The gallbladder is a pear-sized sac that lies near the liver in the abdominal cavity. It’s main job is to store bile until it is needed for digestion. After each meal, it contracts and sends bile into the intestine; once digestion ends the gallbladder relaxes.
Gallstone disease is a common medical issue that affects more than 25 million people in the U.S. About 1 million new cases of gallstone disease are diagnosed each year, and half of them require treatment.
What Causes Gallstones?
Gallstones are pieces of hard solid matter in the gallbladder. They form when the components of bile precipitate out of solution and form crystals — this is typically caused by cholesterol or bilirubin. These gallstones can be as small as a grain of sand or as large as a golf ball. There is no known reason for why certain people get them and certain people don’t, but doctors say that anything that increases the amount of cholesterol in bile can cause them. Other factors are poor contraction of the gallbladder muscle and the presence of substances in bile which may speed up or delay precipitation of crystals. Diets that are high in cholesterol and fat and low in fiber may increase the risk of gallstones.
Pigment (bilirubin) gallstones are found most often in:
• Patients with severe liver disease
• Patients with some blood disorders such as sickle cell anemia
Cholesterol gallstones are found most often in:
• Women over 20, especially pregnant women, and men over 60 years old
• Overweight men and women
• People on “crash diets” who lose a lot of weight quickly
• Patients who use certain medications including birth control pills and cholesterol-lowering agents
• Native-Americans and Mexican-Americans
What are the symptoms of gallstones?
The most common symptom of gallstone disease is severe steady pain in the upper abdomen or right side. The pain may last anywhere from 15 minutes to several hours. Pain may also be felt between the shoulder blades or in the right shoulder. Some patients even vomit or sweat. Attacks of gallstone pain can be separated by weeks, months or even years. This pain is typically caused by a stone blocking the gallbladder duct. When the blockage is prolonged, the gallbladder may become inflamed. This condition, also known as acute cholecystitis, can lead to fever and eventually an infection. Hospitalization is needed for observation, antibiotic treatment, and surgery.
Many people with gallstones have no symptoms. Gallstones are usually found when a test is performed to evaluate another issue. These “silent gallstones” are likely to remain silent and no treatment is recommended.
What tests are used to diagnose gallstones?
When gallstones are suspected to be an issue, a routine liver blood test is typically administered. An abdominal ultrasound may also be performed.
Once gallstones have entered the common bile duct, it is a bit more difficult to diagnose them. In this case, an X-ray dye must be injected directly into the bile ducts with a needle passed through the liver or a flexible swallowed tube.
What treatments are available for gallstones?
The surgical removal of the gallbladder, or a cholecystectomy, is the most common solution for gallstones. Patients typically have no difficulty with digesting food after this surgery. Surgical options include an open cholecystectomy or a laparascopic cholecystectomy, where a surgeon removes the gallstone through incisions made in the abdomen. It is also known as “belly-button surgery.” In some cases, stones in the bile duct can be left in place and removed with a ERCP at a later date. The only issue with some non-surgical approaches is that gallstones can return several years later in about half the patients that are successfully treated.
They can also be dissolved by a chemical called urosodiol or chenodiol, which is available in pill form — but this only works for small gallstones.