GALL STONE DISEASE: An overview

Dr.  PRIYANKA SAKARKAR KAWALKAR
MBBS, MS, MRCS (England), FMAS, FACRSI.
(Laparoscopic and colorectal surgeon)
Orange City Hospital and Research Centre, Nagpur

What are gallstones?

Gallstones are solid, pebble-like masses or stones that form in the gallbladder or the biliary tract (the ducts leading from the liver to the small intestine). Gallstones are basically 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. Gallstone disease is the most common disorder affecting the biliary system, the body’s system of transporting bile.

How are gallstones formed?

80 percent of gallstones are made of cholesterol. The other 20 percent of gallstones are made of calcium salts and bilirubin. It’s not known exactly what causes gallstones to form, though there are some theories.

Too much cholesterol in your bile: Having too much cholesterol in your bile can lead to yellow cholesterol stones. These hard stones may develop if your liver makes more cholesterol than your bile can dissolve.

Too much bilirubin in your bile: Bilirubin is a chemical produced when your liver destroys old red blood cells. Some conditions, such as liver damage and certain blood disorders, cause your liver to produce more bilirubin than it should. Pigment gallstones form when your gallbladder can’t break down the excess bilirubin. These hard stones are often dark brown or black.

Concentrated bile due to a full gallbladder: Your gallbladder needs to empty its bile to be healthy and to function properly. If it fails to empty its bile content, the bile becomes overly concentrated, which causes stones to form.

Risk Factors for gall stone disease

Many risk factors for gallstones are related to diet, while some factors are uncontrollable. Uncontrollable risk factors are age, race, gender and family history, which can’t be changed.

     Lifestyle risk factors

      Uncontrollable risk factors

      Medical risk factors

  • Being overweight or obese
  • Being female
  • Having cirrhosis
  • Eating a diet that’s high in fat or cholesterol or low in fiber
  • Being of Native American or Mexican-American descent
  • Being pregnant
  • Having rapid weight loss in a short period of time
  • Having a family history of gallstones
  • Taking certain medications for lowering cholesterol
  • Having diabetes mellitus
  • Being 60 years or older
  • Taking medications that have a high estrogen content

 

What are the symptoms of gallstone disease?

  • Pain in upper belly, often on the right, just under your ribs
  • Pain in right shoulder or back
  • An upset stomach
  • Vomiting
  • Other digestive problems, including indigestionheartburn and burping.

 

Signs of seeing a doctor immediately are

  • Belly pain that lasts several hours
  • Fever and chills
  • Yellow skin or eyes
  • Dark urine and light-colored stools

 

What are the complications of gallstones?

  • Gallbladder inflammation (acute cholecystitis) 

     This happens when a stone blocks your gallbladder so it can’t empty. It causes constant pain and fever. Your gallbladder might burst, or rupture, if you don’t get treatment right away.

  • Pancreatitis

     This can cause fever, chills, and yellowing of your skin and eyes (jaundice) along with severe abdominal pain. If a stone blocks the duct to your pancreas, that organ may become inflamed                    (pancreatitis).

  • Infected bile ducts (acute cholangitis)

    A blocked duct is more likely to get infected. If the bacteria spread to your bloodstream, they can cause a dangerous condition called sepsis. It presents as fever with chills, jaundice and pain.

  • Gallbladder cancer

     It’s rare, but gallstones raise your risk of this kind of cancer.

 

How are gallstones diagnosed?

  • Blood tests: These check for signs of infection or blockage, and rule out other conditions.

  • Ultrasound: This makes images of the inside of your body. It is the most preferred modality of diagnosis.

  • CT scan: Specialized X-rays let your doctor see inside your body, including your gallbladder and the biliary system.

  • Magnetic resonance cholangiopancreatography (MRCP): This test uses a magnetic field and pulses of radio wave energy to make pictures of the inside of your body, including your liver and gall bladder.

  • Endoscopic retrograde cholangiopancreatography (ERCP): Your doctor runs a tube called an endoscope through your mouth down to your small intestine. They inject a dye so they can see your bile ducts on a camera in the endoscope. They can often take out any gallstones that have moved into the ducts.

 

How are gallstones treated?

You don’t need treatment if you don’t have any symptoms. Some small gallstones can pass through your body on their own.
Most people with gallstones have their gallbladders taken out. You can still digest food without it.

Laparoscopic cholecystectomy:
       This is the most common surgery for gallstones. The doctor passes a narrow tube called a laparoscope into your belly through a small cut. It holds instruments, a light, and a camera. They take out your gallbladder through another small cut.

 

       Advantages of laparoscopic removal 

  • Smaller incision                                                     
  • Lesser pain
  • Quicker recovery

   

      In some cases, open cholecystectomy (i.e. a large cut in your belly is made to remove the gall bladder); or ERCP is done to remove gallstones stuck in the biliary passage before the gall bladder is removed.

How can gallstone formation be prevented?

  • Don’t skip meals: Try to stick to your usual meal times 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.
  • Eat more high-fiber foods: Include more fiber-rich foods in your diet, such as fruits, vegetables and whole grains.
  • 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.