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What You Need to Know About Gallstones

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Updated November 30, 2011

The gallbladder is a pear-shaped organ that sits under your liver. It acts as a storehouse for bile, which is a fluid produced by your liver to help your body digest fat. When everything is functioning as it should, your gallbladder releases bile through a tube called the common bile duct when you eat food that contains fat. It then is released into your small intestine to help your body break down and absorb the fat.

When the gallbladder isn't functioning as it should, one of the causes of this could be gallstones. You are most likely to have problems with your gallbladder if something blocks the flow of bile through the bile ducts. The cause of this is usually a gallstone. The type of gallbladder disease that results from gallstones is called cholelithiasis.

What Are Gallstones?

There are two types of gallstones

  • Cholesterol stones, which are made mostly of hardened cholesterol, and are usually yellowish-green in color

  • Pigment stones, which are made of bilirubin, and are usually small and dark in color.

Cholesterol stones are the most common type of gallstone to develop, occurring in approximately 80% of patients with gallstones. Gallstones can be as small as grains of sand or as big as golf balls. Smaller stones are more common, though bigger stones do develop.

Gallstones can form in the gallbladder when bile hardens into stone-like material. Bile can harden if there is too much bile salts, cholesterol, or bilirubin in it.

Symptoms of Gallstones

Approximately 80% of individuals with gallstones do not have any symptoms of gallstones. They are said to have "silent" gallstones, because they do not suffer any pain.

For the other approximate 20% of individuals with gallstones, they can have intense pain, and this is often referred to as a "gallbladder attack." These gallbladder attacks will most often occur after a person eats a fatty meal, though they can occur at other times, such as during the night.

If a person has any symptoms of gallstones, it can be pain in the upper abdomen, in the back between the shoulder blades, or under the right shoulder. Bloating and heartburn can also occur.

Causes of Gallstones

Risk factors for developing gallstones include:

  • Obesity
    Obesity is a major risk factor for gallstones, especially in women

  • Rapid weight loss
    When a person loses weight rapidly, the body metabolizes fat at a faster rate, causing the liver to secrete more cholesterol, which in turn increases the risk of developing gallstones

  • Excess estrogen
    Excess estrogen can occur during pregnancy, hormone replacement therapy, or in birth control pills

  • Ethnicity
    Certain ethnic groups are at a higher risk of developing gallstones

  • Gender
    Women are twice as likely as men to develop gallstones

  • Age
    Risks for gallstones increases with age

  • Cholesterol-lowering drugs
    While lowering cholesterol in the blood, they can have the opposite effect on the levels of cholesterol in the bile

  • Diabetes
    Diabetes increases the risk for gallstones by affecting the levels of fatty acids.

Diagnosing Gallstones

Sometimes people discover they have gallstones after developing severe pain, requiring emergency care. This, however, isn't always the case for diagnosing gallstones. For people who have "silent" gallstones, their condition is usually found when their doctor is testing them for other problems.

Gallstone symptoms are similar to symptoms of a heart attack, appendicitis, peptic ulcers, irritable bowel syndrome, hiatal hernia, pancreatitis and hepatitis, so tests are needed to make an accurate diagnosis.

Diagnostic tests for gallstones include:

  • Ultrasound
    Ultrasound is most often used if gallstones are suspected

  • Cholescintigraphy
    This scan is done by nuclear medicine physicians and can be used to detect an obstruction of the gallbladder, bile ducts or bile leaks.

  • Blood tests
    Blood tests may be used to look for signs of infection or abnormal levels of bilirubin, which can happen if a bile duct is obstructed

Gallstone Treatment

Treatment of gallstones depends partly on whether you are experiencing symptoms or not. If symptoms (especially severe pain) are present, surgical removal of the gallbladder is the most common treatment. If you have no symptoms, you and your doctor may decide that no treatment is needed.

The most common operation for gallbladder removal is called laparoscopic cholecystectomy. If infection or scarring from other surgeries is found, a surgeon may perform an open surgery instead of the laparoscopic surgery.

Nonsurgical treatment of gallstones is rarely used, as it can only be used for cholesterol gallstones. If a patient has a serious medical condition that would prevent surgery, a nonsurgical treatment for the gallstones may be attempted.

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