The gallbladder is a small sized organ in the right side of the abdomen, situated under the liver. It’s most important function is the storage of bile, a yellow or green fluid important to the digestive process. Gallstones are solidified deposits that can form within the gallbladder due to a change in the chemical makeup of bile. Gallstones can be one of two types - cholesterol stones and pigment stones. Cholesterol stones are the most common type of gallstones - they form about 80% of all gallstone cases. Cholesterol stones are hardened green to yellow solids formed due to the presence of excessive cholesterol in bile. Pigment stones are a rare type of gallstone that consist of the remaining 80% of the cases. They are brown to black in colour and are made of bilirubin and calcium. Bilirubin is a waste product of the destruction of red blood cells (RBCs) in the liver that is found in bile. Symptomatic gallstones are usually remedied by surgery while asymptomatic gallstones are left without treatment.
In most cases, there are no symptoms of gallstones. Asymptomatic gallstones cases make up a majority. In case of symptoms of gallstones, they are not signs of gallstones but of the movement of the stones from the gallbladder to common bile ducts which connect the organ to the liver. This pain is caused by the blocking of bile ducts and is called biliary colic. It is characterised by acute pain in the upper abdomen or a dull prolonged pain. Pain that is a symptom of biliary colic can visit in the form of “attacks”. The worst of the pain lasts for up to 30 minutes while the following lower-intensity pain can last for several hours after the “attack”. Biliary colic is also called a gallstone attack.
- Pain in the following places:
- Middle abdomen to upper-right abdomen under the ribs
- Upper back between the shoulder blades
- Right shoulder
- Nausea or vomiting
Repeated gallstone attacks are common and the most obvious symptom of gallstone among patients. Attacks can be spaced by weeks or days, depending on the amount of cholesterol and fat in the patient’s meal. The pain subsides once the gallstone stops blocking the duct.
Cholecystitis is inflammation of the gallbladder and another sign of gallstones. It is most commonly caused by gallstones blocking the common bile ducts. If left untreated, cholecystitis can cause gallbladder rupture.
- Pain in the upper right abdomen
- Pain spreading to upper back (between shoulder blades) and shoulders
- Tenderness of the upper right area of the abdomen
- Bloating or the abdominal area
- Nausea and/or vomiting
- Fever and chills
- Loss of appetite
There are no known causes of gallstones unanimously agreed upon by the medical community. Medical professionals theorise the most probable causes are the following:
- Excessive cholesterol in bile: The gallbladder is usually able to dissolve the cholesterol in bile. But sometimes due to an abnormal chemical makeup of bile, the gallbladder may be unable to dissolve the excess cholesterol. This cholesterol then solidifies to form stones.
- Excessive bilirubin in bile: Bilirubin is a chemical that is formed as a waste product on the destruction of red blood cells (RBCs) in the liver. Bile may have an increased amount of bilirubin in its composition because of conditions such as cirrhosis of the liver or sickle cell anaemia. The increased bile solidifies to form brown to black pigment stones (a form of gallstones).
- Concentration of bile: If the gallbladder is ineffective in disposing of the bile, it causes a concentration of the fluid which leads to the production of gallstones.
- Obesity: Obesity in people causes an increase in the body’s cholesterol level which may lead to cholesterol stones.
- Birth control pills: Intake of birth control pills by women increases the levels of oestrogen in the body which causes a spike in cholesterol levels that the gallbladder may not be able to empty
- Diabetes: Diabetics have higher triglyceride levels which could lead to gallstone formation
- Diet with high intake of fat: A diet with high intake of fat increases the cholesterol levels in the body.
- Hormone Replacement Therapy: Women, especially those going through menopause, undertaking Hormone Replacement Therapy with a high dosage of oestrogen risk increasing their cholesterol levels which may lead to gallstone formation as the gallbladder may not be able to empty all the cholesterol
- Pregnancy: Women who have been pregnant are at a higher risk of developing gallstones
- Rapid loss of weight: The livers of those who lose weight rapidly produce an increased amount of cholesterol which may lead to gallstone formation.
- Cholesterol-lowering drug intake: Intake of cholesterol-lowering drugs like statins.
- Age: People over the age of 60 are at a higher risk of developing gallstones.
- Gender: Women have twice the amount of incidences of gallstones than men.
- Family history: Having a history of gallstones in the family, especially a close relative who has had gallstones, puts one at a higher risk of developing gallstones.
- Ultrasound: It is a non-invasive imaging test that takes images of the abdomen to confirm the presence of gallstones. Ultrasound is the most used method of gallstone diagnosis
- CT Scan: Alternatively known as CAT scan, it is a specialised imaging test that takes pictures of the abdomen to detect the location of gallstones.
- Cholescintigraphy (HIDA scan): HIDA scan is a diagnostic test used to check for abnormalities in gallbladder contraction. A safe radioactive material is injected into the body. Contractions are induced in the gallbladder on it reaching the organ to observe it’s movement.
- Blood Test: Blood tests are used to rule out infections like jaundice as well as to check bilirubin levels in the body. This method checks for signs of gallstone indirectly.
- Endoscopic retrograde cholangiopancreatography (ERCP): ERCP is an invasive X-ray imaging technique where the doctor inserts an endoscope through the mouth to the small intestines. He uses a dye to help locate the gallstones.
Many risk factors like gender, age, race, and genetics cannot be controlled or changed in order to effect a prevention of gallstones. One can attempt a prevention of gallstones through lifestyle, especially dietary, changes. Some of these gallstone prevention methods are listed below:
- Maintain a healthy weight. Obesity is a risk factor for gallstones. One should try to keep their weight within the healthy BMI range so as to reduce the chances of developing gallstones. This can be done by reducing one’s intake of calories and regular exercise.
- Avoid a rapid loss of weight as it puts one at a higher risk of developing gallstones. Restrict your weight loss to a maximum of 1 to 2 pounds per week.
- Avoid skipping meals. Skipping meals and fasting increases the chances of gallstone formation.
- Have many meals in smaller portions. These small meals should be spaced regularly throughout the day. Such steps assist in efficient digestion.
- Adopt a vegetarian diet. Vegetarians have been observed to be a low-risk group when it comes to gallstones.
- Adopt a low-fat diet. A diet that avoids high-fat, greasy food helps lower the cholesterol levels in the body thus preventing the formation of cholesterol gallstones.
- Adopt a high fibre diet. Diets high in fibre help in the production of solid bowels.
- Drink an adequate amount (6-8 glasses) of water each day.
If they cause no pain, doctors usually do not advise on surgical treatment of gallstones. Asymptomatic gallstones may be treated with vitamin C and iron supplements. In case of pain, treatment of gallstones is usually in the form of surgery.
The most common form of treatment of gallstones are:
- Laparoscopic Cholecystectomy: Laparoscopic cholecystectomy is the most common form of treatment of gallstones. The surgeon makes several small incisions in the abdomen to insert light, camera and several instruments through the abdomen. He or she observes their progress on a video monitor. This is a minor surgery and the patient may be given the same-day discharge.
- Open Cholecystectomy: This surgery requires the doctor to make several large incisions in the patient’s abdomen through which he performs gallbladder removal. The patient is advised a post-surgery stay at the hospital for some days.
- Ursodeoxycholic acid: If the patient cannot undergo surgery, they are prescribed a treatment of oral ursodeoxycholic acid. This course can be for up to a year. Gallstones may form again after one stops taking the medication.
- Lithotripsy: Lithotripsy is a non-invasive procedure where a machine called lithotripter sends shockwaves through the body in order to break down the gallstones into smaller pieces. These smaller gallstones may then exit the body on their own along with solid excreta.
Gallstones may present the following complications in the human body:
- Acute cholecystitis: Gallstones that move from the gallbladder may block the passage of bile through the duct. This blockage leads to infection of the gallbladder, giving rise to a situation termed acute cholecystitis. Symptoms of cholecystitis include pain in the upper abdomen and back, loss of appetite, nausea and vomiting, and fever.
- Pancreatitis: Pancreatitis is a situation that arises when gallstones move out of the gallbladder to block the pancreatic duct and causes bile reflux back into the pancreas.
- Jaundice: When gallstones move from the gallbladder to block the bile duct, they block the passage of bile from the gallbladder to the intestine. This bile then enters the bloodstream thus causing jaundice. A common symptom of jaundice is yellow-tinged eyes.
- Sepsis: Sepsis is a blood infection that is caused when the blockage of ducts connecting the gallbladder to other organs causes gallbladder infection.
- Cholangitis: An obstruction of the bile duct by gallstones that have moved out of the gallbladder may lead to an infection of the said bile duct. This is known as cholangitis.
The most widespread myth associated with gallstones is that of gallbladder flush. It is a natural diet-based remedy purported to treat gallstones without surgery. Gallbladder flush claims to break the gallstones into smaller pieces such that they may leave the body naturally through stool. Usually, gallbladder flush requires the intake of olive oil and a fruit juice over a course of two days along with long hours of fasting.
Two common forms of gallbladder flush are:
Myth #1: Lemon juice and olive oil:
After fasting for 12 hours until 7 pm, 4 tablespoons of olive oil and one tablespoon of lemon juice are consumed every 15 minutes eight times.
Myth #2: Apple juice and vegetable juice:
One only intake apple juice and vegetable juice until 5 pm after which one must consume 240ml in portions of 18ml of olive oil and 9 ml of lemon juice every 15 minutes.
There is no scientific research that backs up claims of the efficacy of gallbladder flush. On the contrary, one may suffer side-effects such as nausea, pain in the abdomen, and diarrhoea.
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