What are Gallstones?

Gallstones (also called cholelithiasis) are hard particles or stones that are present within the gallbladder.

The gallbladder is a small, pear-shaped organ present in the upper abdomen on the right side, just below the liver. The size of gallstones vary from small grains to that of a golf ball. The number of gallstones vary from a single stone to hundreds of small stones.

How Common are Gallstones?

Gallstones are very common. Every year, more than one million people are diagnosed with gallstones in the United States.

Symptoms of Gallstones

Most patients with gallstones have no symptoms. Gallstones are typically discovered during other exams.

However, gallstones can block the ducts of gallbladder or cause the gallbladder to swell up and become inflamed (called cholecystitis). In these cases, you will experience one or more of the following symptoms:

  • Colicky pain in the upper abdomen, usually on the right side. The pain may increase with consumption of fatty foods
  • Nausea and vomiting
  • Fever
  • Increased heart rate
Causes of Gallstones

The liver produces a greenish-brown fluid called bile, which is important in the digestion of food. The normal function of gallbladder is to store and concentrate bile. When we eat meals, the gallbladder contracts and releases bile into the intestine to help in the digestion of food. In some persons with risk factors, the bile tends to over concentrate and precipitate within the gallbladder forming gallstones.

Types of Gallstones

There are two main types of gallstones:

  • Cholesterol gallstones: These are most common type of gallstones that account for approximately 80 percent of gallstones. They are brown to yellow in color.
  • Pigment stones: They are of the less common type and account for about 20 percent of gallstones. They are black or dark brown in color and usually in persons with blood disorders, such as thalassemia and sickle cell anemia.
Risk Factors of Gallstones

Gallstones are more frequently found in:

  • Middle-aged women
  • Overweight and obese persons
  • Pregnant women
  • Those using birth control pills
  • Patients with rapid weight loss
  • Those who lack in physical activity
  • Diabetes mellitus patients
  • Persons with blood disorders such as sickle cell disease and thalassemia
Complications of Gallstones
  • Gallstones may dislodge and block the ducts of pancreas, resulting in inflammation and swelling of pancreas (pancreatitis).
  • Gallstones may cause the inflammation of lining of the abdominal cavity (peritonitis).
  • Sepsis and shock
Diagnosis of Gallstones

Your doctor will first take a detailed history and perform the relevant physical examination. Your physical examination may be normal in cases of gallstones. If gallbladder gets inflamed (cholecystitis), then you will feel pain when your doctor touches your upper abdomen with his hand.

Gallbladder are routinely diagnosed during exams such as:

  • Ultrasound of the abdomen
  • Computed tomography (CT) scan or magnetic resonance imaging (MRI) of the abdomen

Your doctor may also advise for additional tests if needed, such as

  • Magnetic resonance cholangiopancreatography (MRCP)
  • X-ray abdomen
Treatment of Gallstones

Gallstones are common. If your gallstones are not causing you any problems, you should be reassured that no further treatment or follow-up is necessary. You will be only advised to maintain healthy life style by losing weight, if you are overweight. You should eat fruits, vegetables, and a high-fiber diet.

If you are having any symptoms suggestive of gallstones, your doctor will order further tests to confirm that gallbladder is inflamed (cholecystitis). If the gallstones are causing symptoms then your doctor may advise surgery to remove the gallbladder.

  • Surgical Management of Gallstones

The main surgical treatment is to remove the gallbladder if it is inflamed and causing symptoms. This procedure is called cholecystectomy. It is often performed by a laparoscopic procedure.

  • In laparoscopic cholecystectomy surgery, your doctor will make several small, half-inch incisions in the abdominal wall. Your doctor will then insert a laparoscope, which is a thin tube with a tiny video camera attached. Your doctor will then cut the gallbladder and remove it from the body. This procedure is performed on an outpatient basis and you may be discharged on the same day. You may even continue your daily activities after a day or two.
  • In some cases, an open cholecystectomy is required. In this procedure, your doctor will make a larger incision in your abdomen wall and to directly visualize the gallbladder and then remove it. He will apply sutures and close the abdominal wall. This procedure takes more time for recovery than a laparoscopic surgery.
Diet and Exercise
  • To prevent constipation, increase your water intake, use stool softeners, and increase dietary fiber intake.
  • No limitations on physical activity if you had a laparoscopic cholecystectomy. Standard moderate physical activity of at least 30 minutes for at least five days per week is recommended.
  • In cases of open cholecystectomy, you will be advised for rest for an initial few days before resuming yourdaily activities.
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