What are gallstones?
Your gallbladder is a tiny pouch like organ that is located just underneath your liver. This sac like structure is storage organ for bile, which is a greenish liquid that helps in the digestion of fats. Gallstones are actually hardened deposits that form when the bile inside the gall bladder contains too much of cholesterol. Most of the time the presence of a gallstone goes unnoticed, and is found on routine investigations or when it ends up blocking the bile duct, which is the tube that allows bile to flow from the gallbladder to the small intestine, and then it ends up producing symptoms.
How common is this condition?
There are multiple factors affecting the development of gallstones such as ethnicity, genetics, gender and other comorbidities. Gallstones are much more common in the western world than in the Asian countries. And women are much more likely to develop gallstones than men, especially if they are in the reproductive age group.
What causes this condition?
Since the gallbladder acts as a storage site for bile, the bile tends to becomes saturated within the gallbladder. And when there are substances in increased concentrations within the bile then the bile tends to become supersaturated with these substances and these will then precipitate to form crystals. Over time these crystals will grow and join together to form tiny rock like structures called gallstones. The two most common substances that lead to stone formation are cholesterol and bilirubin (a substance that is formed when your red blood cells break down). When there is an increased concentration of cholesterol in your bile, it leads to the formation of hard, yellow colored stones inside the gallbladder. When there is an increased concentration of bilirubin in your bile, it leads to the formation of hard, dark brown or black colored stones.
Signs and symptoms:
On most occasions, you might not notice that you have an existing problem until is found on routine investigations. But on occasions where the stone is causing an obstruction and preventing the flow of bile, it will produce symptoms such as:
- Episodic pain in the right upper region of your abdomen, which is precipitated when you have meals that are rich in fatty food.
- Nausea and vomiting
- Pale colored stools/stools that don’t get flushed that easily and float in the water
- Dark urine
- Diarrhea
- Indigestion
All these symptoms put together is called a biliary colic. Symptoms such as continuous pain associated with fever, chills, nausea and vomiting, should be reported to the doctor immediately because they are indicative of acute inflammation/swelling of the gallbladder.
How are gallstones diagnosed?
The first step of diagnosis is always a history and examination. During the examination your doctor might pay special attention to the color of your eyes and skin, because a yellowing discoloration indicates that there is too much bilirubin in your circulation. If the physical examination leads along the line of gallstones, then you doctor will order more tests such as:
- Blood tests to estimate the level of bilirubin in your blood (serum bilirubin levels)
- Blood tests that will indicate the gallbladder is inflamed (CRP)
- Blood test that will show signs of infection (full blood count)
- Ultrasound scan of the abdomen, which will help visualize the gallbladder and its walls, as well as confirm the presence or absence of a gallstone.
- If all the above mentioned investigations don’t turn out to be helpful and the diagnosis is still suspicious then your doctor might order a CT scan of the abdomen, where the gallstone cannot be missed.
Treating the condition:
If your gallstones are not causing any symptoms then they don’t require any form of treatment. But if they do cause pain and show signs of an acute episode, then your doctor will most likely want to try and get rid of the stones by removing the gallbladder. This can be done wither surgically or medically.
Removal of the gallbladder through surgery is the most common form of practice, when patients present with an acute episode, because it provides immediate relief to the patient. The surgery to remove the gallbladder can be done as an open surgery or laparascopically, where you make three tiny incisions to pass miniature instruments through them, using which the surgery is conducted. This procedure is better than open surgery because it damages the surrounding tissue less, and therefore reduces your recovery time. You don’t have to be worried about removal of the gallbladder, because it is merely a storage site, and it is your liver which actually produces the bile that is required for digestion. So once your gall bladder has been removed surgically, the bile produces in the liver will flow directly into the small intestine.
Medical treatment of gallstones involves the use of oral bile salts such as ursodeoxycholic acid, which will help dissolve the cholesterol stones. This method is not practiced very often today because it takes years for the stones to dissolve, and it is used only in patient who cannot undergo surgery. You can also try and use Extra Corporeal Shockwave Lithotripsy, where a high intensity laser beam is directed at the location of your gallbladder from the outside, and it is then used to crush the stones within it. But the success of this method is not guaranteed.
What to look out for:
Once the gallbladder had been through surgery then there is no chance of recurrence. But if you haven’t had surgery then you should try and prevent the recurrence of an acute episode again.
Prevention:
Methods to prevent recurrence include:
- Eating a low fat diet
- Drink plenty of water, at least 6-8 glasses per day
- Try and eat several small meals a day, making it easier for the body to digest it
- If you are planning to lose weight, do it slowly. Not more than 1kg a week.
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