Gallstones
What are Gallstones?
Gallstones refer to the crystalline bodies of calcium or cholesterol formed in any part of the biliary tree, especially in the gallbladder or nearby bile ducts. Gallstones, alone, show no symptoms and require no treatment. But if a gallbladder attack occurs, nausea and an ache in the abdomen may result. Women, older and overweight people are at more risk of developing gallstones than normal individuals.
If untreated, gallstones could be destructive and in some cases even fatal. The sizes of gallstones may vary from a grain of sand to a golf ball. The stones are made of components of the bile, a juice secreted by bile duct to digest fat.
Symptoms of Gallstones
Usually, minor gallstones do not show any symptom of their own. However, in severe cases some symptoms may occur. One of the most common symptoms of gallstones is chronic indigestion, which may show symptoms like nausea, gas, bloating and abdominal pain. However, many other diseases including gastroesophageal reflux disease (GERD) and peptic ulcers may show similar symptoms. Thus, it is advisable to follow up with a doctor in case of such symptoms.
Gallstones may also lead to upper abdominal pain. The pain may start one to two hours after eating, however, in some cases, it may start any time, including nights. Usually the pain lasts for half an hour. Nausea and vomiting may also be symptoms of gallbladder stones. If gallstones get trapped in the duct, chills and fever may also occur.
The symptoms of bile duct obstruction due to gallstones may include yellowing of your skin and the whites of your eyes (jaundice), Fever and clay-colored stools.
Diagnosis of Gallstones
Diagnosis becomes important in case of gallstones as they primarily don’t show any symptoms. The diagnosis process may start with a physical exam, in which inspection of the medical history and physical symptoms are tested. The major physical symptoms which are checked include tests for jaundice and the checks of the abdomen if it’s tender.
The doctor may also go for a blood test to check abnormal levels of bilirubin or pancreatic enzymes and signs of infection.
Apart from physical examination, there are various tests to diagnose gallstones. The most common tests include ultrasound images of the abdomen and nearby parts or an endoscopy to judge the openings of pancreatic and bile ducts. In many hospitals magnetic resonance cholangiopancreatography is also performed to test duct obstructions. A computerized tomography (CT) scan may also be performed to check any abnormality of the internal organs. Apart from these common tests, checking the internal organs by radioactive tracing may also be performed. Another process known as endoscopic ultrasound may also be used to detect the presence of gallstones.
Causes of Gallstones
The causes of gallstones may be a combination of hosts of factors, including inherited body chemistry, body weight, diet and gallbladder motility (movement). It has also been found that people suffering from erythropoietic protoporphyria (EPP) are more vulnerable to gallstones.
Lack of bile salts and an increased level of cholesterol in the bile juice may also be the reason behind gallstones. The two factors associated with gallstones include the frequency of gallbladder contraction and presence of proteins that promote or inhibit crystallization of bile components.
It is also proved that increased levels of estrogen sue to pregnancy, use of hormonal contraceptives and hormonal therapies may decreases the movements of the gall bladder and also increases the levels of cholesterol resulting in gallstones.
Although there is no proof of dietary habits contributing to gallstones, it is suggested that low-fibre, high-cholesterol diets, and diets high in starch may result in the formation of gallstones.
Additionally, lack of melatonin is also found to contribute to gallstones. Melatonin is found to inhibit cholesterol secretion and help in converting the cholesterol to bile and reduce oxidative stress to gall bladder.
Types of Gallstones
Gallstones are usually divided into two categories depending upon the contents of the stones. Usually, size, position and occurrence of the gallstones are not taken into consideration while dividing the gallstones into two categories.
Pigment Gallstones: These gallstones form due to too much bilirubin in the bile. The color of pigment gallstones vary from dark brown to black. These stones are predominantly found in people suffering from cirrhosis, biliary tract infection and sickle cell anemia. Interestingly, these disorders are also responsible for excess bilirubin production. However, the exact reasons of the formation of pigment gallstones are not clear yet.
Cholesterol Gallstones: These gallstones are predominantly formed of undissolved, excess amount of cholesterol present in the bile juice. However, the stones can be formed of other components, such as calcium and bilirubin too. The colors of these gallstones are usually yellow.
Treatment of Gallstones
Majority of gallstones usually require no treatment and the doctors advise silent monitoring for them. However, in case symptoms appear and are severe, there are various possible treatments available.
A majority of gallstones cases require surgery for the removal of the stones. Usually, two types of surgery are undertaken for this. The laparoscopic surgery is undertaken with the help of a laparoscope, a thin tube with its own lighting and a tiny video camera. This camera provides images of the abdomen and the surgeon knows how to use the instruments to cause minimum incisions to remove the stones. The open surgery makes a large incision of the abdominal region and the gallstones are removed manually. The open surgery is usually performed in severe cases of gallstones.
Apart from surgeries, there are a host of nonsurgical options to treat gallstones. Percutaneous electrohydraulic lithotripsy is performed for individuals who are at high risk of surgeries. A catheter is inserted into the gallbladder several weeks earlier in this process. This catheter is made capable to offer bursts of energy to break up the stones.
Another nonsurgical process, the sound wave therapy uses high frequency sound waves to break up the stones. The fragments are dissolved by taking ursodiol tablets after the break downs.
In some cases, ursodiol tablets are also taken alone to dissolve the gallstones.
Another process, the topical gallstone dissolution uses a catheter inserted into the gall bladder to deliver a solution that dissolves the gallstones. Although quite successful, this method is still in experimental mode.
Living with Gallstones
Living with gallstones can be an annoying phase of life. Usually, most of the gallstones do not show any symptom and are not harmful. But in severe cases, medications or surgery may be required. In any case a close monitoring and checkup of the stones is essential. If surgeries are performed and there are signs of infection, such as redness and puffiness near the incision area, the doctor should be immediately consulted. Losing too much weight in too short period of time can also lead to the formation of gallstones. If you need to lose weight, do it gradually and in a controlled manner. Moreover, in cases where the signs of jaundice appear which is due to obstruction of the bile duct, go for immediate checkups.
Prevention of Gallstones
Several measures can be taken to prevent gallstones from forming and blocking the ducts. The first step is to be active and exercise regularly to keep the natural metabolism intact and avoid any accumulation of the cholesterols or other components into a gallstone. Maintaining a healthy body weight is also a necessary precondition to avoid gallstones. Avoidance of crash diets and inclusion of low fat, high fiber diet is also helpful in preventing gallstones.
