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Gallstones
Gallstones are formed in the gallbladder as clumps of solid bile. Bile is made in the liver and helps digest the fats in our food. Bile is stored in the gallbladder, a small pear-shaped sac underneath the liver, until it is needed for digestion.
Sometimes one single gallstone forms, but there can be many. They vary in size from almost microscopic to the size of a golf ball. Gallstones become more common as you get older. They are two to three times more common in women than in men, and seem to occur more frequently in pregnant women.
Formation
Gallstones build up from chemicals present in the bile, usually cholesterol. Gallstones develop when some factor causes the precipitation of chemicals present in the bile. For example, there may be too much cholesterol. Small, solid particles form, which clump together and gradually form a gallstone.
Symptoms
Many people have gallstones, but are not bothered by symptoms. Gallstones only cause problems in about one in five of the people that have them. If a gallbladder causes problems, it is usually because a stone has blocked the duct (passageway) from the gallbladder to the bile duct, or from the bile duct to the intestine. The bile duct is the narrow passage through which bile leaves the liver and empties into the intestine to help digest food. A stone squeezing through or stuck in the bile duct may cause the following symptoms:
• Severe, cramping pain called biliary colic. The pain is felt in the upper right or mid-abdomen. It may spread (radiate)upward to the shoulder or through to the back. This is common when the stone is stuck in the gall bladder (cystic) duct
• Yellowing in the skin and eyes, known as jaundice. This occurs when the stone blocks the exit of bile from the liver, and the major chemical of the bile (bilirubin) backs up into the bloodstream.
• Nausea and vomiting.
• Fever
Diagnosis
When a person has pain in the abdomen that suggests biliary colic, an ultrasound of the liver and gallbladder is obtained, and most stones will show up on this test. If jaundice is present, a special procedure called an ERCP (endoscopic retrograde cholangiopancreatography) may be performed to make this diagnosis.
Treatment
Most gallstones are treated by surgically removing the gallbladder. Today, this is done primarily using an instrument called a laparascope, and is a minimally invasive procedure. In fact, if there is no infection present, people typically spend just one night in the hospital. If the inflammation of the gallbladder is severe, the conventional open approach may be necessary.
If stones are present in the bile duct, the above-mentioned ERCP is often used not only to diagnose the bile duct stones, but to remove them. If this is not possible, the surgeon must open the bile duct and remove them manually.
For some time, shock wave treatment (lithotripsy) and dissolving medications were used to treat gallstones. However, the success with these modalities was marginal, and with the advent of laparascopic surgery, these are rarely considered.
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Please note: We do not answer questions regarding individual medical problems on this website. We advise you to contact your physician for your specific health related concerns.
©2007 Syracuse Gastroenterological Associates, P.C.
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