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Sep 29

Gallstones: Symptoms, Causes, Treatment, Pain & Surgery

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What Are Gallstones?

Gallstones (commonly misspelled gall stones or gall stone) are solid particles that form from bile cholesterol and bilirubin in the gallbladder.

Bile is a fluid made by the liver to help in the digestion of fats.

There are two types of gallstones: 1) cholesterol stones and 2) pigment stones.

Gallstones can be any size, from tiny as a grain of sand to large as a golf ball.

Gallstones within the gallbladder often cause no problems. If there are many or they are large, they may cause pain when the gallbladder responds to a fatty meal. They also may cause problems if they block bile from leaving the gallbladder or move out of the gallbladder and block the bile duct.

Up to 20% of adults in the United States may have gallstones, yet only 1% to 3% develop symptoms.

Gallstones Causes

Gallstones occur when bile forms solid particles (stones) in the gallbladder.

Risk factors for the formation of cholesterol gallstones include the following:

Gallstones are the most common cause of gallbladder disease.

When the gallbladder or gallbladder ducts become inflamed or infected as the result of stones, the pancreas frequently becomes inflamed too.

Gallstones and Diet

The role of diet in the formation of gallstones is not clear.

Gallstones Symptoms

Most people with gallstones have no symptoms. In fact, they are usually unaware that they have gallstones unless symptoms occur. These "silent gallstones" usually require no treatment.

Symptoms usually occur as complications develop. The most common symptom is pain in the right upper part of the abdomen. Because the pain comes in episodes, it is often referred to as an "attack."

Other common symptoms of gallstones include the following:

Warning signs of a serious problem are fever, jaundice, and persistent pain.

When to Seek Medical Care for Gallstones

If a person has an episode or recurring episodes of abdominal pain 30 minutes to one hour following meals, call a health care practitioner for an appointment.

Go to a hospital emergency department if the person has this abdominal pain with any of the following conditions:

Gallstones Diagnosis

Upon hearing the patient's symptoms, the health care practitioner will probably suspect gallstones. Because the symptoms of gallbladder disease can resemble those of other serious conditions, he or she will ask the patient questions and examine them to try to confirm this diagnosis and rule out other conditions.

There is no blood test that can identify gallstones.

Ultrasound is the best test to examine the gallbladder for stones.

An alternative to ultrasound is an oral cholecystogram (OCG).

Both ultrasound and OCG can detect gallstones in the gallbladder about 95% of the time.

These tests are the alternatives to ultrasound and OCG. They are better choices if gallstones have left the gallbladder and moved into the ducts.

A chest X-ray may be performed to make sure there are no other reasons for the abdominal pain.

As most gallstones are asymptomatic, many times gallstones are diagnosed when the patient undergoes a test for another reason.

Gallstones Home Remedies

After a diagnosis of gallstones, the patient may choose not to have surgery or may not be able to have surgery right away. There are measures the patient can take to relieve the symptoms to include:

Call a health care practitioner if symptoms worsen or if new symptoms appear. Abdominal pain with vomiting, fever, or jaundice warrants an immediate visit to a doctor's office or a hospital emergency department.

Gallstones Treatment

There is no permanent medical cure for gallstones. Although there are medical measures that can be taken to remove stones or relive symptoms, they are only temporary. If a patient has symptoms from gallstones, surgical removal of the gallbladder is the best treatment. Asymptomatic (producing no symptoms) gallstones do not require treatment.

Extracorporeal shockwave lithotripsy (ESWL): A device that generates shock waves is used to break gallstones up into tiny pieces.

Dissolving stones: Drugs made from bile acids are used to dissolve the gallstones.

If an individual goes to an emergency department, an IV line may be started, and pain medication and antibiotics may be given through the IV.

If the patient's health permits it, the health care practitioner will probably recommend surgery to remove the gallbladder and the stones. Surgical removal helps prevent future episodes of abdominal pain and more dangerous complications such as inflammation of the pancreas and infection of the gallbladder and liver.

Gallstone Surgery (Cholecystectomy)

The usual treatment for symptomatic or complicated gallstones is surgical removal of the gallbladder. This is called cholecystectomy.

Many people who have gallbladder disease are understandably concerned about having their gallbladder removed. They wonder how they can function without a gallbladder.

Laparoscopic removal: Most gallbladders are removed by laparoscopic cholecystectomy. The gallbladder is removed through a small slit in the abdomen using small tube-like instruments.

Open removal: The gallbladder is sometimes removed through a 3 to 6 inch incision in the right upper abdomen.

Occasionally, ERCP is done just before or during surgery to locate any gallstones that have left the gallbladder and are located elsewhere in the biliary system. These can be removed at the same time as surgery, eliminating the risk that they might cause a complication in the future. ERCP also may be performed after surgery if a gallstone is later found in the biliary tract. Sometimes ERCP is done without surgery, for example in people who are too frail or ill to undergo surgery.

Gallstones Follow-up

If the gallbladder has been removed, office visits to the general surgeon are required to check the operation sites one to three times following the operation. No other follow-up or long-term care is required.

Gallstones Prevention Diet

A low-fat, low-cholesterol diet can prevent symptoms of gallstones but cannot prevent formation of stones. It is not known why some people form stones and others do not.

Gallstones Prognosis

If gallstones block one of the biliary ducts, the result is inflammation and swelling of the organs "upstream" of the blocked duct.

If a patient has surgery, you should know the following:

If a person chooses not to have their gallbladder removed, it is likely they will have recurring abdominal pain and possibly complications.

Reviewed on 11/17/2017

Medically reviewed by a John A. Daller, MD; American Board of Surgery with subspecialty certification in surgical critical care

REFERENCE: eMedicine.com. Cholelithiasis.<http://emedicine.medscape.com/article/774352-overview>

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