What is the gallbladder?
Gallstones are made of material in the bile that crystallizes.
The gallbladder is a small pear-shaped organ located below the liver on the right side of the belly. The main function of the gallbladder is to store bile, a substance secreted by the liver that is required for digestion. The bile contents in the bile may sometimes crystallize and form gallstones. They may be as small as a grain of salt or as large as a tennis ball causing serious symptoms and complications.
Why do you get gallstones?
The exact cause of gallstones cannot usually be determined. Some possible causes are as follows:
- High cholesterol in the bile: Normally, the cholesterol excreted by the liver is digested and dissolved by the chemicals in the bile. If the liver excretes excess cholesterol, beyond what the bile can dissolve, the excess cholesterol may crystallize, forming stones.
- High bilirubin in the bile: Bilirubin is a chemical that's produced when the body breaks down red blood cells. Certain conditions of the liver like liver cirrhosis or liver infections or blood disorders cause increased production of bilirubin. The excess bilirubin can lead to gallstone formation.
- Decreased gallbladder emptying: If the gallbladder doesn't empty completely, bile concentration may increase, contributing to the formation of gallstones.
Risk factors for gallstones: Certain factors increase the risk of gallstones, such as:
- Age over 40 years
- Being woman (women who are overweight and above 40 years have an even higher risk)
- Being of Native American or Mexican American descent
- Obesity
- Sudden loss of weight
- Sedentary lifestyle
- Pregnancy
- Eating diet containing high fat, high cholesterol, and low fiber
- Family history of gallstones
- Having diabetes or liver disease
- Blood disorders such as sickle cell anemia or leukemia
- Certain medications such as oral contraceptives or hormone therapy drugs
What are the types of gallstones?
There are two types of gallstones that can form in the gallbladder:
- Cholesterol gallstones: This is the most common type of gallstone. They appear yellow in color. These gallstones mainly consist of undissolved cholesterol and small amounts of other components.
- Pigment gallstones: These stones contain high amount of bilirubin. The appear dark brown or black.
What are the signs and symptoms of gallstones?
There may be no symptoms in the initial stages. Some signs and symptoms that may develop later are as follows
- Pain in the right upper abdomen, which may be mild or severe
- Back pain
- Digestive discomfort, especially after a heavy meal
- Tenderness over the right upper abdomen
- Fever with chills, in case of infection
- Nausea and vomiting
Can gallstones be prevented?
The following may help prevent gallstones
- Maintaining a healthy body weight
- Eating a balanced diet, with low fat and high fiber
- Not skipping meals
- Slow and steady weight loss
How are gallstones treated?
If gallstones are not very large, the doctor may advise nonsurgical treatment methods to dissolve the gallstones.
Nonsurgical treatment options
- Medication: Medications such as ursodiol cause thinning of the bile, helping gallstones dissolve. Medication to reduce cholesterol levels in the bile may help. These medications usually take years to work and do not prevent recurrence.
- Extracorporeal shock wave lithotripsy (ECSWL): ECSWL is a nonsurgical treatment that uses external shock waves to fragment the gallstones, less than 2 cm in diameter.
- Methyl tertiary-butyl ether (MTBE) injection: A solvent called MTBE is injected into the gallbladder to dissolve gallstones.
- Endoscopic drainage: An endoscope (a thin tube attached to a camera and light) along with a wire is passed down the throat and into the gallbladder, helping the gallbladder resume normal drainage.
- Percutaneous cholecystostomy: This is ideal for seriously ill patients who are not fit for surgery. A needle is used to withdraw fluid from the gallbladder followed by inserting a catheter through the skin to drain the fluid that is left in place for a few weeks until surgery is possible.
- Transmural drainage: This involves creating a new tract through the stomach into the gallbladder. A metal stent is placed, allowing gallbladder to drain into the small intestine.
- Acute cholecystostomy: In patients with acute cholecystitis, cholecystostomy may be performed for those who are unable to undergo surgery to drain infection.
- Surgery: Cholecystectomy (surgery to remove the gallbladder) is indicated if nonsurgical techniques are not possible or in the case of recurrence. Once the gallbladder is removed, the bile flows directly from the liver into the small intestine. Gallbladder is not required to live, and its removal doesn't affect digestion or quality of life. Sometimes, there may be bloating or diarrhea on eating food with a high fat content but having a balanced diet can make such complaints go away.