Gallstones are small stone-like deposits that form in the gallbladder or nearby ducts. The gallbladder, a small sac located under the liver, stores the bile produced by the liver then delivers it to the small intestine through a series of ducts or canals. Bile, which is composed of water, cholesterol, fats, bile salts, proteins, and bilirubin, helps you to digest fats. Under certain conditions, some components of bile can harden into gallstones, which range in size from a grain of sand to a golf ball. There may be many small stones or just one large stone, or a combination of sizes and amounts.
One in 12 Americans may develop gallstones at some point in their lives, and in most cases they are harmless and cause no symptoms. However, some gallstones block the ducts leading into and out of the gallbladder or migrate into these ducts. This can cause inflammation, infection, and damage to the gallbladder or surrounding ducts and organs. It is important to seek treatment in these cases.
Again, most gallstones are harmless and cause no symptoms. However, pain related to gallstones, known as a gallstone attack, should be taken seriously and treated to avoid serious, even fatal, consequences. Signs that you are having a gallstone attack include:
- Sudden steady pain in the upper abdomen lasting from 30 minutes to several hours and increasing in intensity
- Chronic indigestion
- Nausea and vomiting
- Pain in the back between the shoulders or under the right shoulder
- Intolerance of fatty foods
If a gallstone is blocking a bile duct, you may also experience symptoms such as fever, chills, and yellowing of your skin and the whites of your eyes. If any of these symptoms appear, it is important to seek treatment right away.
Causes and Risk Factors
It is believed that gallstones can form if bile contains too much cholesterol, too much bilirubin, or low level of bile salts. They may also develop when the gallbladder does not empty frequently or completely, which causes bile to become too concentrated. Common risk factors for gallstones include:
- Excess weight (even being moderately overweight increases the chance of gallstones)
- Age (people over 60 are more likely to develop gallstones)
- Estrogen production (causes higher levels of cholesterol in the bile and increases the risk for all women of child-bearing age as well as women on birth control pills, pregnant women, and women taking estrogen to treat menopause)
- Dietary habits (fasting can cause the gallbladder to contract less frequently)
- Rapid weight loss (may lead to higher cholesterol production in the bile in order to metabolize fat)
- Diabetes (increased levels of triglycerides can lead to higher risk of gallstones)
- A family history of gallstones
Often gallstones are discovered during diagnostic procedures for other issues. However, when you have a gallstone attack or when your doctor suspects gallstones might be a problem, an ultrasound can be performed to determine if they are present. Other techniques that may be used to diagnose gallstones include computed tomography (CT) scans, radionuclide scans (HIDA scans), and endoscopic retrograde cholangiopancreatography (ERCP), among others. These tests can help your physician pinpoint where your gallstones are located and if they are blocking any ducts. Blood tests may also be used to determine if infections, obstructions, or jaundice are present.
Surgery to remove the gallbladder is a common solution to gallstones; over 500,000 Americans have this surgery, called cholecystectomy, each year. It is often performed as a laparoscopic procedure, which is less invasive than open surgery and has a shorter recovery time. More complicated or severe cases may require open surgery, however. Your doctor will determine which option will work the best for your particular condition.
Non-surgical interventions are used when surgery can't be performed for some reason, usually due to other medical conditions that make surgery too risky. The most common option is to use drugs to break up the gallstones. Gallstones generally recur, however, when non-surgical treatments are used.
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