Patient's Complete Guide to Gallstones

Overview of Gallstones

The liver produces digestive fluid or bile that is used for the digestion of food. This fluid is stored in the gallbladder. The gallbladder is a small, pear-shaped organ just beneath the liver. Bile juice contains fats and cholesterol in a balanced amount. If the level of cholesterol increased in the bile, it can result in gallstones formation in the bile ducts, a condition termed as Choledocholithiasis or صفرا کی نالیوں میں پتھری کی موجودگی. 

The bile duct is a small tube that transports bile from the gallbladder to the intestine. These stones are usually small in size and asymptomatic. As these gallstones increase in size you may feel pain in your gallbladder. 

Occurrence of Gall Stones

As per studies, in western countries, the prevalence of choledocholithiasis is 10-15%. Among them, 80% of stones are cholesterol stones. 

In Pakistan, cholesterol stones are most common as compared to other gallstones.

Females are at high risk of developing choledocholithiasis as compared to men.

Signs and Symptoms of Gallstones

Bile duct gallstones may remain asymptomatic for months or years. But you may experience the following symptoms if a stone blocks the duct: 

  • Abdominal pain in the right upper or middle upper abdomen
  • Jaundice (yellowing of the skin and eyes)
  • Fever
  • Nausea and vomiting
  • Loss of appetite
  • Clay-coloured stools

The pain caused by gallstones can be either irregular or permanent. The pain can be mild or severe. Severe pain may require immediate treatment. Severe symptoms are sometimes confused with a heart attack.

Gallstone obstruction in the bile duct can cause bile infection. The bacteria spread rapidly and infect the liver. Live infection is a serious condition that can cause death.

Causes of Gallstones

Cholesterol gallstones can be caused by bile that contains:

  • Too much cholesterol
  • Not enough bile salts
  • Too much bilirubin

These stones can also occur due to incomplete emptying of the gallbladder. 

The cause of pigment stones is still unknown. They mostly occur in people suffering from:

  • Liver cirrhosis  
  • Hereditary blood disorders in which bilirubin is produced in excess
  • Biliary tract infections

Risk Factors of Gallstones

The risk of smallpox occurrence is usually increased by the following factors such as:

  • History of gallstones
  • Obesity
  • Pregnancy
  • Low-fiber, high-calorie, high-fat diet
  • Gallbladder diseases
  • Rapid weight loss
  • Prolonged fasting
  • Lack of physical activity

There are some risk factors that cannot be changed such as:

  • Age: With age risk of gallstones is increased.
  • Gender: Gallstones mostly develop in females.
  • Genetics: Family history of gallstones play an important role.

Prevention

If you have gallstones once in life you have risks for the recurrence for the rest of your life. This risk can be prevented by:

  • Moderate physical activity

Dietary changes (increase fibre intake and reduce fat in your diet)

Diagnosis

To verify the symptoms of gallstones, your doctor will recommend the following imaging tests such as:

  • Transabdominal Ultrasound (TUS): This imaging test uses high-frequency sound waves to get a detailed image of the liver, gallbladder, spleen, kidneys, and pancreas.
  • Endoscopic Ultrasound (EUS): Through this test, the digestive tract is examined. An ultrasound probe attached with a flexible endoscopic tube is inserted in the GI tract through the mouth.
  • Endoscopic Retrograde Cholangiography (ERCP): A procedure performed for the identification of stones, tumours, and narrowing in the gallbladder.
  • Magnetic Resonance Cholangiopancreatography (MRCP): MRI imaging is performed to get a detailed image of the gallbladder, bile ducts, and pancreatic duct.
  • Percutaneous Transhepatic Cholangiogram (PTCA): X-ray imaging of the bile ducts.

Following tests can be performed for the diagnosis of infection in the liver or pancreases.

  • Complete blood count
  • Bilirubin
  • Pancreatic enzymes
  • Liver function tests

Treatment of Gallstones | When to Consult a Doctor

Gallstones can be treated by removing the blockage in the bile duct. These treatments may include:

  • Stone extraction
  • Surgery to remove the gallbladder and stones (cholecystectomy)
  • Fragmenting stones (lithotripsy)
  • Biliary stenting
  • Surgery in which the bile duct is cut to remove stones or help them pass (sphincterotomy)
  • Biliary Endoscopic Sphincterotomy (BES): This is the most common approach for the treatment of gallstones in the bile duct. In this procedure, a balloon-type device is inserted into the gallbladder to remove the stones. BES is used to remove approximately 85% bile duct stone. 

Doctors often use lithotripsy if stones can’t be removed with BES procedure. This procedure breaks the stones into small pieces that can easily pass down.

  • Surgical Removal: If stone can’t be removed with BES and lithotripsy, patients may be treated by surgically removing the gallbladder. 
  • Biliary Stents: These stents are used if the patient does not wish to surgically remove the gallbladder. Stents are tiny tubes that are inserted to open the blocked bile ducts. Biliary ducts can provide drainage and prevent infection.

Speciality for Gallstones

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