What are gallstones?
Gallbladder stones, gallstones, or cholelithiasis occur in 15 out of 100 people globally. They are solid lumps of digestive juices that form in the gallbladder. It may or may not cause symptoms. But people who experience symptoms may require surgery to remove their gallbladder. We should understand the gallbladder and its functions to know more about gallstones.
What is a gallbladder?
The gallbladder is a small, pear-shaped sac-like organ present beneath the liver, which is present in the right rib cage.
What are the functions of the gallbladder?
Every day, the liver produces about one litre of digestive juice called bile to digest fats in our diet. The bile juice enters the gallbladder through the bile duct and gets stored there. On average, the gallbladder can store 30 to 80 milli-litres of bile.
The gallbladder prepares to release the bile as the stomach starts digesting the food. When the partially-digested food travels from the stomach into the small intestine, the gallbladder squeezes itself to release bile into the small intestine. The bile, along with pancreatic juice, helps digest the food in the small intestine.
What causes gallstones?
- Chemical imbalances: Chemical changes in the bile juice secreted by the liver can cause small crystal-like structures in the gallbladder. These grains can slowly enlarge to form gallstones. However, the reasons for chemical imbalances in the bile are known.
- High cholesterol: Higher quantities of cholesterol in the bile can lead to gallstone formation. Cholesterol stones are the most common type of gallstones seen in 8 out of 10 patients.
- High bilirubin: Bilirubin is a pigment produced due to the breakdown of red blood cells. Higher amounts of bilirubin also cause gallstones called pigment stones. These stones account for gallstones in less than 20 out of 100 patients.
- Delayed gallbladder emptying: Issues in the gallbladder emptying and how the sac squeezes out bile can also lead to gallstones. Delayed emptying can make the bile concentrated and slowly turn it into crystals that eventually convert into stones.
What are the risk factors for gallstone formation?
Anyone can develop gallstones. But some people have risk factors which make them prone to gallstones.
- Women: Females who have children and women on oral contraceptives or high doses of hormonal therapies are prone to gallstone formation
- Overweight: People who are overweight, especially those who carry more weight in the centre, have a higher risk of gallstones.
- Age above 40: Every 10 years increase in age is associated with a higher risk of developing gallstones. But the prevalence of gallstones is increasing in younger adults in their 20s and 30s.
- Sluggish bile flow: Some conditions like liver cirrhosis, inflammation in the bile duct, and pregnancy can affect how the gallbladder works, leading to stone formation.
- Inflammatory bowel disease: Ulcerative colitis or Crohn's disease can increase the risk of gallstones.
- Drastic weight loss: Losing a lot of weight quickly through crash diets or weight loss surgeries can also increase the risk.
- High-fat diets: Regular consumption of foods rich in saturated fats can lead to stone formation.
- Blood disorders: Thalassemia is a risk factor got gallstones.
- Family history: Having a family member who had gallstones can also be a risk factor.
What are the symptoms of gallstones?
- The majority of people with gallstones do not show any symptoms. They may have been detected on routine scans or tests done for something else.
- However, people with symptoms experience severe upper abdominal pain in the centre or under the right rib cage. The pain spreads across the upper abdomen to the back and between the shoulder blades.
- The pain can be so intense that a patient can double in pain in bed. It can last 30 minutes to 2 hours, during which a patient can vomit due to pain intensity. Patients will be fine after the pain episode.
What causes intense pain and other symptoms?
- The gallstones can get stuck in the neck of the gallbladder when it squeezes to release bile into the small intestine. The severe stretching and distension of the gall bladder due to obstruction produces intense pain.
- Sometimes the stone manages to escape the gallbladder and gets lodged in the bile duct, causing a buildup of bile, ultimately leading to jaundice. It causes yellowish discolouration of the eyes and skin.
- The buildup of bile in the bile duct for longer periods may lead to infections. It causes fever with shivering.
- Sometimes gallbladder also gets swollen and irritated, leading to cholecystitis. It also causes fever and pain.
- In rare cases, the gallstones can also block the flow of pancreatic juices into the small intestine, triggering pancreatitis. It causes continuous and more intense pain.
How can gallstones be diagnosed?
An abdominal ultrasound scan is a simple and the best method to diagnose gallstones. It is done preferably on an empty stomach or after fasting for 6 hours to achieve good distension of the gallbladder.
The sonographer looks for stones or sludge in the gallbladder and evaluates the thickness of the gallbladder’s wall to detect inflammation. Sometimes, doctors may prescribe an additional MRI scan or endoscopic ultrasound.
How can gallstones be treated?
- Wait and watch: As most patients with gallstones have no symptoms, a wait-and-watch approach is preferred.
- Medication: Unfortunately, there are no medicines available to dissolve gallstones. However, some drugs are given to patients under special circumstances like pregnancy as a preventive treatment.
- Surgery: Gallbladder removal surgery through laparoscopy, called cholecystectomy, is the gold-standard treatment for patients with symptoms.
Why is the gallbladder removed, not just the stones?
- Patients with gallstones commonly ask this question. Removing just the stones and leaving behind the gallbladder will not solve the problem, as gallstones are formed due to abnormal bile or gallbladder.
- Leaving behind the gallbladder after removing stones can lead to stone formation again in the future. Moreover, the gallbladder would be severely inflamed in people with gallstones. Thus, removal of the gallbladder is the standard practice in treating gallstones.
How will gallbladder removal affect digestion?
- People who underwent gallbladder removal surgery can lead a normal life. The body adapts to the absence of a gallbladder. The bile is continuously and slowly released into the bile duct and the small intestine.
- The bile duct gets elongated and enlarged to accommodate the continuous flow of bile juice and acts as a temporary gallbladder. The small intestines also adapt to the constant flow of bile juice.
- Most people who undergo gallbladder removal surgery do not face any health issues, but some might have problems eating large meals or experience loose motions. These conditions can be managed easily with simple medications.
How to minimize the risk of developing gallstones?
- Follow a healthy diet: Eat a healthy diet balanced with fruits, vegetables, and whole grains.
- Lose weight: Lose extra weight and maintain the weight loss.
- Reduce saturated fat intake: Avoid foods like butter, margarine, pastries, and creams, which are rich in saturated fats.
- Exercise: Exercise 30 mins a day, 5 times a week.
- Avoid crash diets: Do not follow crash diets to lose more weight in a short period. Severe calorie restriction can affect the emptying of the gallbladder.
- Do not skip meals: Avoid fasting and follow regular meal times
Takeaway points
- Gallstones are extremely prevalent, and the majority of patients show no symptoms.
- Patients with symptoms may require laparoscopic gallbladder removal surgery.
- Modifying risk factors for gallstones through lifestyle modifications can help prevent gallstone formation.
If you are experiencing symptoms of gallstones like severe abdominal pain accompanied by fever and yellowish discolouration of skin and eyes, consult a gastroenterologist immediately. If you are looking for liver and gastro doctors in Bangalore to get the best liver and gastro treatment in Bangalore, visit Bangalore Gastro Centre Hospitals in HSR Layout. The top gastroenterologists and liver specialists at this hospital are top-rated and most trusted digestive health specialists in Bangalore.
