Gallstones

by Dr. Ramnath Hebbar / Michael Schultz PA-C

1. What are gallstones?

Gallstones are solid pebbles which form within the organ called gall bladder, which is located under the dome of the liver. These are usually composed of cholesterol or pigment stones. Majority of the people with gallstones have no symptoms and require no treatment. However, in some cases it can cause pain or other complications requiring medical, endoscopic or surgical interventions.

2. What are the risk factors for gallstone formation?

There is no clear cause known to cause gallstones. High concentrations of cholesterol and/or calcium in the bile can cause stone formation. The risk factors for gallstone formation include female gender, increasing age, pregnancy, genetic predisposition, medications (birth control pills), obesity, rapid weight loss, sickle cell disease and diabetes.

3. What are the symptoms of gallstones?

The majority of people who have gallstones do not have symptoms. These are often found on an ultrasound or CT scan done for other reasons. Asymptomatic gall bladder stones do not need to be treated as there are risks involved in removing the gallbladder. In some cases, it can cause attacks of abdominal pain, mainly in the right upper abdomen just under the lower ribs. It can be associated with nausea, and vomiting. It usually occurs after a fatty meal. If this occurs, there is a high chance that these symptoms can recur and can be more severe.

4. What are the complications of gallstones?

  • Acute cholecystitis:
    Refers to inflammation of gallbladder which occurs due to blockage of bile flow in gall bladder by gallstones. People can have constant upper abdominal pain associated with fevers. This requires immediate treatment with hydration, antibiotics and pain control. Surgery is usually required to remove the diseased gall bladder during the hospitalization or shortly thereafter to prevent complication of gall bladder rupture which is a life threatening emergency.
  • Choledocholithiasis:
    Refers to migration of the gallstones to the common bile duct causing blockage to bile flow. People can present with jaundice (yellowish discoloration of the eyes and skin) or acute cholangitis which is infection within the bile ducts. This needs urgent endoscopic procedure called ERCP (Endoscopic retrograde cholangiopancreatography) for prompt removal of the obstructing stone. They can also cause inflammation of pancreas called acute pancreatitis.

5. How do you treat gallstones ?

Asymptomatic gallstones can be left alone. If symptomatic, gall bladder removal (cholecystectomy) should be considered to prevent any further attacks. This can be done by surgeons by an open incision or laparoscopically by inserting video cameras through small puncture holes in the abdomen. Medical management of gallstones should be considered in people who cannot undergo surgical procedures. A bile acid pill called ursodeoxycholic acid can be used to dissolve the gallstones, however may take several years to dissolve them.

Summary

Gallstones are usually asymptomatic but in some cases can cause inflammation of the gall bladder or pancreatitis or obstruction and in these cases, surgical and/or endoscopic and medical management should be considered to prevent any further attacks or complications.