Gallbladder stones, technically known as Cholelithiasis, are solidified by-products of bile juice deposited in the gallbladder. The gallbladder is a pouch-like organ located under the upper right side of the liver. Gallbladder stores bile, a digestive juice, before releasing it into the small intestine. Bile juice helps in digesting fats. However, bile also excretes cholesterol and bilirubin, produced by the breakdown of blood cells in the liver. When these products solidify, they form stones in the gallbladder. The size of gallstones ranges from very minute multiple stones called sludge to as big as golf balls.
Types Of GallStones (Gallbladder Stones)
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Cholesterol Gallstones
80% of gallstones are made up of cholesterol and are greenish-yellow in colour.
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Bilirubin or Pigmented Gallstones
Constitutes the rest of 20%. They are made up of bilirubin, a yellow pigment formed after the breakdown of red blood cells (RBCs).
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Epidemiology of Gallstones
The prevalence of gallstones is more among the western population than in Asians and Africans. In addition, women are more susceptible than men, which may be due to the estrogen hormone in females, which increases the cholesterol secretion in bile. Other modifiable factors attributing to gallstones are increased obesity rates, a sedentary lifestyle, metabolic disorders, and a diet rich in heavy and fried foods.
Gallbladder Stones Causes
There is no specific reason for gallbladder stone formation. However, some factors which can give rise to gallstone formation are
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High Cholesterol in the Bile: Bile juice formed in the liver breaks down cholesterol from time to time. However, if an excessive amount of cholesterol is excreted in bile juice, more than it can clear, gallstones start forming in the gallbladder.
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Too Much Bilirubin Excretion in Bile Juice: Certain conditions push the liver to produce too much bilirubin, like certain blood disorders like hemolytic anaemia, liver infections, and cirrhosis. This excess bilirubin gets collected in the gallbladder, eventually forming stones.
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Hypomotility of Gallbladder: Impairment of the gallbladder to empty the contents of bile properly leads to a concentration of bile contents which causes stone formation in the gallbladder.
Gallbladder Stone Symptoms
In most people, gallbladder stones remain asymptomatic and cause no harm as such. The problem arises when these stones start impinging on bile ducts, causing cholecystitis or inflammation of the gallbladder. The pain occurs in an episodic manner and continues for 3-4 hours. Sometimes this pain can happen late at night.
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Pain in the upper right side of the abdomen, under the ribs moving towards the back, especially after having fatty foods
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Vomiting and nausea
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Paleness of the skin and eyes
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Loss of appetite
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Flatulence and bloating
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Restlessness and confusion
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Sweating and sometimes a low-grade fever with pain over the gallbladder area
Risk Factors of GallStones (Gallbladder Stones)
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Age: Age over 40 years predisposes anyone to gallstone formation.
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Gender: Female predominance than males
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Family History: Having a family history of gallbladder stones also increases the chances of having gallstones
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Diet: A high-cholesterol diet with no fibres
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Lifestyle: Sedentary lifestyle with no exercise
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Certain Medications: Medications like hormonal therapy in women for menopause. Estrogen hormone has been linked to the formation of gallstones.
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Ethnicity: More common in native American and Hispanic people than the Asian population
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Liver diseases like cirrhosis
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Blood disorders like hemolytic anaemia
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Rapid weight loss
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Pregnancy
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Diabetes
Gallbladder Stones Diagnosis
When a patient presents with a history of episodic pain in the upper right abdominal area, various tests are done for diagnosing gallstones that include
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Abdominal Ultrasound: This provides a clear image of the stone in the gallbladder. The stone's size, shape, and location can be seen clearly on an ultrasound.
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Endoscopic ultrasound is used to identify tiny gallstones, commonly known as sludge. An endoscope is passed through the mouth inside the gallbladder to detect gallbladder stones.
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Computed tomography (CT scans)
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Magnetic resonance imaging (MRI)
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Hepatobiliary iminodiacetic acid scan (HIDA scan) or cholescintigraphy
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Blood tests to check for possible infections like jaundice, pancreatitis, and other complications
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Tissue biopsy to detect malignancy, if any.
Differential Diagnosis of Gallbladder Stones
The pain in gallstones is very similar to following conditions like
Gallbladder Stone Treatment
Gallbladder Stone treatment is determined by the size of the gallstones
Surgical Treatment To Remove Gallbladder Stone (Cholecystectomy)
If the gallstone isn’t causing pain, then no treatment is required. However, gallbladder stones surgery is the only option if it is symptomatic and causing trouble. This procedure is known as cholecystectomy. The whole gallbladder is removed through laparoscopic technique or conventional cholecystectomy in this treatment.
Laparoscopy Treatment To Remove Gallbladder Stone
It is a treatment of choice in gallbladder stone removal these days as it is minimally invasive with the least postoperative complications. Full Recovery with a laparoscopic procedure takes around two weeks, and you are discharged after 24 hours post-surgery.
Medications To Dissolve Gallbladder Stone
Some medications like ursodeoxycholic acid help disintegrate the gallstone over time, but it takes a very long time with a definite possibility of recurrence. Alternative treatments like lithotripsy use ultrasonic shock waves to disintegrate the gallstones. However, it is rarely used in the case of tiny stones. Surgical removal of the gallbladder is the only treatment with a 99.9% success rate as it completely removes the gallbladder, which can harbour bile juice.
Gallbladder Stone Prevention
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Prevention of gallstones involves leading a healthy lifestyle with a minimal-fat diet and exercise, especially if you have a family history of gallstones and obesity.
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Eating vegetables, whole grains, and a dairy-free diet can help prevent gallstones.
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Avoiding foods rich in cholesterol and fats
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Exercising and maintaining a healthy lifestyle
Complications of Gallbladder Stones
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Pancreatic duct blockage leading to pancreatitis, if left untreated
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Biliary colic due to gallstone hampering the gallbladder contraction causing severe pain
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Infections due to blockage of the bile duct which releases bile causing symptoms of jaundice known as acute cholangitis.
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After gallbladder stone surgery, people complain about indigestion after a heavy meal.
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Frequent stools than before occur because of bile juice directly flowing into the small intestines.
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However, Gallbladder cancer is very rare.
Prognosis of GallStones
Most people having gallbladder stones remain asymptomatic throughout their life. In 80% of people, gallstones remain silent throughout life. If there are no symptoms, no treatment is done in such cases. But in case it is symptomatic, surgery should be done. The success rate of gallbladder removal surgery is good, and the patient leads a normal life after the surgical removal without any side effects.
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