Gallstones

What are Gallstones?

Gallstones are solid particles that form from bile cholesterol and bilirubin in the gallbladder.

Types of gallstones:
 Cholesterol stones: Patients with cholesterol stones are more common in the United
States; cholesterol stones make up a majority of all gallstones. They form when there
is too much cholesterol in the bile.
 Pigment stones: form when there is excess bilirubin in the bile.

Gallstones Causes:

Gallstones occur when bile forms solid particles (stones) in the gallbladder.

 The stones form when the amount of cholesterol or bilirubin in the bile is high.
 Other substances in the bile may promote the formation of stones.
 Pigment stones form most often in people with liver disease or blood disease, who
have high levels of bilirubin.
 Poor muscle tone may keep the gallbladder from emptying completely.
 The presence of residual bile may promote the formation of gallstones.

Symptoms of Gallstones:

 May be silent.
 May be severe and sudden pain in the upper right abdomen and possibly extending to
the upper back.
 Tachycardia.
 Diaphoresis.
 Occurs usually 3-6 hours post meals.
 Obstructive Jaundice (yellowing of the skin or eyes)
 Pruritus.
 Clay colored stools or dark urine.
 Intolerance to fatty food.
 Fever and shivering.
 Severe nausea and vomiting.

Risk factors for the formation of cholesterol gallstones:

 Taking certain medications such as birth control pills or cholesterol lowering drugs.
 Female gender.
 Being overweight.
 Losing a lot of weight quickly on a "crash" or starvation diet.

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Complications:
 inflammation of the gallbladder (cholecystitis);
 inflammation of the bile duct (cholangitis);
  inflammation of the pancreas (biliary pancreatitis);
 obstruction of the intestine (gallstone ileus) ;
 Biliary cirrhosis ;
 Carcinoma ;
 Peritonitis.

Diagnosis:
Tests and procedures used to diagnose gallstones include:
 Tests to create pictures of your gallbladder.
Your doctor may recommend an abdominal ultrasound and a computerized
tomography (CT) scan to create pictures of your gallbladder. These images can be
analyzed to look for signs of gallstones.

 Tests to check your bile ducts for gallstones.

A test that uses a special dye to highlight your bile ducts on images may help your
doctor determine whether a gallstone is causing a blockage.
Tests may include a hepatobiliary iminodiacetic acid (HIDA) scan, magnetic
resonance imaging (MRI) or endoscopic retrograde cholangiopancreatography
(ERCP).

 Blood tests to look for complications.

Blood tests may reveal an infection, jaundice, pancreatitis or other complications
caused by gallstones.

Treatment:

 Surgery to remove the gallbladder (cholecystectomy).

Your doctor may recommend surgery to remove your gallbladder, since gallstones
frequently recur. Once your gallbladder is removed, bile flows directly from your
liver into your small intestine, rather than being stored in your gallbladder.
Gallbladder removal doesn't affect your ability to digest food, but it can cause
diarrhea.

 Medications to dissolve gallstones.

Medications you take by mouth may help dissolve gallstones. But it may take months
or years of treatment to dissolve your gallstones in this way and gallstones will likely
form again if treatment is stopped.

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