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Gallstones are hardened collections of bile materials that develop in your gallbladder. They can be as small as a grain of sand or as big as a ping pong ball. Most don’t cause any problems, but they can cause problems if they get loose and travel into your bile ducts. The condition of having gallstones is called cholelithiasis.
Gallstones form in your gallbladder, the small, pear-shaped organ where your body stores bile. They are pebble-like pieces of concentrated bile materials. Bile fluid contains cholesterol, bilirubin, bile salts and lecithin. Gallstones are usually made up of cholesterol or bilirubin that collect at the bottom of your gallbladder until they harden into “stones.”
Gallstones can be as small as a grain of sand or as big as a golf ball. They grow gradually, as bile continues to wash over them and they collect extra materials. Actually, it’s the smaller stones that are more likely to cause trouble. That’s because smaller stones can travel, while bigger ones tend to stay put. Gallstones that travel may get stuck somewhere and create a blockage.
Cholelithiasis is the condition of gallstones. Many people have cholelithiasis and don’t know it. Gallstones won’t necessarily cause any problems for you. If they don’t, you can leave them alone. But gallstones can sometimes cause problems by creating a blockage. This will cause pain and inflammation in your organs. If it goes untreated, it can cause serious complications.
Gallstones are common in developed countries, affecting about 10% of adults and 20% of those over the age of 65. Only 20% of people diagnosed with gallstones will need treatment.
How does having gallstones (cholelithiasis) affect me?
Your gallbladder is part of your biliary system. It belongs to a network of organs that pass bile between each other. These organs are connected by a series of pipelines called bile ducts. Bile travels through the bile ducts from your liver to your gallbladder, and from your gallbladder to your small intestine. Your pancreas also uses the bile ducts to deliver its digestive juices.
A gallstone that travels to the mouth of your gallbladder can obstruct the flow of bile in or out. A gallstone that makes its way out of your gallbladder and into the bile ducts could block the flow of bile through the ducts. This will cause bile to back up into the nearby organs. When bile backs up, it builds pressure and pain in your organs and bile ducts and causes inflammation.
This can lead to a variety of complications, including:
As much as 75% of the gallstones healthcare providers discover are made up of excess cholesterol. So, we could say that having excess cholesterol in your blood is the leading cause of gallstones. You might have extra cholesterol for a variety of reasons. Some of the most common reasons include metabolic disorders, such as obesity and diabetes.
High blood cholesterol leads to higher cholesterol content in your bile. Your liver filters cholesterol from your blood and deposits it in bile as a waste product before sending the bile to your gallbladder. Chemicals in bile (lecithin and bile salts) are supposed to dissolve cholesterol. But if there’s too much of it, these chemicals might not be up to the task.
What else causes cholelithiasis?
Other factors that contribute to gallstones include:
Who gets gallstones?
Anyone can get gallstones, including children, but they are more common after the age of 40. That’s because gallstones grow very gradually. It may take 10 to 20 years for gallstones to grow large enough to cause an obstruction. They are also more common in people assigned female at birth than in those assigned male at birth, by a ratio of 3:1. This is due to the effects of female hormones.
Other common risk factors include:
Why are women more at risk of developing gallstones?
Estrogen increases cholesterol, and progesterone slows down gallbladder contractions. Both hormones are especially high during certain periods in your reproductive life, such as menstruation and pregnancy. When hormone levels begin to drop in menopause, many people use hormone therapy (HT) to replace them, which elevates them again.
Women and people assigned female at birth are also more likely to gain and lose body fat more frequently. Excessive body fat can translate to extra cholesterol in your blood. Obesity increases estrogen. On the other hand, rapid weight loss has a similar effect to weight gain. When you lose a lot of body fat at once, it sends an unusually large load of cholesterol to your liver for processing, which ends up in your bile.
What are the first signs of gallstones?
You won’t notice your gallstones unless one gets stuck somewhere and causes a blockage. When that happens, the most typical symptom is a type of abdominal pain, in the right upper quadrant of your abdomen, called biliary colic. It occurs in episodes that last for one to several hours, usually after a large or rich meal. That’s when your gallbladder contracts to send bile to your small intestine for digestion.
If you have occasional episodes of biliary colic, it means that a gallstone is causing a partial blockage, but you can’t feel it until your gallbladder contracts. The contraction forces pressure through your bile ducts and causes that pressure to build up inside when it meets resistance. This is a warning sign. When the blockage becomes more severe, your pain will too.
Gallbladder pain most often occurs in the upper right side of your abdomen, under your ribcage, where your gallbladder is located. But sometimes it feels more vaguely located in your abdomen. The pain can also radiate somewhere else, most often to your right arm or shoulder blade. It starts as an ache and then steadily increases in intensity over the first hour before receding again.
Despite the name, biliary colic is not “colicky pain,” it is sharp and comes in waves. It has a slow and steady arc, and it’s usually dull but severe. It may bring you to the emergency room for relief. You may also notice that your upper right abdomen is tender to the touch. Biliary colic is often accompanied by nausea and vomiting. It’s also called a “gallbladder attack.”
Do gallstones cause other symptoms?
When a gallstone causes a persistent blockage or an infection, you’ll have symptoms of acute inflammation. This may include:
You may also begin to show symptoms of bile accumulating in your bloodstream, such as:
If you’re experiencing symptoms of biliary colic, your healthcare provider will investigate with blood tests and imaging tests. Blood tests can detect inflammation, infection or jaundice. They can also give your healthcare provider clues about which organs are being affected. Imaging tests will help locate the source of the blockage. They will usually start with an ultrasound.
What tests are used to diagnose cholelithiasis?
Ultrasound: An abdominal ultrasound is a simple and noninvasive test that requires no preparation or medication. It’s usually all that’s needed to locate gallstones. However, it doesn’t visualize the common bile duct very well. If your healthcare provider suspects there’s a gallstone hidden in there, they might need to use another type of imaging test to find it.
MRCP: Magnetic resonance cholangiopancreatography (MRCP) is a type of MRI that specifically visualizes the bile ducts. It’s non-invasive and creates very clear images of your biliary system, including the common bile duct. Your provider might use this test first to find a suspected gallstone there. But if they’re already pretty sure it’s there, they might skip it and go straight to an ERCP.
ERCP: ERCP stands for endoscopic retrograde cholangiopancreatography. This test is a little more invasive, but it’s a useful one for finding gallstones because it can also be used to remove them from the ducts if they are stuck there. It uses a combination of X-rays and endoscopy, which means passing a tiny camera on the end of a long tube down your throat and into your upper GI tract. (You’ll have medication to make this easier.)
When the camera (endoscope) reaches the top of your small intestine, your healthcare provider will slide another, smaller tube into the first one to reach farther down into your bile ducts. They will inject a special dye through the tube and then take video X-rays (fluoroscopy) as the dye travels through the ducts. They can insert tools through the tube to remove the stones they find.
Most people with gallstones will never need treatment. But if your gallstones cause problems, your healthcare provider will want to remove them. Usually, they will want to remove all of your gallstones, even if only one of them is currently causing trouble. If a blockage happens once, it’s likely to happen again. The risk isn’t worth waiting around for.
Since there’s no way to access the gallstones inside your gallbladder without removing them, the standard treatment for problematic gallstones is to remove the gallbladder entirely. This is a minor surgery, and you can live well without a gallbladder. If you have gallstones in your bile ducts, your healthcare provider will have to remove those separately as well.
Gallstones in your bile ducts that aren’t stuck can successfully pass through them and into your intestines. You can pass them out through your poop. That's a lucky scenario, but in general, you don’t want to risk having gallstones in your bile ducts in the first place. If they don’t pass out of you, they will only grow bigger over time.
Some medications can help to dissolve smaller gallstones. These take many months to work, so they aren’t the most practical option for people experiencing symptoms. But they offer an alternative for people who may not be in a safe health condition for surgery. They may also be practical for people who have gallstones but don’t have symptoms yet.
There are a few different ways to remove gallstones.
Endoscopy
Gallstones in your bile ducts are removed by endoscopy (ERCP). This doesn’t require any incisions. The gallstones come out through the long tube that’s been passed down your throat. Gallstones in your gallbladder are removed by removing the gallbladder (cholecystectomy). This can usually be done by laparoscopy, a minimally-invasive surgery technique.
Laparoscopy
A laparoscopic cholecystectomy uses small, “keyhole incisions” in your abdomen to operate with the aid of a small camera called a laparoscope. Your surgeon inserts the laparoscope through one keyhole and removes your gallbladder through another. Smaller incisions make for less post-operative pain and a faster recovery time than conventional, “open” surgery.
Open surgery
Some people may have more complicated conditions that require open surgery to manage. If you have open surgery, you’ll have a longer hospital stay afterwards and a longer recovery at home for your larger incision. Some laparoscopic cholecystectomies may need to convert to open surgery if your surgeon runs into complications during the procedure.
How long is the recovery from gallstone surgery?
If you have a laparoscopic cholecystectomy, you can be home within 24 hours. You can recover in about two weeks. If you have open surgery, you’ll need to stay in the hospital for three to five days afterwards. Your recovery at home will be six to eight weeks. Your digestive system may take two to eight weeks to adjust after the operation.
The Chawla IVF medical team at Chawla Nursing Home understands the risks and rewards that come with Gallstones and Gallbladder Treatment, and we will help you through every step of the way. Schedule a consultation appointment with one of our doctors at our Jalandhar location to find out if Gallstones and Gallbladder Treatment is your best option for prevention and safety purposes.
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