Diseases & Conditions

 

Gallstones

Diseases & Conditions

What are gallstones?

The gallbladder is a small organ located in the right side of the abdomen below the liver. The liver produces the bile which is used to digest and process food and stores it in the gallbladder. When the body needs the bile, the gallbladder releases it through a small tube called a bile duct into the small intestine. Gallstones are hard particles composed of cholesterol that develop in the gallbladder. Gallstones can vary in size and number and can irritate the gallbladder or block the bile duct. This will cause sudden pain in the abdomen called a gallbladder attack or biliary colic.

Gallstones constitute a significant health problem in developed societies, affecting 10% to 15% of the adult population in Western countries.1

A study in Saudi Arabia showed that gallstones disease is a prevalent disorder affecting 11.7% of the Saudi population.2

 

What causes gallstones?

Gallstones are thought to develop because of imbalances in bile chemicals. Gallstones develop when bile contains a high amount of cholesterol that may turn into stones. Scientists do not know why bile imbalances happen but it is thought that gallstones may form when the gallbladder does not empty completely.3

 

Who is at risk for gallstones?

Certain people have a higher risk of developing gallstones than others:4

  • Female gender: Women are more likely to develop gallstones than men. It is known that a high amount of estrogen can increase cholesterol levels in bile. Due to hormonal factors like the increase of estrogen during pregnancy, estrogen replacement therapy and when taking contraceptive pills, women are more prone to develop gallstones.
  • Increasing age: The risk of developing gallstones increases in people over 40
  • Family history: The risk of developing gallstones increases if a parent or a sibling develops the disease
  • Dietary factors: High caloric diets, high refined carbohydrate diets, low-fiber diets increase the risk of forming gallstones
  • Obesity
  • Dyslipidemia
  • Sedentary life style
  • Rapid weight loss can prevent the gallbladder from emptying properly and thus increasing the risks of developing gallstones.

 

What are the symptoms of gallstones?

Gallstones often do not cause any symptoms. However, if gallstones build-up and lodge in the bile duct, pressure increases in the gallbladder, leading to a gallbladder attack. The most common symptoms of gallstones are:5

  • Pain in the upper right part of the abdomen lasting for several hours
  • Pain in the center of the abdomen
  • Pain in the upper back
  • Pain in the right shoulder
  • Pain between the shoulders
  • Nausea
  • Vomiting

 

How are gallstones diagnosed?

The doctor will order tests in order to create an image of the gallbladder. These tests include:6

  • Ultrasound examination to create image of the gallbladder. This is the most accurate method to detect gallstones.
  • Computerized tomography (CT) scan to produce a 3D image of the gallbladder using the X-ray technique.
  • Magnetic resonance imaging (MRI) to produce detailed pictures of the gallbladder using radio waves magnets.
  • Cholescintigraphy to produce pictures of the gallbladder after injecting unharmful radioactive material into the blood.

 

How are gallstones treated?

If the gallstones are not causing pain, treatment is not recommended. However, if the patient develops symptoms, the doctor will recommend surgery:6

  • Surgery: A laparoscopic cholecystectomy consists of removing the whole gallbladder by making several small incisions in the abdomen in order to insert the laparoscope (camera). Removal of the gallbladder should have little effect on a patient’s lifestyle or diet. The liver will produce bile to digest food, but the bile will not build up in the gallbladder. It will be directly dropped off in the small intestine.
  • Open cholecystectomy: This procedure is performed when the gallbladder is severely inflamed. It consists of creating a large incision in the abdomen to remove the gallbladder.

 

Can gallstones be prevented?

The risk of developing gallstones can be reduced if a person:8

  • Respects the eating times: It is important to not skip meals during the day and eat on a regular schedule to reduce the risks of developing gallstones.
  • Reduces his weight slowly: Rapid loss of weight increases the risk of gallstone formation because it increases the amount of cholesterol in bile.
  • Maintains a healthy weight: A sensible weight loss program can reduce the risk for gallstones.

 

References

  1. Stinton, Laura M., and Eldon A. Shaffer. "Epidemiology of gallbladder disease: cholelithiasis and cancer." Gut and liver 6.2 (2012): 172.
  2. Abu-Eshy, S. A., et al. "Prevalence and risk factors of gallstone disease in a high altitude Saudi population." Eastern Mediterranean Health Journal 13.4 (2007): 794-802.
  3. Gallstones (Gallstones) http://www.nhs.uk/conditions/Gallstones/Pages/Introduction.aspx (Accessed December 15, 2015)
  4. Marschall, H?, and C. Einarsson. "Gallstone disease." Journal of internal medicine 261.6 (2007): 529-542.
  5. Gallstones (Symptoms) http://www.mayoclinic.org/diseases-conditions/gallstones/basics/symptoms/con-20020461 (Accessed December 15, 2015)
  6. Gallstones (Gallstones) http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/gallstones/Pages/facts.asp (Accessed December 15, 2015)
  7. Gallstones Picture, Types, Causes, Risks, Symptoms, Treatments (WebMD) http://www.webmd.com/digestive-disorders/gallstones?page=2#3 (Accessed December 15, 2015)
  8. Gallstones (Prevention) http://www.mayoclinic.org/diseases-conditions/gallstones/basics/prevention/con-20020461 (Accessed December 15, 2015)