cause may be the inability of the gallbladder to empty properly.
Pigment stones are more common in people with certain medical conditions, such as cirrhosis (a liver disease in which scar tissue replaces healthy liver tissue) or blood diseases such as sickle cell anemia.
It's not clear what causes gallstones to form. Doctors think gallstones may result when:
Your bile contains too much cholesterol. Normally, your bile contains enough chemicals to dissolve the cholesterol excreted by your liver. But if your liver excretes more cholesterol than your bile can dissolve, the excess cholesterol may form into crystals and eventually into stones.
Your bile contains too much bilirubin. Bilirubin is a chemical that's produced when your body breaks down red blood cells. Certain conditions cause your liver to make too much bilirubin, including liver cirrhosis, biliary tract infections and certain blood disorders. The excess bilirubin contributes to gallstone formation.
Your gallbladder doesn't empty correctly. If your gallbladder doesn't empty completely or often enough, bile may become very concentrated and this contributes to the formation of gallstones.
What Are the Risk Factors for Gallstones?
Risk factors for getting gallstones include:
- Genetics. If other people in your family have had gallstones, you are at increased risk of developing gallstones.
- Obesity. This is one of the biggest risk factors. Obesity can cause a rise in cholesterol and can also keep the gallbladder from emptying completely.
- Estrogen. Estrogen can increase cholesterol and reduce gallbladder motility. Women who are pregnant or who take birth control pills or hormone replacement therapy have higher levels of estrogen and may be more likely to develop gallstones.
- Ethnic background. Certain ethnic groups, including Native Americans and Mexican-Americans, are more likely to develop gallstones.
- Gender and age. Gallstones are more common among women and older people.
- Cholesterol drugs. Some cholesterol-lowering drugs increase the amount of cholesterol in bile, which may increase the chances of developing cholesterol stones.
- Diabetes. People with diabetes tend to have higher levels of triglycerides (a type of blood fat), which is a risk factor for gallstones.
- Rapid weight loss. If a person loses weight too quickly, his or her liver secretes extra cholesterol, which may lead to gallstones. Also, fasting may cause the gallbladder to contract less.
Factors that may increase your risk of gallstones include:
- Being female
- Being age 60 or older
- Being an American Indian
- Being a Mexican-American
- Being overweight or obese
- Being pregnant
- Eating a high-fat diet
- Eating a high-cholesterol diet
- Eating a low-fiber diet
- Having a family history of gallstones
- Having diabetes
- Losing weight very quickly
- Taking some cholesterol-lowering medications
- Taking medications that contain estrogen, such as hormone therapy drugs
What Are the Symptoms of Gallstones?
Gallstones often don't cause symptoms. Those that don't are called "silent stones." A person usually learns he or she has gallstones while being examined for another illness.
When symptoms do appear, they may include:
Gallstones may cause no signs or symptoms. If a gallstone lodges in a duct and causes a blockage, signs and symptoms may result, such as:
- Nausea
- Vomiting
- Other gastrointestinal problems, including bloating, indigestion and heartburn, and gas
- Sudden and rapidly intensifying pain in the upper right portion of your abdomen. The pain may last for several hours.
- Back pain between your shoulder blades
- Pain in your right shoulder
When to see a doctor
Make an appointment with your doctor if you have any signs or symptoms that worry you.
Seek immediate care if you develop signs and symptoms of a serious gallstone complication, such as:
- Abdominal pain so intense that you can't sit still or find a comfortable position
- Yellowing of your skin and the whites of your eyes
- High fever with chills
How Are Gallstones Diagnosed?
If your doctor suspects you have gallstones, he or she will do a physical exam and may perform various other tests, including the following:
- Blood tests: Blood tests may be given to check for signs of infection or obstruction and/or to rule out other conditions.
- Ultrasound: This procedure produces images of various parts of the body and can be used to identify gallstones.
- CAT scan: This test uses specialized X-rays to create cross-section images of organs and body tissues.
- Cholescintigraphy (HIDA scan): This test can determine whether the gallbladder is contracting correctly. A radioactive material is injected into the patient and makes its way to the gallbladder. The technician can then observe the movement of the gallbladder.
- Endoscopic ultrasound: This test combines ultrasound and endoscopy to look for gallstones.
- Endoscopic retrograde cholangiopancreatography (ERCP): The doctor inserts an endoscope through the patient's mouth down to the small intestine and injects a dye to allow the bile ducts to be seen. The doctor can then remove gallstones that have moved into the ducts.
How Are Gallstones Treated?
Gallstones are usually treated with surgery to take out the gallbladder. The traditional operation is called an open cholecystectomy. A newer procedure, called laparoscopic cholecystectomy, is less invasive, has fewer complications, and is used more often.
Laparscopic cholecystectomy. During this procedure, instruments, a light, and a camera are passed through several small incisions in the abdomen. The surgeon views the inside of the body by looking at a video monitor. This procedure is used in approximately 80% of gallbladder removals. After the surgery, the patient spends the night in the hospital.
Open cholecystectomy. This is a more invasive procedure in which the surgeon makes incisions in the abdomen to remove the gallbladder. The patient stays in the hospital for a few days after the surgery.
If gallstones are in the bile ducts, endoscopic retrograde cholangiopancreatography may be used to find and remove them before or during gallbladder surgery.
Are There Any Nonsurgical Treatments for Gallstones?
If you have a medical condition and your doctor feels you shouldn't have gallstone surgery, he or she may prescribe the medications Actigall or Chenix. These drugs work by dissolving cholesterol stones. Mild diarrhea is a side effect of both medications.
The downside of using either medication is that you may have to take it for years to completely dissolve the stones. In addition, the stones may come back after you stop taking the drug.
What are the complications?
Complications of gallstones may include:
Inflammation of the gallbladder. A gallstone that becomes lodged in the neck of the gallbladder can cause inflammation of the gallbladder (cholecystitis). Cholecystitis can cause severe pain and fever.
Blockage of the common bile duct. Gallstones can block the tubes (ducts) through which bile flows from your gallbladder or liver to your small intestine. Jaundice and bile duct infection can result.
Blockage of the pancreatic duct. The pancreatic duct is a tube that runs from the pancreas to the common bile duct. Pancreatic juices, which aid in digestion, flow through the pancreatic duct. A gallstone can cause a blockage in the pancreatic duct, which can lead to inflammation of the pancreas (pancreatitis). Pancreatitis causes intense, constant abdominal pain and usually requires hospitalization.
Gallbladder cancer. People with a history of gallstones have an increased risk of gallbladder cancer. But gallbladder cancer is very rare, so even though the risk of cancer is elevated, the likelihood of gallbladder cancer is still very small.
How to prevent it?
You can reduce your risk of gallstones if you:
Don't skip meals. Try to stick to your usual mealtimes each day. Skipping meals or fasting can increase the risk of gallstones.
Lose weight slowly. If you need to lose weight, go slow. Rapid weight loss can increase the risk of gallstones. Aim to lose 1 or 2 pounds (about 0.5 to 1 kilogram) a week.
Maintain a healthy weight. Obesity and being overweight increase the risk of gallstones. Work to achieve a healthy weight by reducing the number of calories you eat and increasing the amount of physical activity you get. Once you achieve a healthy weight, work to maintain that weight by continuing your healthy diet and continuing to exercise.
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