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Gallstones Treatment

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What are gallstones?

To understand what gallstones are, one must have little knowledge about the bile and the gallbladder as well.

Bile: A liquid which is created in the liver. Bile contains water, bile salts, cholesterols, fats, proteins and bilirubin (a waste product). It helps us to digest food especially fatty food. Bile is passed in to tiny tubes called bile ducts (hepatic ducts) which branch together to form the main bile duct. From the main bile duct, bile drips down to the small intestine. Gallbladder: A small pear-shaped sac located under the liver in the right upper abdomen. The gallbladder is a small pouch off the common bile duct, which acts like a reservoir to store bile. As we eat, the gallbladder contracts and the stored bile are flushed back to the common bile duct via the cystic duct.

The medical condition wherein the bile hardens to form stones is known as Gallstones.

What are the types of Gallstones?

Cholesterol stones: Primarily caused due to hardened cholesterol. Stones are of yellow-green colour.

Pigment stones: they are small dark stones made of bilirubin.

Gallstones can be small as a grain of sand or as large as a golf ball. The gallbladder can have just one large stone, a hundred small stones, or a combination of the two. These stones can block the flow of the bile if they move out from the gallbladder and lodge themselves in any of the ducts.

Bile trapped in these ducts causes inflammation in the gallbladder, the ducts and in some rare cases, the liver. Sometimes gallstones passing through the main bile duct cause inflammation in the pancreas (gallstone pancreatitis, an extremely painful and dangerous condition).

If any of the bile duct remains blocked for a period of time, severe damage or infection of the gallbladder, liver or the pancreas can occur. This can be fatal also, if not treated.

What are the signs and symptoms?

Usually no symptoms are shown, especially if they are small and do not interfere with the normal digestive functioning.

However, following symptoms are shown due to bigger gallstones.
  • Persistent pain in the abdomen
  • Nausea and vomiting
  • Low grade fever and chills

What are the causes?

  • Excess of cholesterol in the bile
  • Calcium deposits
  • Excess of bile pigments (bile salt and bilirubin)

Who are at risk of getting the disease?

You are at a risk for gallstones if:
  • You have liver cirrhosis, biliary tract infections, or hereditary blood disorders (like sickle cell anaemia in which the liver makes too much bilirubin).
  • You are a woman. Women are twice more vulnerable than men. Excess estrogens from pregnancy, hormone replacement therapy, and birth control pills tend to increase cholesterol levels in bile and decrease gallbladder movement, leading to gallstones.
  • You have a family history of gall stones.
  • You are obese. This is due to the amount of bile salts in bile is reduced, resulting in higher cholesterol levels. Increased cholesterol reduces gall bladder emptying.
  • You have a diet which is high in fat and cholesterol and low in fibre.
  • You have been on a crash diet for weight loss. This is because as the body metabolizes the fat during prolonged fasting, the liver secretes extra cholesterol into bile causing gallstones.
  • You are older than 60. At this age the body tends to secrete more cholesterol into bile.
  • You have diabetes. Diabetics generally have high levels of fatty acids, triglycerides which increase the risk of gallstones.
  • You are taking cholesterol-reducing drugs. These drugs while reducing cholesterol in the blood actually increase the amount of cholesterol in the bile, resulting in gallstones.

When to seek medical advice?

The presence of gallstones will lead to minor complications in usually 1/3rd of people with gallstones.

You should seek immediate medical advice if you experience the following:
  • Steady pain in the upper right abdomen which could last for hours.
  • Pain in the back between the shoulder blades.
  • Pain under the right shoulder.
  • Jaundice
  • Fever

What are the procedure for the screening and diagnosis?

Gallstones are usually detected when you are undergoing screenings for other health conditions.

Screening for gallstones includes:
  • Ultra sound exam
  • CT scan
  • Cholescintigraphy (HIDA scan)
  • Endoscopic retrograde cholangiopancreatography (ERCP)
  • Blood tests to look for the signs of infection, obstruction, pancreatitis or jaundice.

What is the treatment?

No symptoms:
  • No treatment required
Frequent gallbladder attacks:
  • Cholecystectomy (surgery) needs to be performed. In this surgery, your gallbladder is removed. Nearly all Cholecystectomies are performed with laparoscopy (key-hole surgery).
  • Non-surgical method to remove the gallstones: If a patient has a serious medical condition preventing surgery. Also if the patient has cholesterol stones. However in this case, stones usually reappear after 5 years in this approach.
Non surgical procedures for removal of gallstones include:
  • Oral dissolution therapy
  • Contact dissolution therapy

How to prevent?

To prevent gallstones you must:
  • Try to reduce your weight if you are obese.
  • Avoid fatty foods and turn to a high fibre diet.
If your gallbladder has been removed:
  • You can continue with your normal diet, as gallbladder is not required for digestion of food.
  • You could suffer from indigestion at times
  • You could experience bloating sometimes.
  • You might also notice an increase in frequency of your bowel actions.

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