Gallstones

What are gallstones?

Gallstones are solid particles made from bile in the gallbladder. Bile is a substance made by the liver to help you digest fats. The bile is stored in the gallbladder. The gallbladder is a small sac that lies under the liver and is part of the digestive system. Bile ducts are small tubes that drain bile from the liver into the gallbladder and small intestine. Gallstones may stay in the gallbladder or they may move into the bile ducts. If they block the outlet of the gallbladder or a duct, they can cause a lot of pain.

The formation of gallstones in the gallbladder is called cholelithiasis. Gallstones can be any size--from a grain of sand to as large as a golf ball.

What is the cause?

Bile can contain cholesterol or other substances from the breakdown of old blood cells (bilirubin). If there is too much cholesterol or bilirubin in the bile, the bile can turn into a solid form called a gallstone.

You are more likely to have gallstones if:

• You are female.
• You have had multiple pregnancies, are on hormone replacement therapy, or take birth control pills.
• You are overweight.
• You have type 2 diabetes.
• You are Native American.
• You have sickle cell anemia or another disease that breaks down red blood cells.
• Other members of your family have had gallstones.
• You are taking drugs to lower cholesterol.
• You are over 40 years old.
• You lost a lot of weight in a short time (for example, more than 3 pounds a week), especially if this happened from eating a very low calorie diet.
• You have been getting intravenous (IV) feedings for a long time.

What are the symptoms?

Gallstones often do not cause any symptoms and do not need treatment. When they do cause symptoms, they may include:

• pain in your upper abdomen or back, or in the center of your chest after meals, especially after heavy or high-fat meals
• indigestion, bloating, belching
• nausea and vomiting
• fever
• yellow-tinged skin (jaundice)

Biliary colic is the medical term for the pain caused by gallstones. It happens when the gallbladder tries to empty and a stone is in the way. The pain may be mild or severe. It may last a few minutes or an hour or more. You may have nausea and vomiting with the pain. The pain may spread from your chest or abdomen to your right shoulder or back.

It's possible for stones to move into the main duct and clog it, causing you to turn yellow (jaundice). The stones can also cause pancreatitis, an inflammatory reaction in the pancreas that can be life threatening. The main symptom of pancreatitis is severe pain in the middle of the upper abdomen.

How are they diagnosed?

Your healthcare provider will review your symptoms, ask about your medical history, and examine you. He or she may use the following tests:

• X-rays
• ultrasound scan
• CT scan
• nuclear gallbladder scan (called a HIDA or DISIDA scan)
• blood tests

Not all gallstones show up on regular X-rays. Ultrasound can most often show whether stones are present.

A nuclear gallbladder scan uses an injection of radioactive dye and can show whether the gallbladder is blocked and inflamed. It can also show if the gallbladder is working properly. Your provider will check to see if your symptoms happen again when the scan shows the gallbladder emptying during the test.

How are they treated?

Usually gallstones that cause symptoms are treated with surgery to remove the gallbladder. In most cases the gallbladder and stones can be removed with a laparoscope and several small cuts rather than open surgery with a large incision. A laparoscope is a thin metal tube with a light and tiny camera. Your provider can put the scope and tools into your abdominal cavity through the small cuts. Open surgery through a large incision is necessary when the gallbladder disease is more serious or there is severe infection. It may also be necessary if you are very obese or pregnant. Removal of the gallbladder should cause few, if any, long-term problems because the digestive system can function normally without it. Some people have looser bowel movements after its removal.

In some cases, especially if you are not well enough to have surgery, other treatments may be tried. For example, if you have only a couple of very tiny stones, your healthcare provider may try to dissolve the stones with medicine. The stones may come back, so the best treatment is usually removal of the gallbladder.

If you are extremely overweight and need to follow a very low calorie diet for quick weight loss, your healthcare provider may prescribe the medicine ursodiol, which may help prevent gallstones.

How long will the effects last?

The pain caused by gallstones usually keeps coming back until the stones are removed. If the pain lasts over a few hours, you should seek care from your healthcare provider. Gallstones that are not removed can cause an infection in the gallbladder or slide into the bile duct and block bile flow. Both of these conditions need emergency care.

How can I take care of myself?

To take care of yourself during and after treatment, follow these guidelines:

• Follow the treatment plan prescribed by your healthcare provider.
• Follow your healthcare provider’s advice about diet.
• After surgery don’t lift more than 10 pounds until your healthcare provider says it’s OK. Take frequent short walks to help you get your strength back.

Call your healthcare provider right away if:

• Your symptoms are getting worse, not better.
• You have abdominal or back pain with nausea and vomiting that are not getting better with treatment.
• Your skin or eyes look yellow.
• You have a fever over. 100°F (37.8°C).
• You have any symptoms that worry you.

How can I help prevent gallstones?

To prevent gallstones, follow these guidelines:

• Follow your healthcare provider's advice for weight control if you are overweight. You should not try to lose weight too fast because that can lead to more gallstones.
• Eat a high-fiber diet that includes healthy fats.
• Eat healthy foods that are high in fiber, such as whole grains, fresh fruits, and vegetables.
• Avoid fasting. Long periods of fasting can cause gallstones because the bile stays in the gallbladder too long.
• Lose weight if you are overweight and then keep a normal weight with a healthy diet and physical activity.