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The liver produces a green-yellowish digestive fluid called bile and stores it in the gallbladder - which then releases this bile to the intestine through biliary ducts. However, sometimes bile forms hard deposits inside the gallbladder or in biliary ducts. This condition is called gallstone formation or cholelithiasis.
Gallstones that don’t block the biliary duct are often asymptomatic and not a major health risk.
Statistics show that only10% of people experience symptoms of gallstones. The primary symptoms of gallstone include pain in the upper right portion of your belly, nausea, fever, and upset stomach.
Generally, gallstones that don’t cause discomfort or block bile passage don’t need treatment. Small gallstones can break and pass out through stool by itself.However, gallbladder removal remains the primary option if gallstones are big enough or in the right anatomic location to block the bile flow.
Gallstones affect about10-15% of the US population (~20 million people) at some stage of their life. The ratio istwo to three times higher in women than men, as pregnancy is a significant risk factor in causing gallstone formation.
Gallstones vary in size, from a grain of sand to an oversized pebble. Small gallstones that don’t disrupt bile flow into the intestine are usually asymptomatic. When a stone is large enough to block the bile flow, it can result in pain and discomfort.
The pain from gallstones becomes sharp soon after a high-fat meal, especially when you consume a meal high in fats. The fat content in the intestine causes it to signal the gallbladder to release bile, as thebile helps in fat digestion.
The gallbladder contracts in response and increases the pressure on the blocked gallbladder. This results in sharp pain in the upper right section of your abdomen. This sudden onset of intense pain is called a gallbladder attack orbiliary colic.
The pain intensity reduces with time, lasting from several minutes to a few hours. The pain can also radiate to the upper arms and between your shoulder blades.
Followed by pain, some other symptoms of gallstones are:
Bile combines different ingredients, including bile acids, cholesterol, and bilirubin. In normal functioning bile, an appropriate quantity of each ingredient is present. When the balance of these chemical ingredients in the bile gets messed up, it can lead to the formation of stones.
This usually happens because one ingredient is present in more than its required amount.
The ingredient accumulates and gradually solidifies as hard deposits in the gallbladder. With time, the deposit grows in size and forms stones of variable sizes.
Some of the key changes in the bile that can lead to stone formation include:
The proportion of cholesterol in the bile correlates to cholesterol in the blood. The liver takes the excess cholesterol from the blood and adds it to the bile.
As bile requires a balanced proportion of each ingredient to function optimally, adding an excess of cholesterol disturbs thechemical makeup of bile. The extra cholesterol starts settling down as crystals, eventually forming stones.
Cholesterol gallstones are the most common and are estimated to account for75 to 80% of gallstone cases across several countries. Oral contraceptives, pregnancy, anti-cholesterol medicines, and obesity are someleading factors causing cholesterol gallstones.
Bilirubin is a by-product of destroyed old red blood cells. The liver is responsible for the excretion of bilirubin from the body.
However, in case of blood disorders or abnormal functioning liver, the levels of bilirubin can elevate in the bile. The excess bilirubin starts forming hard deposits inside the bladder. Gallstones from bilirubin deposits are pigmented stones, ranging from dark brown to black.
Pigmented stones account for20 to 25% of total gallstone incidences.
Therole of bile acids is to absorb and balance the cholesterol levels in the chemical makeup of bile. It prevents the crystalline cholesterol deposits and keeps the bile in liquid form.
Two main reasons for decreased bile acids in the body are that the liver might not make enough bile acids or the body might not absorb them properly from the small intestine, leading to more bile acids loss in feces.
Low bile acid levels fail to dissolve cholesterol efficiently and promote cholesterol stone formation.
The gallbladder stores bile for short periods and releases it as needed. Bile can stay longer and form hard deposits if the gallbladder doesn't empty regularly.
If you are experiencing the symptoms of gallstones, there are several ways to diagnose it. Here are a few common practices that your doctor may proceed with to diagnose gallstones:
Your physician will start by asking questions about your symptoms and if you have any family history of gallstones. The questions can include your medical history, dietary habits if you’ve recently eaten food, and lifestyle.
Next, your doctor will conduct a physical exam by pressing firmly on your right upper abdomen to elicit pain caused by an inflamed gallbladder. They will also examine your skin and eyes for any yellow coloration. A yellowish tint on the skin or eyes could suggest elevated bilirubin levels and the potential for a severe bile blockage.
Blood tests help diagnose gallstones as they tell about the infection in the body. They also indicate the levels of bilirubin in the blood, and elevated bilirubin levels hint at bilirubin gallstones.
Blood tests can also assess liver function by comparing levels of specific proteins and enzymes in the blood sample with average values. This comparison helps determine if the liver is functioning properly. Accessing the liver to diagnose gallstones is important, as liver function directly correlates to normal bile production. If you have an elevated white blood cell count in your blood, it may be evidence of a gallbladder infection.
Imaging tests are the most common and accurate way of diagnosing gallstones. Some standard imaging tests that are available in hospital setups include:
Endoscopic ultrasound can detect those minute and hard-to-access stones. This involves the insertion of a tube in your digestive tract through your mouth. The end of the tube contains a small ultrasound device that creates images and sends them to the computer.
The liver picks this radioactive material from the bloodstream and adds it to the bile. The doctor records the flow of this chemical to the liver, gallbladder, and bile ducts using a specialized camera that detects radiations.
The results obtained help to analyze the activity of the liver and gallbladder. Any blockage in the flow of radioactive chemicals hints at gallstones.
After finding the ducts, the operator injects a dye into them. X-ray is used to picture the location and concentration of dye inside the bile and pancreatic ducts.
This test helps detect any blockage or sedimentation occurring in the bile duct and the endoscopist can clear the blockage as well.
Not all gallstones require medical management, as they mostly don’t cause discomfort or other complications. However, if you start to feel pain due to gallstones, it is most likely that the stone is big enough to block the bile flow.
In this case, you require proper treatment for the removal of gallstones. After removing the gallbladder, the bile flows directly from the liver to the intestine.
The most common treatment for gallstones is gallbladder removal, also calledcholecystectomy. According to the statistics, about300,000 cholecystectomies are performed annually in America.
Depending on your conditions, choice, and availability of equipment, your surgeon can perform cholecystectomy by one of these two procedures:
Laparoscopic cholecystectomy is an easy and widely practiced procedure for the removal of the gallbladder. Almost all surgeons prefer this method unless there are any risks associated.
The surgeon will start with general anesthesia. He will proceed further by making three to four incisions in the abdominal area. One of the incisions is for camera and light, while others act as a passage for the apparatus used in cutting and removing the gallbladder.
Laparoscopic cholecystectomy accounts for around92% of all cholecystectomy procedures.
Thecomplications with laparoscopic cholecystectomy include injuries of the common bile duct and hepatic duct. In some cases, there’s damage to the intestine and diaphragm.
Open cholecystectomy was the standard procedure for the removal of the gallbladder before the technological advancements. It is still thepreferred treatment option when there is very severe inflammation in the gallbladder or gallbladder cancer.
The patient is under general anesthesia in open cholecystectomy. The surgeon makes one large cut in the abdominal area and exposes the bladder and bile ducts. The next step is to carefully cut the gallbladder from its origin while avoiding damage to surrounding tissues.
Some commoncomplications associated with open cholecystectomy are significant pain, hernia formation, wound infection, and hematoma.
The most effective and permanent treatment for gallstones is gallbladder removal. However, doctors can utilize non-surgical procedures when surgery is not possible or there is a high risk of complications from surgery. Unfortunately, these therapies are not often successful in eliminating gallstones.
Two of the common options for the removal of gallstones without surgery are:
Ursodiol and chenodiol are the two widely usedgallstone dissolution agents for treating gallstones. These medicines contain bile salts that are effective in treating small cholesterol stones. Bile salts dissolve the hard cholesterol deposits into liquid form and resume the normal bile flow.
The medication is ineffective for larger stones and may take months or years to show results.
Lithotripsy or extracorporeal shock wave lithotripsy uses high-energy sound waves targeted at gallstones and is not very popular in the U.S. The sound waves are strong enough to break the stone into smaller pieces.
The doctors usually prescribe bile salt medications such as ursodiol after lithotripsy. It is to dissolve small stone fragments and pass them to the intestine with bile release.
Statistics show that lithotripsy is only suitable for28%of people with gallstones. The stones must be less than three in number and smaller than 3cm in diameter to qualify for lithotripsy treatment.
The incidence of gallstones is somewhat dependent on your lifestyle and diet. Some lifestyle and diet changes can help reduce gallstone risk factors.
Cholesterol is one of the major causes of gallstones. Nearly75% of gallstones are hard deposits of cholesterol. You must avoid eating a diet high in saturated fats to prevent gallstones from cholesterol.
Obesity is asignificant contributing factor to gallstone disease. Being overweight increases cholesterol levels in the bile and can result in stone formation. You must replace a diet high in saturated fats with a healthy plant-based food to reduce your calorie consumption.
Exercise also helps prevent gallstones as it improves digestion and helps maintain a healthy weight. TheAmerican Heart Association (AHA) states that 150 minutes of moderate aerobic exercise helps lower cholesterol levels.
Appropriate food choices improve your overall health and are also effective in preventing gallstones. Here are some food options helpful in preventing gallstones:
A fiber diet is low in calories and is beneficial for gut health and reducing weight, which may translate into a low risk for gallstones.
Another role of fiber in preventing gallstones is that itslows digestion. Food stays in your stomach longer, giving your body time to release bile and other digestive juices properly.
The most common sources of fiber are whole fruits and vegetables, whole grains, seeds, and nuts. You can also buypowdered fiber from trusted vendors to meet your daily fiber requirements.
See also:21 Easy Ways to Get More Fiber to Your Diet
AMendelian Randomization Study shows that people who consume more than six cups of coffee daily have a 23% lower risk of gallstone disease. The same study explains that caffeine is excreted via bile and so, it lowers the cholesterol saturation in the bile. This in turn prevents the formation of hard cholesterol deposits.
Other mechanisms include the role of cafestol, an ingredient of coffee, in facilitating the synthesis of bile acids. Bile acids dissolve cholesterol and maintain normal cholesterol levels in the bile.
However, one should be aware of the health impacts high doses of caffeine can have as well.
Unsaturated fats obtained from seeds, nuts, and fish promote digestive health. They stimulate the small intestine to promote gallbladder functioning byimproving the contraction of the gallbladder. It makes it easy for the gallbladder to empty regularly and lowers the risk of crystalline deposit formation.
Aprospective study on the influence of a plant-based diet on gallstone disease shows that plant-based proteins have a positive role in preventing gallstones. The study indicates that plant-based proteins lower the risk of gallstones by lowering cholesterol levels.
Gallstones are hard crystalline deposits inside the gallbladder. The causes of gallstones include elevated levels of cholesterol and bilirubin as well as reduced bile acid production and inactivity of the gallbladder.
The most common and effective treatment option is the removal of the gallbladder. However, if the surgical procedure is not possible, less effective treatment options may involve gallstone dissolution medications and lithotripsy.
You can prevent gallstones by modifying your lifestyle and diet. Plant-based foods, especially those high in fiber, are extremely helpful in preventing gallstones. Consuming healthy fats and regular exercise significantly prevent digestive problems, including gallstones.