Gallstones are stones ranging in size from a sand grain to a golf ball. They are composed of cholesterol or bilirubin and form in the gallbladder. The gallbladder is a small, pear-shaped sac on the right side of the abdomen. It is found just beneath the liver. It stores bile (a digestive fluid) made by the liver, which helps in fat digestion. Cholelithiasis is a term to describe stones in the gallbladder. Gallstones may pass into the cystic duct, common bile duct or pancreatic duct.[1,2]
Cholesterol stones: They are mostly made of hardened cholesterol. The gallstones are yellow-green in colour. They are the most common type of gallstones.[2,3]
Pigment stones: When red blood cells break down in the liver, bilirubin is formed. If an excess of bilirubin leaks in the bloodstream, it causes the skin and eyes to turn yellow. Some people have both types of gallstones.[2,3]
Symptoms
Often, gallstones do not show any symptoms. They are called silent gallstones and usually require no treatment. However, if the gallstones obstruct one of the bile ducts, the pain in the abdomen can be sudden and severe. It can last for a few minutes or a few hours. The symptoms are listed below: [2,4,5]
Abdominal pain (biliary colic) [2,4,5]
Pain caused in the centre of your abdomen
Pain caused under your right-hand side may spread from there to your shoulder blade.
Other symptoms are:[2,4,5]
You may feel pain in the upper mid abdomen or upper right abdomen
Related pain in the right shoulder
Fever
Nausea and vomiting
Chest pain
Clay-coloured stools
Jaundice
Repeated similar episodes.
Symptoms
Causes
There is no single cause of gallstones. They vary and are listed below:[4,6]
Gallstones may be formed if the bile contains excessive cholesterol, forming cholesterol stones [4,6]
They may be formed if excessive bilirubin is accumulated, thus forming pigment stones[4,6]
They may be formed if an insufficient amount of bile salts are present [4,6]
They may be formed when the gallbladder fails to empty normally or often enough[4,6]
Risk Factors
Specific factors that raise your risk of developing gallstones are listed below:
Obesity: It is a significant risk factor. [2,7,8]
Estrogen: If you are undergoing high-dose oestrogen therapy, hormone replacement therapy, have excess oestrogen from pregnancy, or take birth control pills can lead to gallstones because they increase cholesterol levels in bile and reduce gallbladder movement.[2,7,8]
Gender: Women are more at risk for developing gallstones than men.[2,7,8]
Age: People over the age of 40 are more likely to develop gallstones than younger people.[2,7,8]
Ethnicity: Native Americans are at a higher risk because they secrete high levels of cholesterol in bile.[2,7,8]
Cholesterol-lowering drugs: Drugs decrease the level of cholesterol in the blood and can increase the amount of bile, which increases the chances of developing gallstones.[2,7,8]
Weight loss: People who have recently lost weight from dieting or weight loss surgery are at risk.[2,7,8]
Diabetes: Patients with diabetes usually have high levels of fatty acids, called triglycerides. This increases the risk for gallstones.[2,7,8]
Fasting: It decreases gallbladder movement, which causes an overconcentration of cholesterol in bile.[2,7,8]
Cirrhosis, obstetric cholestasis, or primary sclerosing cholangitis: These conditions affect the flow of bile and put people at a higher risk.[2,7,8]
Irritable bowel syndrome (IBS) or Crohn’s disease: People with this condition are at risk of developing gallstones.[2,7,8]
Family history: People who have a history of gallstones in the family are more likely to develop it.[2,7,8]
Prevention
There is no way to prevent the formation of gallstones. However, you can decrease the possibility of developing gallstones by having a balanced diet, maintaining an average weight, exercising regularly, and reducing your alcohol consumption. Talk to your doctor about cholesterol management. Avoiding fatty foods will not prevent gallstones but decrease the frequency of attacks.[4,9]
Diagnosis
Your doctor may do the following test to confirm the diagnosis of gallstones:
Blood test: The doctor may order a blood test for bilirubin levels, complete blood count, pancreatic enzyme and liver function test. [4,10]
Ultrasound: An ultrasound examination of your abdomen will be performed to identify gallstones or determine if the gallbladder is inflamed.[2,4,10]
Cholescintigraphy or Hepatobiliary (HIDA) scan: A radioactive tracer is injected into the vein. It can help determine if the cyst duct of the gallbladder is obstructed and if the gallbladder is normally contracting.[2,4,10]
Computerised tomography (CT) scan: It will help detect gallstones but is less accurate than abdominal ultrasound.[2,4,10]
Endoscopic retrograde cholangiopancreatography (ERCP): This test is performed by inserting an endoscope (a flexible tube with light and camera) into the small intestine via the mouth. To allow the bile ducts to stand out, a dye is injected. This method can be used as a treatment.[2,4,10]
Magnetic resonance cholangiopancreatography (MRCP): In this test, the bile ducts are examined via magnetic resonance imaging (MRI). This test will create a very clear image of body parts and help detect gallstones. It is less invasive and preferred over ERCP.[2,4,10]
Endoscopic ultrasound (EUS): In this procedure, endoscopy and ultrasound are combined. This test helps visualise the common bile duct and helps confirm the diagnosis.[2,4,10]
Treatment
Gallstones may not require to be treated if they are not causing any symptoms. Although if you are having a gallbladder attack or other symptoms and they do not go away, your doctor will recommend the following treatment options:[7,10,11,12]
Non-surgical method:
Endoscopic retrograde cholangiopancreatography (ERCP): The doctor will use a long, thin, flexible tube attached with LED lights and a tiny camera and guide it into the mouth, down to the upper digestive system. Next, they slide a tool down the tube and uses it to remove the gallstones that are stuck in the common bile duct. [7,10,11,12]
Extracorporeal shockwave lithotripsy (ESWL): A shockwave lithotripsy is used to blast gallstones into smaller pieces that will flow through the bile ducts without causing any blockage. This procedure is rarely used and sometimes with ursodiol.[7,10,11]
Oral dissolution therapy: Medications such as ursodiol or chenodiol that contain bile acids can be used to break the gallstones apart.[7,10,11]
Methyl-tert-butyl ether: It is a solution injected into the gallbladder to dissolve the stones.[7]
Surgical Methods: Surgery, known as cholecystectomy, is performed to remove the gallbladder. You can live normally without a gallbladder because it is not an essential organ. Two types of cholecystectomy are listed below:
Laparoscopic cholecystectomy: It is a minimally invasive surgery to remove the gallbladder. You will be able to leave the hospital in a day and go back to your normal routine within a week.[7,10,11]
Open cholecystectomy: This procedure is performed when your gallbladder is severely infected, inflamed or scarred from another operation. You might need to stay at the hospital for about a week and will be able to return to normal routine activities after around a month.[11,12]
Lifestyle Management
Some food habits that can help you manage gallstones: [2,13]
You can eat more foods that are high in fibre such as:
whole grains, brown rice, oats, and whole wheat bread
vegetables and fruits
You should eat less sugar and limited refined carbohydrates
You need to avoid unhealthy fats such as those found in desserts and fried foods.
You can eat healthy fats, such as olive oil or fish oil, to help your gallbladder contract and regularly empty it.
Prognosis & Complications
Prognosis
Data report that 50% of patients with gallstones develop symptoms. The mortality rate is <1% for elective laparoscopic cholecystectomy but emergency cholecystectomy is known to have high mortality rates. The chances of complication after gallstone surgery is low. Although there can be stones in the bile duct after surgery, incisional hernia and injury to the bile duct, most people who have their gallbladder removed do not have a relapse in symptoms.[4,14]
Complications
People with gallstones may develop serious complications if not treated:[4,14,15]
Acute cholecystitis
Jaundice
Acute cholangitis
Pancreatitis
Cancer of the gallbladder
Gallstone ileus
Alternative Treatment
Some alternative treatments are listed below:
Elimination of foods that cause an allergy: The foods most frequently found to provoke gallbladder symptoms were eggs, milk, onion, coffee, wheat, corn, beans, nuts, tomatoes, and pork.[16,17]
Herbal medicines:
Turmeric root (Curcuma longa): It is used as a digestive aid and choleretic in Asian, Ayurvedic and Western herbal medicines. It is antioxidant and anti-inflammatory.[16,17]
Milk thistle (Silybum marianum): It helps in liver and gallbladder detoxification.[16]
Green tea (camelia Sinensis): It is used for its antioxidant effects. It can be prepared as tea from the leaf of this herb.[16]
Globe artichoke (Cynara scolymus): It is used to support gallbladder and liver function.[16]
Acupuncture: It may be helpful for restoring the normal liver and gallbladder function, easing bile flow, the expulsion of gallstones, decreasing spasms, and pain relief.[16,17]
References.
Overview Gallstones. NHS. Available at: https://www.nhs.uk/conditions/gallstones/ (https://www.nhs.uk/conditions/gallstones/)
Gallstones. Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/diseases/7313-gallstones (https://my.clevelandclinic.org/health/diseases/7313-gallstones)
Definition & Facts for Gallstones. NIH. Available at: https://www.niddk.nih.gov/health-
Gallstones. MedlinePlus. Available at: https://medlineplus.gov/ency/article/000273.htm (https://medlineplus.gov/ency/article/000273.htm)
A gallbladder attack usually happens after having large meals, most likely in the evening. It is a medical emergency that requires immediate care. Watch out for the warning signs.
Coffee is associated with a reduced risk of various diseases. But excessive consumption of coffee can also lead to an increased risk of a few health complications.
Get yourself checked for digestive problems and get treatment or medical counselling for this at the earliest before it progresses into something more serious.
Almost everything that changes or affects the natural food habits, physical routine, physical exercise, and surrounding environment leads to digestive diseases.
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