Gallstones are small, but hard stone-like objects, that are formed in the gallbladder due to hardening of the bile components. Bile is synthesized by the liver, mainly for digesting fats. The gallbladder is a small sac-like organ, located just beneath the liver, on the right side of the abdomen. It acts as the reservoir of bile, until it is required to digest fats in the intestine.
When we consume a high fat or cholesterol meal, bile is released by the gallbladder to the bile duct, through which it ultimately reaches the small intestine, and helps digest fats. Bile is mainly composed of water, bile salts, fats, cholesterol, and bilirubin. Gallstones generally develop when the bile contains high concentration of cholesterol and bilirubin.
Types of Gallstones
There are basically two types of gallstones, cholesterol and pigment stones. The cholesterol stones are usually yellow or green in color, and they are mainly formed as a result of hardening of cholesterol found in the bile. They are the most prevalent type of gallstones, accounting for about 80% of the total cases of gallstone formation. A stone to be classified as a cholesterol stone, should have a cholesterol content of about 70 to 80%. On the other hand, the pigment stones are black or dark brown in color, and they are formed due to the presence of excess bilirubin and calcium salts in the bile.
Signs and Symptoms of Gallstone Formation
Initially, there may not be any symptom of gallstone formation, until the stone reaches a particular size or obstructs any of the bile duct. Occasionally, a mild and vague pain can be felt in the upper right portion of the abdomen. The pain can be steady, lasting for more than hours, or it may subside within a few minutes. The most common symptom is a 'gallstone attack', which can cause
✦ Intense pain in the upper-right side of the abdomen.
✦ Sudden and intense pain in the center of the abdomen, below the breastbone
✦ Referred pain between the shoulder blades and under the right shoulder
✦ Pain worsened by deep breaths
✦ Nausea and vomiting
✦ Abdominal bloating
The intensity of the abdominal pain can increase over time and it can last for 30 minutes to several hours. The symptoms of a 'gallstone attack' have been observed to follow a fatty meal, and they occur mostly in the night. When the gallstones block the bile duct, it can lead to an increase in the pressure in gallbladder. In such a situation, the affected individual can experience fever and chills as well.
When the gallstones obstruct the common bile duct, the condition is termed as choledocholithiasis. Obstruction of the biliary ducts by the gallstones can cause jaundice, which can be evident in yellowing of the skin and white portion of the eyes. Other symptoms that can result from the obstruction of the bile ducts are
✦ Dark urine
✦ Fever and chills
✦ Light-colored stool
Pancreatitis or inflammation of the pancreas can follow, if the gallstones block the pancreatic duct. This condition is known as gallstone pancreatitis. The most common symptoms of this condition are
✦ An intense abdominal pain, that can spread to the back
✦ An increase in the severity of the pain after eating.
✦ A tender abdomen
✦ Nausea and vomiting.
The serious symptoms of gallstones that calls for immediate medical attention are
✦ A high-grade fever with chills
✦ Yellowing of the skin and sclera of the eyes
✦ Severe abdominal pain
✦ Clay-colored stool
What Causes Gallstones?
The most important factor that can cause the formation of gallstones, is the presence of too much cholesterol and bilirubin, and less than the required amount of bile salts in the bile. Another major factor is incomplete, as well as less frequent emptying of the gallbladder, which actually causes the bile to become concentrated. This promotes crystallization of its components. Generally, it is observed that women have a greater likelihood to develop gallstones, especially before menopause, as compared to men. The risk for gallstones also increases for men over 40 years. Some notable factors that may put an individual at higher risk for developing gallstones are
✦ Intake of cholesterol lowering drugs
✦ Being pregnant
✦ Hormone therapy
✦ Use of estrogen containing contraceptive pills
✦ A diet high in fat and cholesterol, but low in fiber
✦ Presence of protein in the bile
✦ Biliary tract infection
✦ Rapid weight loss
✦ A family history of gallstones.
Diagnosis and Treatment of Gallstones
The diagnosis usually begins with a careful study of the symptoms. If formation of gallstone is suspected, then ultrasound examination, CT scan, blood test, cholescintigraphy, and endoscopic retrograde cholangiopancreatography, are carried out to ensure proper diagnosis of the condition. Sometimes, medications may be prescribed to dissolve the gallstones. But, it may take months to completely dissolve them with medications, for which physicians generally suggest surgery, which is termed as cholecystectomy. It can be an open cholecystectomy or laparoscopic cholecystectomy, though nowadays, laparoscopic cholecystectomy is usually preferred.
Gallstones, if remain lodged in the bile ducts for a considerable time period, can lead to some potentially serious complications, like infection of the gallbladder, liver, and pancreas. Therefore, recognizing the symptoms of this condition and seeking medical attention at the earliest, are crucial for preventing such complications. Removal of the gallbladder is considered to be the most effective method for preventing the recurrences of gallstone formation.
Disclaimer: This article is for informative purposes only, and should not be treated as a substitute for professional medical advice.