Gallstones – Causes, Symptoms, Treatment, Removal, Prevention

Gallstones are small solid particles that are either found within the gallbladder or the bile ducts which drain bile out of the liver and gallbladder. Most gallstones are cholesterol stones and either dissolve in the bladder or pass out with no symptoms. However, if the stone lodges in the duct, it can cause severe pain and lead to a number of conditions like jaundice.

Causes of Gallstones

Cholesterol is passed out of the liver in the bile. If the concentration of cholesterol is too high, it cannot remain soluble in combination with bile salts within the bile and sediments begin to form. The sediment eventually meshes together to form a small stone. This then dissolves within the gallbladder or passes out into the small intestine. Sometimes a stone is too large to pass out of the gallbladder or through the bile ducts. These stones may cause a blockage of the ducts. Most stones do not occur in isolation and it is not uncommon to find several small stones within the gallbladder.

While cholesterol stones are the most common type of gallstone, it is not entirely due to a diet high in cholesterol. The liver produces most of the cholesterol in the body and the process has more to do with the ability of the bile salts to hold the cholesterol in suspension. However, a diet that is high in fats and sugar may predispose a person to the development of gallstones because it causes an elevation in the triglyceride levels in the body and lowers HDL cholesterol levels. Triglycerides are a major source of compounds for the production of cholesterol in the body.

Another type of gallstone that occurs less frequently is a pigment stone. These types of stones mainly occur as a result of the impairment of bile flow (cholestasis) or infections. Cholestasis usually results in black pigment stones while brown pigment stones tends to arise from infections.

Most gallstones are actually mixed stones – these are cholesterol stones that undergo changes in which it takes on the characteristics of pigment stones. There are many risk factors for the development of gallstones but these are not clear causes. Many people with the same risk factors will not develop gallstones.

Some of the risk factors include :

• Weight – being overweight or obese. Rapid weight loss can also increase the risk of developing gallstones.
• Gender – women are more likely to develop gallstones. This led to the medical acronym for the typical clinical presentation of gallstones known as the four F’s – Fat, Female, Fertile and Forty.
• Family history of gallstones increases your risk.
• Diet that is high in fats and low in fibre.
• Diabetes.
• Drugs like cholesterol-lowering drugs.
• Age and ethnicity are also risk factors as gallstones tend to occur in older groups and particularly in Caucasians of northern European descent. However, today gallstones is seen in younger people of varying ethnic groups.
• Pregnancy.

Gallbladder sludge, or biliary sludge, is a mucus like mixture containing small sediments of stones that may be seen in the gallbladder upon conducting an ultrasound. This sludge is usually not a problem but may indicate that the risk factors for gallstone development is present.

Signs and Symptoms of Gallstones

Most gallstones are ‘silent’ meaning that it does not cause any signs and symptoms. However, a gallstone can be very painful and cause attacks of gallstone pain that can be severe and debilitating.

Nausea and vomiting are also common symptoms along with pale stools and dark urine. A fever may also be present. If left untreated, it can result in serious liver disturbances that may initially present with jaundice and then complicate further to damage the liver or even cause pancreatitis. In rare cases, a large gallstone can cause an intestinal obstruction known as a gallstone ileus resulting in constipation, severe pain and swelling of the abdomen.

Treatment of Gallstones

No treatment is necessary if the gallstones that are not causing any pain or other symptoms associated with stones. If gallstones do result in symptoms, either uncomplicated or complicated gallstone disease, immediate treatment is required. The gallstones needs to be surgically removed and often the gallbladder is removed as well to prevent a recurrence of gallstones. There are different procedures to remove gallstones and includes :

• Gallbladder removal for gallbladder stones (cholelithiasis). This is known as a cholecystectomy and these days it is performed by laparoscopic surgery for quicker recovery time and minimal complications.

• Bile duct stones (choledocholithiasis) may be removed a procedure known as ERCP (endoscopic retrograde cholangiopancreatography) with sphincterorotomy.

• Open surgery is rarely conducted these days but may be necessary if laparoscopic procedures are not an option or if the stone is too large.

“Blasting” the stones as is the case with kidney stones is not extremely effective for gallstones although this procedure known as a lithotripsy (either endoscopic or extracorporeal shock wave lithotripsy, ESWL) is available in some facilities.

Drugs for treating gallstones, ursodiol and chenodiol, may help with dissolving gallstones, particularly cholesterol stones. These drugs take a long time to work and surgical removal of gallstones is still the most effective means of dealing with gallstone disease.

Prevention of Gallstones

Preventing gallstones should focus on reducing the risks associated with gallstones. Losing weight involves both dietary changes and exercise and the proper management of diabetes is also important. A low fat diet aimed at lowering cholesterol may also be helpful. Frequent scans will allow your doctor to identify the presence of any stones and advise you on measures to prevent any complications that may result from an impacted stone.