Gallstones

The gallbladder is a small organ present under the liver which helps in the digestive process by storing bile and releasing it in the presence of food. Bile helps in breaking down the fat in the food and allows for its absorption by the body. Gallstones are stones formed by the hard particles of cholesterol and pigments present in bile.

Types of Gallstones: 

Cholesterol gallstones: Cholesterol stones are made up of 80% of cholesterol and vary from light yellow to dark green or brown in color and are oval in shape.

Pigment gallstones: These are small, dark and contain bilirubin and calcium that are present in the bile and have less than 20% of cholesterol.

Mixed gallstones: Mixed gallstones typically contain 20–80% cholesterol along with other constituents like calcium carbonate, palmitate phosphate, bilirubin and other bile pigments.

Risk factors :

• Forty, Fatty, Female – Risk is higher in the obese, females and those more than 40 years of age
• Ethnic groups like American Indian/Mexican American
• Pregnant ladies
• Eating a high-fat /cholesterol diet
• Eating a low-fiber diet
• Family history of gallstones
• Having diabetes
• Losing weight very quickly
• Taking cholesterol-lowering medications or estrogen

Symptoms:

• Pain in the right upper abdomen and upper back
• Nausea
• Vomiting
• Other gastrointestinal problems that include bloating, indigestion, heartburn and gas

Investigations:

• Diagnosis is confirmed by ultrasound of abdomen
• Cholescintigraphy (HIDA scan):  to know the contraction of the gallbladder
• Blood tests: for the presence of infections
• MRCP (Magnetic Resonance Cholangiopancreatography) or ERCP (Endoscopic Retrograde CholangioPancreatograpy): to view the bile ducts for the presence of any stones. ERCP can also help in removal of stones from the common bile duct.

Complications if not treated:

• Inflammation of the gallbladder (cholecystitis), common bile ducts, common hepatic ducts, and liver
• Gangrene of the gallbladder
• Blockage of the common bile duct which produces jaundice and bile infection
• Blockage of pancreatic duct leading to pancreatitis.
• Gallbladder cancer

Treatment:

Asymptomatic or single stone – needs to be kept under observation with regular ultrasound of the abdomen.

Symptomatic or multiple gallstones – excision of the gallbladder through laparoscopy or open cholescystectomy.

If the person is at high risk of surgery or the stones have a high cholesterol content then cholesterol dissolving drugs like ursodeoxycholic acid can be given. It has to be taken for 2 years to dissolve the stones and there is also a high risk of recurrence after stopping the medication.

Extra Corporeal Shock Wave Lithotripsy (ESWL) – It’s a method to concentrate ultrasonic shock waves onto the stones to break them into pieces; but, is not used frequently.