Causative and risk factors
Being middle aged or beyond carries a higher risk of gallstone formation. Females are much more likely to develop gallstones compared to their male counterparts. Being overweight is associated with a higher likelihood of developing gallstones. Having a first degree relative with gallstones, you are more likely to develop them too. American-Indians or Mexican-Americans are more likely to develop gallstones.
Regularly eating high cholesterol or fatty foods especially when combined with a very low fiber diet increases your risk of developing gallstones. Other risk factors include pregnancy, rapid weight loss, diabetes and being on birth control pills or hormone replacement.
Clinical presentation
Gallstones are mostly asymptomatic unless 1 or more stones get lodged in a biliary duct. In case of a blockage, you may experience pain in the right upper part of your abdomen. This pain is known as biliary colic and is usually sudden and very intense. The pain is felt in the central part of your abdomen just below the sternum or between the shoulder blades. Some patients may experience right-sided shoulder pain. Nausea may be present along with these symptoms.
Gallstones can give rise to the following complications:
- Cholecystitis – inflammation of the gallbladder
- Cholangitis – infection of the hepatic,intrahepatic and common bile duct
- Duct blockage – the common bile duct or the pancreatic duct can be blocked due to a lodged gallstone.
- Cancer of the gallbladder – People with gallstones have a slightly elevated risk of developing gallstone cancer in the future.
- Gangrene of the gallbladder – the blood supply of the gallbladder can be cut off due to cholecystitis
- Pancreatitis – can occur as a result of blockage of the pancreatic duct by a gallstone
- Sepsis
Diagnosis & Investigations
Ultrasonography, CT or MRI scanning of the gallbladder to visualise the gallstones.
ERCP (endoscopic retrograde cholangiopancreatography) – A dye is injected into the bile duct and then X-ray images are taken. This is a diagnostic as well as treatment procedure.
Blood tests are done to check the levels of liver function enzymes.
Treatment
Treatment for gallstones is not always necessary, especially in patients who do not have any symptoms.
Lifestyle changes are recommended for patients with gallstones. They must lose any excess weight. Eating a low-fat and high-fiber diet is advised.
Ursodeoxycholic acid is an oral medication that is used to dissolve gallstones. This drug usually takes months or years to act and yet, it may sometimes not act at all. This is the least preferred mode of treatment and is only used in patients who are not fit for surgery.
Cholecystectomy (surgery to remove the gallbladder) is the most preferred mode of treatment in cases of large, multiple or symptomatic gallstones. The recurrence rate of gallbladder stones is very high, thus rendering cholecystectomy a sought after procedure. This surgery can be performed either laparoscopically or as an open procedure. In patients who have undergone cholecystectomy, some amount of bloating or change in bowel pattern may be observed. However, they do not face any major problems since the gallbladder is not an essential organ. The bile can directly flow from the liver to the gut to carry out the process of digestion.
ERCP (endoscopic retrograde cholangiopancreatography) – In this procedure, a heated wire is passed into the bile duct to remove the stones from the duct. However, this procedure leaves the gallstones in the gallbladder intact.
Extracorporeal shock wave lithotripsy – This is a non-surgical procedure used for a stone lodged into the bile duct. Shock waves are focussed on the gallstone from outside the body which breaks the gallstone into tiny pieces. These pieces can then drain into the intestine on their own or can be extracted endoscopically.
