Gallstones: Symptoms, Diagnoses and Treatment

Gallstones, sometimes referred to as gall stone, is a condition in which solids or stones form in the gallbladder. The stones are formed when solid particles collect within the gallbladder from bile. Bile is a digestive juice that is produced in the liver and stored in the gallbladder for onward transmission to the digestive system when needed for digestion of fat. Besides bile, gallstones also contain bilirubin and cholesterol.

There are two types of gallstones; cholesterol stones and pigment stones. Four fifths of gallstones are made of cholesterol while one fifth are made of bilirubin and calcium salts.1)

Gallstones range in size from the size of a small grain of sand to about an inch. While anybody can get gallstones, they are more common in overweight people and especially middle-aged women. Women who have been pregnant, those on birth control pills, and estrogen hormone therapy are also more likely to get gallstones. 

Causes of Gallstones

As mentioned earlier, gallstones are formed by tiny solids coalescing to form larger solids or stones in the gallbladder. These solids form when there are higher than normal amounts of cholesterol and bilirubin in bile. This rise may be the result of liver or blood diseases. Additionally, weak abdominal muscles may mean that the gallbladder never empties completely, which can lead to solidification of dregs of the bile fluid into stones.

Symptoms of Gallstones

Most of the people with gallstones never know about it because they don’t experience any symptoms.2) These people will usually not require treatment. For those who have symptoms, they usually depend on the size of the stones and where they are located. The symptoms may also come and go, and usually become noticeable when the gallstones have been present for long periods of time and are so large that they are causing complications.

The most common symptom of gallstones is pain in the right side of the upper abdomen where the gallbladder is located. This pain is usually intermittent such that it comes and goes every few days or weeks, or even every few months or years. All this time, complications may be developing. When the pain comes, it may radiate from the abdomen to the right shoulder. It is usually serious or severe, and may last for up to five hours.3)

Other symptoms of gallstones include fever, bloating, indigestion, belching, nausea and vomiting; intolerance to fatty foods, and jaundice. Jaundice is the yellowing of skin and the whites of the eyes.

Diagnosis

If you present with pain in your right abdomen that comes and goes, and the other related symptoms, your doctor will most probably suspect that you have gallstones. However, most doctors will not start treatment until they are sure of what you are suffering from. 

While bloodwork may be conducted to find out if you have a kidney infection, an inflamed pancreas or liver, there is no specific blood test to determine if you have gallstones. 

Ultrasound imaging is a more reliable method to diagnose the presence of gallstones. An oral cholecystogram may also be required to further determine the condition of the gallbladder. The procedure involves ingesting a dye that can be picked by an X-ray. 

Other gallbladder diagnosis methods include CT scan and Endoscopic retrograde cholangiopancreatography or ERCP which involves passing a tiny probe through the mouth, stomach and small intestines from where it injects X-ray-sensitive dye through the ducts leading to the gallbladder.4)  This is similar to OCG, but is more specific. The procedure may also involve the removal of a gallstone.

Treatment for Gallstones

Most cases of gallstones may not require a specific treatment, and in any case, there is no permanent medication for the condition. However, some treatment methods have been developed to offer relieve from gallstones. These treatment methods include the following:

Stone dissolving acids. These are medications made from bile acids. They work by dissolving the gallstones. Stone dissolving drugs may, however, take a long time before achieving the desired effects. This is probably because the condition that led to the development of the gallstones have not changed. In any case, the gallstones usually come back even after using the stone dissolving medications.

Extracorpeal shockwave lithotripsy, or ESWL. In this treatment method, shockwaves are directly at the gallstones with the objective of breaking them into small pieces that may pass through the bile duct and into the small intestines for excretion. ESWL may be conducted together with ERCP so that some of the stones are removed at once. This method can lead to severe pain in the right side of the abdomen.

Surgery or Cholecystectomy is the only known permanent treatment method for gallstones. There are two main surgical methods for the removal of the gallbladder: laparoscopic cholecystectomy and open cholecystectomy. In laparoscopic cholecystectomy, small incisions are made in the abdomen through which the gallbladder is removed using a small camera and surgical instruments. The patient may be discharged the same day if there are no post-operative complications.

Open cholecystectomy involves opening up the right side of the abdomen to remove the gallbladder. The patient is discharged three to five days post-operation.

In both surgeries, bile is rerouted directly to the small intestines.

Home Remedies for Gallstones

Additionally, some home remedies can help prevent or dissolve gallstones. These include diet changes such as drinking lots of water, avoiding prepared drinks lie soda and juices, avoiding fatty foods, regular physical exercise and maintaining a healthy weight. Fruits high in vitamin C such as lemons may also help dissolve gallstones.5)

Other home remedies for gallstones include apple cider vinegar, milk thistle, dandelion, peppermint, pears and mixed vegetable juice.

Complications

Many people who get gallstones may never know about it because they never get symptoms. Others may experience mild symptoms and never seek treatment. If gallstones remain untreated for long, and they grow in size or cause infection, they can cause complications. 

Gallstones form in the gallbladder where they mix with bile. As the stones grow in size, they can affect the flow of bile into the bile duct and onwards to the duodenum. Blockage of the bile duct may also affect the flow of digestive juices from the pancreas which use a common duct with bile as they flow into the duodenum. If this happens, inflammation may develop in both the gallbladder and the pancreas. This can lead to an inflamed gallbladder, a condition called cholecystitis that affects up to 3 percent of people with gallstones;6) or pancreatitis or an inflamed pancreas. Swelling and infection of the gallbladder might also develop. If the gallstones still remain untreated, the condition can become life-threatening.

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