Gallstones are oversaturated, pebble-like deposits of bile in the gallbladder. They can be as small as a grain of sand or as large as a golf ball, a single stone or a bunch of different sized stones. There are two types of gallstones - cholesterol stones, which make up 80 percent of gallstones, and pigment stones, which are made up of bilirubin, a chemical found in bile, according to the U.S. National Institutes of Health
As many as 20 million Americans have gallstones, according to the U.S. National Institute of Diabetes and Digestive Research Kidney Diseases. In developed countries, as many as 60 percent to 70 percent of American Indians and 10 percent to 15 percent of white adults have gallstones, according to a 2010 review in the Journal of North American Gastroenterology Clinics. They are also more common in women, people over 40, and those with a family history of gallstones.
CausesBile is produced in the liver and stored in the gallbladder until it is transported to the small intestine, where it helps digest fats and fat-soluble vitamins such as a, D, E, and K.
Gallstones occur when there's an imbalance in the transportation of bile. According to niddkdd, cholesterol stones form when bile contains too much cholesterol, too much bilirubin or not enough bile salts. Dr. Kalman Bencsath, a surgeon at the Cleveland Clinic in Ohio, says:
"Cholesterol is a naturally occurring substance in bile." When you have an abnormal buildup, you can end up with cholesterol crystals settling out and growing over time into what we call stones.
Gallstones can also occur when the gallbladder doesn't empty into the common bile duct completely or often. Women are twice as likely as men to develop gallstones because pregnancy, hormone replacement therapy, and excess estrogen from birth control pills may increase cholesterol levels and decrease gallbladder movement, which promotes the development of gallstones.
Black *** vein stones are usually composed of bilirubin polymers and calcium carbonate, and they rarely contain cholesterol. These stones are most often found in the gallbladder and can develop as a result of liver injury, alcoholic liver disease, hemolytic anemia, and old age, according to the University of Maryland.
Brown *** Vein stones are usually composed of calcium bilirubinate, fatty acids, and a small amount of cholesterol. These are usually found in the bile ducts, and they are almost always associated with biliary infections, inflammation, and occasionally liver parasitic infections.
People with large weight fluctuations, such as after pregnancy or surgery, are also at risk for gallstones, Bencsath said,
Diagnosis and TestingMost people with gallstones are asymptomatic. As a result, gallstone disease is usually detected during routine X-rays, abdominal surgery or other medical procedures, according to the National Institutes of Health (NIH).
Occasionally, cholelithiasis can cause prolonged discomfort and cramping as the gallstones travel down the bile ducts, resulting in blockage and increased pressure in the gallbladder. According to the NIDDKD, these episodes are called gallbladder "attacks" and usually occur at night or after fatty meals.
Symptoms include pain in the center or right upper abdomen, or pain in the back or around the right shoulder blade, Bencsath said.
When the pain occurs, the doctor will order an ultrasound to look for gallstones. Although ultrasound is the most sensitive and specific test for gallstones, if symptoms are more severe, your doctor can also order a CT scan, which can also detect complications, such as a ruptured gallbladder or bile duct or infection.
Hepatobiliary iminodiacetic acid (HIDA) scan, magnetic **** vibrational imaging (MRI), or endoscopic retrograde according to the Mayo Clinic, ade cholangiopancreatography (ERCP) are some of the other imaging techniques that can be used to localize gallstones. In the case of ERCP, doctors can simultaneously locate and remove gallstones using an endoscope, which travels through the mouth, esophagus, stomach, and small intestine to reach the bile ducts, Bencsath said.
Gallstones sometimes cause pancreatitis. They can also lead to cholangitis, an infection that occurs when gallstones become trapped in the bile ducts.
"This is a potentially life-threatening infection of the bile ducts and liver," Bencsath said of ERCP exams, which require quick, prompt antibiotic treatment. Once the patient recovers, then it is recommended that the gallbladder can be removed, which eliminates the risk of recurrence.
Treatment and medicationsIf a person has mild or no symptoms, and if they have few or small stones, then they can take medications for gallstones, Bencsath says. A pill containing arbutin, a substance produced naturally by the body, dissolves cholesterol in the gallbladder. But arbutin can take up to six months to work, and about 50 percent of those who take it will develop gallstones again, Bencsath said.
One treatment in the research phase is to activate androgen receptors by *** altering the biochemistry in the gallbladder. This reduces cholesterol and gallstone formation. In a 2017 study published in the American Journal of Pathology, researchers found that 94.7% of rats not subjected to *** developed gallstones. Only 33.3% of mice subjected to *** developed gallstones. Of course, the study needs more testing before it can be used in humans, and according to the National Institutes of Health, surgery may not be needed unless there are symptoms
. However, people with frequent gallbladder attacks may choose to have their gallbladder surgically removed. This procedure, known as a cholecystectomy, can be done using a laparoscope and a tiny camera. The procedure is minimally invasive, and patients can usually go home after surgery, Bencsath says.
One type of laparoscopic surgery involves four small incisions. One cuts about 0.75 inches (2 centimeters) at the belly button, and the other three cut about 0.25 inches (0.6 centimeters) nearby. The surgery takes about an hour, and the patient can go home the same day, Bencsath said.
The other laparoscopic approach uses only one incision in the belly button. But the incision is longer, only an inch (2.5 centimeters), and people who have the surgery have an increased risk of developing a hernia, he said.
Laparoscopic cholecystectomy is often preferred over open cholecystectomy, which requires a 5- to 8-inch incision in the abdomen and can lead to hospitalization and a longer recovery time. Open surgery accounts for about 5 percent of gallbladder surgeries and is usually performed when the gallbladder has severe inflammation, infection or other surgical scars, according to the NIDDKD.
Once the gallbladder is removed, the liver continues to produce bile, which can travel down the bile ducts and into the intestines, Bencsath said.
People with diabetes should talk to their healthcare professional about the complications that arise due to their health to complications. A 2017 study of more than 81,000 Taiwanese patients by the National Institutes of Health found that type 2 diabetes may worsen the prognosis for people with gallstone disease after cholecystectomy. Those without type 2 diabetes also had higher survival rates.
PreventionGallstones occur more frequently at both ends of the weight spectrum - in people who are overweight or obese, and in those who lose weight quickly or rapidly. In addition, research published in 2005 in the journal Gut suggests that high carbohydrate intake, fluctuating glycemic load, and glycemic index increase the risk of developing gallstone disease cisse in men. Therefore, it is important to adopt a healthy diet and stick to a regular meal schedule.
Additional Resources
University of Maryland Medical Center:Gallstones and Bladder DiseaseNational Institutes of Health:How are gallstones diagnosed? Minneapolis Star-Tribune:Medical devices used to treat gallstones may spread deadly bacteriaNational Institutes of Health:Gallstones