Gallstones

Symptoms: extreme discomfort and pain in the abdomen, right shoulder pain, vomiting or nausea and pain between shoulder blades

Causes: Excessive amount of cholesterol in the bile, high levels of bilirubin in the bile, infrequent emptying of the gallbladder, increased concentration of bile, family history or genetics, consuming a high-fat diet, inactive lifestyle

Risk Factors: Being female and over 40 years, pregnancy, obesity, consumption of high cholesterol diet, diabetes, blood disorders like leukaemia or anaemia, liver diseases, and insulin resistance

Severity: Mild to severe

Which doctor to consult: Gastroenterologist, General Surgeon or Laparoscopy Surgeon

Overview

Gallstones are solidified deposits found in your gallbladder, where bile is produced. The bile fluid is released into the small intestine from the gallbladder. The fluid comprises other substances like bilirubin, bile salts, cholesterol and lecithin.

Gallstones are pebble-shaped deposits that contain cholesterol and bilirubin and are found at the bottom region of the gallbladder. A patient might develop one or multiple gallstones.

Gallbladder stones can be of the size of a grain or even a golf ball. Their size might increase gradually. It happens as the stones continue collecting deposits from the bile juice as the fluid washes over them. That's why in most cases, these stones do not cause any symptoms initially and stay in the gallbladder.

Most gallstones occur due to high levels of cholesterol in the body. These high cholesterol levels may be due to conditions like diabetes, obesity and sedentary lifestyle. Consumption of high-fat and high-cholesterol foods can also lead to gallstones.

If the level of cholesterol is high, the bile is unable to dissolve it. As a result, the extra cholesterol remnants gradually develop into stones that cause the issue. Moreover, excessive bilirubin can also cause these stones to develop.

Gallstones can cause a wide variety of complications, including liver blockage, liver cirrhosis, cholangitis, jaundice, malabsorption, and gallbladder inflammation. So, these stones must not be left untreated and should be immediately examined by a specialist doctor.

When to Consult a Doctor?

On Symptoms Occurrence: It is essential to visit a specialist doctor as soon as the patient experiences the symptoms. The signs include intense abdominal pain that prevents you from sitting comfortably. The patient might experience severe shoulder pain with high fever and chills. Yellowing of the skin or jaundice is a common symptom. 
If the gallstone causes an infection or blockage, the patient may experience abdominal pain and increased heart rate.   
Inability to Digest Fats: If an individual has been experiencing trouble digesting fats, the gallbladder might have complications, as the organ plays a vital role in fat digestion. Symptoms like excessive bloating, chest pain, clay-coloured stools, and dark-coloured urine also need medical supervision.

Annual Screening or Health Checkup: Most gallbladder stones do not depict any initial symptoms even after formation. When the stones get stuck and create a blockage, patients start experiencing abdominal pain. The discomfort might be less due to a partial blockage. However, an annual screening or checkup can detect these issues and address them appropriately.

Diagnosis

Preliminary Examination: The initial diagnosis of gallstones depends on analysing symptoms. The patient can visit a general physician to explain his/her symptoms and problems. If the doctor understands that the patient has gallstones, he/she may refer a gastroenterologist for expert advice and treatment.

During any appointment, the patient must make sure to discuss his/her medical history, current medications, and health complications.

Diagnostic Tests

Blood Tests: The doctor might recommend blood tests to detect the problems caused by gallbladder stones. The tests can diagnose gallbladder infections, jaundice and any underlying pancreatic complications.

Abdominal Ultrasound: It is a common non-invasive diagnostic test to identify gallbladder stones. In this, a device called a transducer is moved around on the patient’s stomach or abdominal region to create an internal imagery of the stomach to diagnose gallstones.

Endoscopic Ultrasound: This test helps in the detection of smaller gallstones that may not be detected through an abdominal ultrasound. The doctor will pass a thin tube into the digestive tract through the patient’s mouth. Then, the transducer will send signals to the connected computer to develop images of the surrounding tissues. So, it helps in detecting gallstones conveniently.

MRCP: The magnetic resonance cholangiopancreatography is an imaging test used for examining bile ducts. It enables the doctor to create clear images of the biliary system to find gallstones. The doctors might conduct additional imaging tests such as a hepatobiliary iminodiacetic acid scan, endoscopic retrograde cholangiopancreatography or computerized tomography test.

Treatment

Home Treatment and Lifestyle Changes: Doctors might suggest some changes to prevent gallstones from growing. These recommendations might be applicable to people who are not suitable for surgeries.

So, a patient must follow a low-fat and low-cholesterol diet, including fruits, vegetables and whole grains. Avoiding foods like cakes, biscuits, butter, sausages, cream pastries, and junk food is essential. It is also important for the patient to engage in some form of physical activity and control his/her weight.

Medication: Doctors might recommend specific drugs to dissolve and prevent gallstone development. Medicines only apply to gallbladder stones that don't have calcium and are smaller in size. A patient might be prescribed ursodeoxycholic acid tablets for two years.

Moreover, this medication might be helpful in case you underwent a weight loss surgery. This is because significant weight loss can lead to gallstone growth.

Surgical Treatment and Alternative Management: The most effective method to remove gallstones is surgical treatment. A patient might undergo an endoscopy, where doctors will remove the gallstones through a long tube. They will pass the tube through the patient’s mouth, which is a non-invasive process.

Another technique is cholecystectomy, where the doctors will surgically removes the gallbladder. This technique prevents gallstone growth and related complications. Further, the process does not affect a patient’s digestion.

If the gallstone situation is complicated, the doctor might opt for an open surgery. It involves an extended hospitalisation and a larger incision. Specific laparoscopic cholecystectomy may be performed as an open surgery to prevent further complications.

Additionally, there are alternative techniques to remove gallstones. Consuming foods like apple juice with apple cider vinegar, milk thistle, and Artichoke might remove gallstones naturally. However, it is crucial to seek medical advice before opting for these foods.

Risks & Complications if Left Untreated

Acute Cholangitis: It is a type of infection caused when the bile duct gets blocked due to gallstone formation. The affected person might experience symptoms like upper abdomen pain, chills, itchy skin, confusion and jaundice.
While antibiotics can address the symptoms, these might not be enough to prevent complications of the bile draining properly. The infection can worsen if the condition is left untreated.

Pancreatitis: Unchecked gallstones increase your risk of developing pancreatitis, where the stone blocks the pancreas opening. The patient might feel a sudden pain in the upper abdomen, which slowly intensifies. The pain might spread to the back, and the affected individual might feel uncomfortable after eating a meal.

Diarrhoea, loss of appetite, sickness, and abdomen tenderness are other symptoms a patient might experience. Hospitalisation and constant medical supervision might be required to address these issues. People getting their gallstones checked may cure acute pancreatitis faster.

Jaundice: This is a very common complication that occurs when suffering from gallbladder stones. It happens when a gallstone gets released into the bile duct from the gallbladder. The symptoms include itching, dark-coloured urine, yellow skin and pale stools.

Jaundice can get worse if a patient neglects the initial symptoms of gallbladder stones. Prompt medical supervision will enable the doctor to analyse the condition of the stones. It will help them develop the necessary treatment plan.        
Gallbladder Cancer: It is a rare condition, but untreated gallstones might increase the chances of this disease. A family history of gallbladder cancer and high calcium levels inside the gallbladder increase the risks. Even though gallbladder cancer is a complicated condition, patients might witness common symptoms like fever and abdominal pain.

In this case, the doctor might suggest gallbladder removal. On the other hand, a patient might also undergo surgical methods, chemotherapy and radiation to treat cancer.

Bile Duct Blockage: It is a very common complication which a patient might suffer from if the gallstones are untreated. The stones in the gallbladder can prevent the bile from getting released into the small intestine.

It happens when gallbladder stones block the bile ducts, leading to severe pain. Moreover, a patient might experience bile duct infection and jaundice.   

Additional Information

Types of Gallstones

There are two types of gallstones that occur in the gallbladder.

• Cholesterol Gallstones - These are yellow in colour and are the most commonly occurring gallbladder stones. These gallstones are usually made of hardened cholesterol which remains undissolved but can also consist of other compounds.
• Pigment Gallstones - These gallstones comprise bilirubin and are black or dark brown in colour. These stones are formed when the concentration of bilirubin increases excessively in bile.   

Women and Their Risks of Developing Gallstones

Progesterone secretion in women might slow down the contractions of the gallbladder, while oestrogen secretion can increase the cholesterol levels in a woman's body. Both these situations put women at risk of developing gallstones.

Most women experience weight gain or loss due to pregnancy. Excessive fat due or obesity can elevate cholesterol levels and also increase oestrogen levels. However, sudden weight loss is also a risk.

When a woman loses a lot of fat, the liver needs to process a large amount of cholesterol. If the liver fails to handle the cholesterol processing, the excess gets deposited in bile leading to cholesterol gallstones.