Gallstones (Stones in the Gallbladder)

Definition

Gallstones are crystal-like masses formed in the gallbladder. These stones are formed by the accumulation and aggregation of bile constituents. The medical condition involving the presence of one or more gallstones is referred to as cholelithiasis. Often there is no symptoms of gallstones as most stones are smaller and pass out into the bowel.

The gallstones formed in the gallbladder may pass into pancreatic duct, common bile duct, or into the duct joining gallbladder to bile duct (cystic duct), causing their obstructions. Presence of gallstones in the gallbladder may lead to inflammation of gallbladder. This may result into bile retention in the gallbladder. This also increases the risks of infections.

Symptoms

Gallstones grow very slowly and can be asymptomatic in the majority of patients. In some individuals, they may cause biliary colic in the upper part of the abdomen, inflammation of gallbladder (cholecystitis), and infection of bile duct (cholangitis).

Biliary colic begins suddenly and is severe in intensity. Nausea and vomiting are also present during the episodes of biliary colic. Non-specific gastrointestinal symptoms like gas and bloating may also be present but can be due to other conditions.

Causes

Biliary sludge is a mixture of mucus, cholesterol crystals, and other particulate matters of bile. Gallstones are formed due to the transformation of biliary sludge into stones. The known risk factors for gallstones are female sex, increasing age, obesity, fast-food diet, and a family history.

Types

The are different types of gallstones :

  1. cholesterol gallstones
  2. black pigment stones
  3. brown pigment stones
  • Cholesterol gallstones are most common types of gallstones. They are made up of cholesterol. Medical conditions like obesity, diabetes, and cystic fibrosis promote the formation of cholesterol gallstones.
  • Black pigment stones are small and hard gallstones. They are composed of a bile component called bilirubinate and inorganic calcium salts. Abnormal breakdown of red blood cells (RBCs), prolonged alcoholism, and older age promote the formation of black pigment stones.
  • Brown pigment stones are soft and greasy. They are composed of bilirubinate and fatty acids. Parasitic or bacterial infections and inflammation leads to the development of brown pigment stones.

Unlike cholesterol gallstones and black pigment stones that are formed in the gallbladder, brown pigment stones are formed in the ducts.

Treatment

Ultrasonography of the abdomen, CT scan, and MRI scan can detect gallbladder stones. The calcified gallstones are also visible on plain x-rays.

Surgery

Surgical resection of gallbladder (cholecystectomy) is performed frequently. The removal of gall bladder is usually well-tolerated. Minimally invasive or laparoscopic technique is usually used in the surgery. Cholecystectomy provides relief from biliary colic but is ineffective for atypical symptoms like stomach indigestion (dyspepsia). Diarrhea is reported in some patients after surgery.

Medication

Oral ingestion of bile acids over a long time helps in dissolving the gallbladder stones in many patients. The approach is recommended to patients with small cholesterol gallstones without gallbladder obstructions.

Ursodeoxycholic acid dissolves most of the tiny stones within few months. Stones recur in many patients in about 5 years and the process needs to be repeated. Ursodeoxycholic acid therapy is recommended to patients on a very low calorie diet.

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