A gallstone is a solid structure in the gallbladder or the ducts of the biliary system. Gallstones usually arise in the gallbladder and are a common problem. Gall (bile) is a fairly thick, yellow-green fluid, that sometimes remains in the gallbladder for long periods and may concentrate. When this fluid concentrates too much, a gallstone is formed.
Cause
Little is known about the cause of the development of gallstones. The composition of the bile and the operation of the gallbladder itself may play a role. Gallstones can arise, for example, when the gallbladder squeezes out insufficiently during the meal. Then, the remaining bile can concentrate. Overweight and rapidly losing weight increase the risk of gallstones. Apart from this, hereditary factors may also play a role.
There are two types of gallstones: cholesterol gallstones and bilirubin pigment stones. Cholesterol gallstones can arise when the bile contains too much cholesterol. Female hormones may play a role here. Bilirubin pigment stones are made up for the most part of bilirubin salts. Gallstones also arise more frequently during pregnancy.
Symptoms
Gallstones come in different sizes, from one millimeter up to more than two centimeters. It’s possible that multiple stones occur simultaneously.
The vast majority of people with gallstones have no trouble. Gallstones located in the gallbladder cause little to no symptoms. Symptoms arise only when a gallstone gets stuck in the bile ducts. This obstructs the flow of bile. The gallbladder will try to remove the barrier and let the gallstone flow through. To do this, the gallbladder contracts violently. This violent contraction of the gallbladder can cause severe pain in the right upper abdomen (biliary colics). This pain can last from one to four hours. The pain often radiates to the back or the right shoulder. The pain is usually triggered or worsened by a (fatty) meal, because bile plays a role in the digestion of fat. Additional symptoms may include nausea, vomiting and jaundice.
A discolored stool may indicate gallstones. Bile will partially end up in the stool and ensures the normal brown color of stool. If the flow of bile is insufficiently, the stool may be decolorized.
Diagnosis
The general practitioner can usually diagnose gallstone on the basis of the symptoms. However, further examination is needed to make the diagnosis with certainty. In most cases, ultrasound may be used for this purpose. With an MRI scan, the doctor can detect gallstones in the gallbladder and especially in the bile ducts. Sometimes, the doctor can't find the gallstones with the examinations above, but can still make the diagnosis based on the determination of dilated bile ducts. Gallstones are often found by chance during an ultrasound or CT scan of the abdomen.
Treatment
Gallstones which cause no symptoms don’t require treatment. For gallstones which do cause problems, the following treatments are available:
- The most effective treatment is surgical removal of the gallbladder (gallbladder resection or cholecystectomy). The gallbladder can be removed in two ways: by regular abdominal surgery or by keyhole surgery. The gallbladder’s function is (temporary) storage of bile. People can live well without a gallbladder.
- In some cases, surgery is not possible or not desirable. Gallstones which are located in the bile ducts, can sometimes be removed by means of an Endoscopic Retrograde Cholangiopancreatography (ERCP). This is an exploratory operation, in which the doctor can reach the bile ducts with a flexible tube (endoscope) through the mouth, esophagus, stomach and duodenum. However, gallstones located in the gallbladder cannot be removed this way. In many cases, surgery is therefore still needed after an ERCP.
- In rare cases, the doctor prescribes medicines. These medicines can dissolve small gallstones. However, the medicines don’t work for all people. New gallstones can emerge after this treatment. Thus, this treatment is less effective than an operation.
- In the past, gallstones were sometimes crushed, as is done with kidney stones. This treatment is no longer performed, because crushing is less effective than the above mentioned treatments. Moreover, a large gallstone may fall apart into small stones and grit due to crushing. These may get stuck in narrow passages, such as the major duodenal papilla. The major duodenal papilla is the place where the duct of the pancreas opens onto the bile ducts and the duodenum.
Prognosis
The risk of complications of gallstones is low. In almost all patients who have had gallbladder surgery for gallstones, the condition is remedied. Possible complications are inflammation of the biliary tract, inflammation of the gallbladder or acute pancreatitis. Acute pancreatitis is a serious complication, which can occur when a gallstone gets stuck in the major duodenal papilla.
Considerations
- People can reduce the risk of gallstones by preventing overweight.
- It is important to eat healthy and varied.
- After the operation, in which the gallbladder is removed, the patient may have diarrhea or loose stools. This is because the body has to get used to the new situation. The symptoms usually diminish and disappear naturally. In case of diarrhea, it’s important that the patient eats lots of fibers and drinks sufficiently. Fibers provide a more solid stool.
