>Cholelithiasis/ Gallstone

Gallstones

Gallstones form in the gallbladder, a small organ located under the liver. The gallbladder aids in the digestive process by storing bile and secreting it into the small intestine when food enters. Bile is a fluid produced by the liver and is made up of several substances, including cholesterol, bilirubin, and bile salts.

What Are Gallstones?

Gallstones are pieces of solid material that form in the gallbladder. These stones develop because cholesterol and pigments in bile sometimes form hard particles.

The two main types of gallstones are:

• Cholesterol stones (approximately 80% of gallstone cases): These are usually yellow-green in color.
• Pigment stones: These stones are smaller and darker and are made up of bilirubin.

What Causes Gallstones?

Several factors may come together to create gallstones, including:

• genetics (others in your family have had gallstones)
• body weight
• decreased motility (movement) of the gallbladder
• diet

Gallstones can form when there is an imbalance in the substances that make up bile. For instance, cholesterol stones may develop as a result of too much cholesterol in the bile. Another cause may be the inability of the gallbladder to empty properly.

Pigment stones are more common in people with certain medical conditions, such as cirrhosis (a liver disease in which scar tissue replaces healthy liver tissue) or blood diseases such as sickle cell anemia.

What Are the Risk Factors for Gallstones?

Risk factors for getting gallstones include:

• Obesity. This is one of the biggest risk factors. Obesity can cause a rise in cholesterol, and can also keep the gallbladder from emptying completely.
• Estrogen. Women who are pregnant or who take birth control pills or hormone replacement therapy have higher levels of estrogen. This can cause a rise in cholesterol, as well as a reduction in gallbladder motility.
• Ethnic background. Certain ethnic groups, including Native Americans and Mexican-Americans, are more likely to develop gallstones.
• Gender and age. Gallstones are more common among women and among older people.
• Cholesterol drugs. Some cholesterol-lowering drugs increase the amount of cholesterol in bile, which may increase the chances of developing cholesterol stones.
• Diabetes. People with diabetes tend to have higher levels of triglycerides (a type of blood fat), which is a risk factor for gallstones.
• Rapid weight loss. If a person loses weight too quickly, his or her liver secretes extra cholesterol, which may lead to gallstones. Also, fasting may cause the gallbladder to contract less.

What Are the Symptoms of Gallstones?

Gallstones often don't cause symptoms. Those that don't are called "silent stones." A person usually learns he or she has gallstones while being examined for another illness.

When symptoms do appear, they include the following:

• Pain in the upper abdomen and upper back. The pain may last a long time (several hours).
• Nausea
• Vomiting
• Other gastrointestinal problems, including bloating, indigestion, and gas

How Are Gallstones Diagnosed?

If your doctor suspects you have gallstones, he or she will do a physical examination and may perform various other tests, including the following:

• Blood tests to check for signs of infection or obstruction and/or to rule out other conditions.
• Ultrasound: This procedure transmits high frequency sound waves through the body. The echoes are recorded and transformed into images of various parts of the body. An ultrasound can be used to identify gallstones.
• CAT scan: This test uses specialized x-rays to create cross-section images of organs and body tissues.
• Cholescintigraphy (HIDA scan): This test can determine whether the gallbladder is contracting correctly. A radioactive material is injected into the patient and makes its way to the gallbladder. The technician can then observe the movement of the gallbladder.
• Endoscopic ultrasound: This test combines ultrasound and endoscopy to look for gallstones.
• Endoscopic retrograde cholangiopancreatography: The doctor inserts an endoscope through the patient's mouth down to the small intestine and injects a dye to allow the bile ducts to be seen. The doctor can then remove gallstones that have moved into the ducts.

How Are Gallstones Treated?

Gallstones are usually treated with surgery to take out the gallbladder. The traditional operation is called an open cholecystectomy. A more recently developed procedure, called laparoscopic cholecystectomy, is less invasive, has fewer complications, and is used in most cases.

• Laparscopic cholecystectomy. During this procedure, instruments and a light and a camera are passed through several small incisions in the abdomen. The surgeon views the inside of the body by looking at a video monitor. This procedure is used in approximately 80% of gallbladder removals. After the surgery, the patient spends the night in the hospital.
• Open cholecystectomy. This is a more invasive procedure in which the surgeon makes incisions in the abdomen to remove the gallbladder. The patient stays in the hospital for a few days after the surgery.

If gallstones are in the bile ducts, endoscopic retrograde cholangiopancreatography (ERCP) may be used to find and remove them before or during gallbladder surgery.

Are There Any Nonsurgical Treatments for Gallstones?

If you have a medical condition and your doctor feels you shouldn't have gallstone surgery, he or she may prescribe the medications ursodiol (Actigall) or chenodiol (Chenix). These drugs work by dissolving cholesterol stones. Mild diarrhea is a side effect of both medications.

The downside of using either medication is that you may have to take it for years to completely dissolve the stones. In addition, the stones may come back after you stop taking the drug.