Gallstones and Surgery

What are Gallstones?

Gallstones are an incredibly common issue that affects millions of people every year. The condition can cause intense abdominal pain, nausea, and vomiting. But what exactly are gallstones?

Gallstones form in your gallbladder, which is a small, pear-shaped organ located in the upper right abdomen. The gallbladder stores bile, a yellowish-green digestive fluid that helps your body break down and digest fats. Bile is made up of cholesterol, bilirubin, bile salts, and lecithin.

Gallstones are pebble-like pieces of hardened bile material. They are usually composed of cholesterol or bilirubin that has collected and solidified at the bottom of the gallbladder. As these substances build up and form stones, they can block the gallbladder’s ducts and cause pain.

Although gallstones can form at any age, they are most common in adults over the age of 40 and women are more likely to develop them than men. Risk factors include age, gender, family history, ethnicity, diet, and certain medical conditions.

The most common symptom of gallstones is pain in the upper right side of the abdomen, usually after a meal. This pain is known as biliary colic and can last anywhere from a few minutes to a few hours. Other symptoms can include nausea, vomiting, and fever.

If you think you may have gallstones, it’s important to talk to your doctor. Treatment options can range from lifestyle changes to surgery. In some cases, gallstones can be dissolved with medications. However, if the gallstones are large or if gallbladder inflammation is present, surgery may be necessary to remove the gallbladder.

Gallstones can be a serious health issue, so it’s important to recognize the signs and symptoms and talk to your doctor about any concerns you may have. Even if gallstones do not cause any symptoms, it’s important to monitor them and take steps to ensure they don’t become larger or cause any problems.

 

What is Cholelithiasis?

Cholelithiasis is the medical condition of having gallstones, which are small, hard stones made up of cholesterol and other substances that form in the gallbladder. Gallstones can form in the gallbladder when there is an imbalance of cholesterol and other substances in the bile. 

In many cases, people who have cholelithiasis do not experience any symptoms and are unaware that they have gallstones. However, if the gallstones start to block the ducts that connect the liver and the small intestine, it can cause pain, inflammation, and other symptoms. 

Gallstones are most commonly caused by an imbalance of cholesterol and other substances in the bile. This can be caused by a variety of conditions, including obesity, high-fat diets, rapid weight loss and changes in hormones. People with diabetes, gallbladder disease, and other conditions are also at risk of developing gallstones. 

If gallstones do not cause any problems, they can usually be left alone. However, if the gallstones cause pain and inflammation, medical attention may be necessary. Treatment may involve medications, lifestyle changes, or minimally-invasive surgery to remove the gallstones. 

If you have cholelithiasis, it is important to talk to your doctor about preventive measures and lifestyle changes to help reduce your risk of developing gallstones. Eating a healthy diet that includes fruits, vegetables, and whole grains, limiting fatty and sugary foods, and maintaining a healthy weight can help reduce your risk. 

Regular exercise, quitting smoking, and avoiding excessive alcohol consumption can also help keep your gallstones from forming. Cholelithiasis is a common condition, but it is important to be aware of the risk factors and symptoms. If you experience any signs of gallstones, be sure to talk to your doctor right away to determine the best treatment plan for you.

How Common are Gallstones?

Gallstones are a common condition that affects many people in developed countries. It is estimated that about 10% of adults in these countries are affected by gallstones, and that number increases to 20% of adults aged 65 and older. While gallstones can be quite painful, the good news is that only 20% of those diagnosed with gallstones will need medical treatment.

Gallstones are formed when bile in the gallbladder hardens into small stones. The gallbladder is an organ in the body that stores bile, which helps to break down fats we consume. When bile becomes too concentrated, the hardening process can occur. Gallstones can be as small as a grain of sand or as large as a golf ball.

What are Possible Complications of Cholelithiasis?

While gallstones alone may not be life-threatening, they can cause several complications if they are not treated properly.

  • Biliary colic: Often, people mistake this as “indigestion” as they experience this pain after food. Biliary colic manifests as a severe and painful cramping of the upper abdominal area. Biliary colic can be very uncomfortable, and it typically lasts for several hours at a time. 
  • Inflammation of the gallbladder: Gallstones can cause blockages in the bile ducts, leading to bile stasis or bile back-up, which can cause inflammation in the gallbladder. This inflammation is known as cholecystitis and can be very painful, leading to symptoms such as nausea, fever, and abdominal pain. Left untreated, cholecystitis can lead to the formation of abscesses and even rupture of the gallbladder.
  • Pancreatitis: Gallstones may also lead to inflammation of the pancreas, a condition known as pancreatitis. Pancreatitis can be very severe, leading to severe abdominal pain, fever, nausea, and vomiting. In severe cases, it can lead to life-threatening complications such as infections, sepsis, or even organ failure.
  • Jaundice: Jaundice is a yellowing of the skin and eyes caused by a buildup of bilirubin in the bloodstream. Gallstones can cause biliary obstruction, leading to jaundice.
  • Cholangitis: Gallstones can also lead to infection of the bile ducts, known as cholangitis. Cholangitis can be very serious, leading to fever, chills, abdominal pain, and jaundice.

The best way to avoid the complications of gallstones is to seek prompt diagnosis and treatment. Some complications can be avoided through lifestyle changes such as eating a healthy diet and exercising regularly. 

In some cases, surgery may be necessary to remove the gallstones or correct any obstructions. If you are experiencing symptoms of gallstones, it is important to seek medical attention right away.

How are Gallstones Diagnosed?

Diagnosing gallstones can be tricky, as the symptoms can be similar to other conditions. The first step in getting a diagnosis is to speak to your healthcare provider. They will ask about your medical history, any family history of gallstones, and your symptoms. They may also perform a physical exam and check your abdomen for tenderness.

Next, your healthcare provider will investigate with blood tests and imaging tests. Blood tests can detect inflammation, infection or jaundice. They can also give your healthcare provider clues about which organs are being affected. Imaging tests will help locate the source of the blockage. They will usually start with an ultrasound, which can detect gallstones in the gallbladder and bile ducts.

Your healthcare provider may also order an abdominal CT scan or an MRI scan to further investigate the area. These tests will provide more detailed pictures of the gallbladder and bile ducts and can help find any other abnormalities. Another test that may be ordered is an oral cholecystogram, or OCG. 

This test uses a contrast material to help the doctor see the bile ducts and gallbladder in detail. The final step in the diagnosis of gallstones is often a biopsy. This involves taking a small sample of tissue from the gallbladder wall, which is then analyzed in a lab. The results of the biopsy can confirm the presence of gallstones and help determine their size and composition.

Once you’ve been diagnosed with gallstones, your healthcare provider will discuss treatment options with you. Treatment typically involves lifestyle changes and medications, and in some cases, surgical removal of the gallbladder may be necessary.

If you’re experiencing symptoms of biliary colic, it’s important to get a diagnosis to begin treatment. Your healthcare provider will use blood tests and imaging tests to diagnose gallstones and determine the best course of action. With proper diagnosis and treatment, you can find relief from your symptoms and reduce your risk of developing complications.

How are Gallstones Removed?

Gallstones are a common health issue that can be painful, uncomfortable, and even life-threatening if not treated properly. Fortunately, there are a few different ways to remove gallstones, depending on the size and location of the stones.

Endoscopy

Endoscopy, or ERCP (endoscopic retrograde cholangiopancreatography), is an effective way of removing gallstones located in the bile ducts. During this procedure, a long tube is passed down the throat, allowing your physician to locate and remove the gallstones with minimal invasiveness.

Laparoscopy

Laparoscopic cholecystectomy is another minimally-invasive procedure used to remove gallstones located in the gallbladder. This procedure involves making several small “keyhole” incisions in your abdomen, through which a laparoscope is inserted. 

Once your gallbladder is identified, your surgeon can then remove it. The benefits of using laparoscopic cholecystectomy to remove gallstones include smaller incisions, less postoperative pain, and a faster recovery time than conventional surgery.

Ultrasonic Extracorporeal Shock Wave Lithotripsy

Ultrasonic extracorporeal shock wave lithotripsy (ESWL) was once employed to break up large gallstones, allowing them to be naturally passed out of the body through the urinary system. 

During this procedure, shock waves are used to break up the stones so they can pass through the bile ducts more easily. This is however fraught with recurrence and also no longer considered the standard of care for patients with gallstones. 

Medication

In some cases, your physician may recommend medication to help break down the gallstones. This option is only suitable for smaller stones, as larger stones require more advanced treatments. Similarly, these medications are very limited in their clinical use as surgery is safe and more effective in the eradication of gallstone and preventing complications. 

While many patients are concerned about the loss of the gallbladder, almost all continue to live a normal life after cholecystectomy. The main symptoms they experience are loose stools and flatulence especially after a fatty or heavy meal. 

Frequently Asked Questions

  • How can having gallstones affect my life?

    Gallstones can cause several complications. See the above section under complications for details. These include gallstone colic, cholecystitis, cholangitis and pancreatitis. 

    These conditions, although potentially serious, are usually effectively treated upon prompt medical attention. The need for surgery and timing of surgery are pertinent issues to discuss with the medical team.

  • How do I know if gallstones are serious?

    In general, it is not a serious condition. There are possible complications that can occur with gallstones (see above section under complications). Most gallstones are detected on ultrasound and patients can undergo a safe procedure to have the gallbladder removed via keyhole surgery. Under such circumstances, the complication rate is low and it is a day surgery procedure with minimal downtime for recovery.

  • What are the common complications of gallstones?

    There are several complications as mentioned above. Amongst which, the most serious complications are cholangitis and pancreatitis. Both are a result of the gallstone causing a blockage in the common bile duct thereby leading to infection or inflammation. These two complications are potentially serious and life-threatening. 

    They will require immediate admission to a hospital with specialist management. Some of the management may include a need for Endoscopic retrograde cholangiopancreatoscopy (ERCP) or laparoscopic common bile duct exploration with cholecystectomy. 

  • Can drinking lots of water dissolve gallstones?

    No. Hydration is important in general, but once gallstones are formed, no amount of hydration will dissolve these unlike urinary stones. The reason is gallstones are a result of supersaturation of cholesterol crystals mixed with other debris within the gallbladder and these are not hydrophilic. The only way to remove them effectively is through surgical removal of the entire gallbladder. See more under the section for how gallstones are removed. 

  • Do all gallstones need treatment?

    No. Not all patients with gallstones require any treatment. Most patients who are asymptomatic can leave their gallstones alone. There are other considerations that may require treatment for patients with asymptomatic gallstones. 

    These include patients who may require chemotherapy and patients who may have concomitant surgery in nearby areas where the removal of the gallbladder may assist the subsequent treatment. These situations are uncommon and should be discussed with both the primary physician and the surgeon.

  • How do I know if I have gallstones?

    Most gallstones are picked up on ultrasound of the gallbladder. This is a simple outpatient test and does not have any radiation involved. There are also some instances where a CT scan was done for a non related cause and gallstones are detected. 

    Under such circumstances, it is important to discuss with the primary physician about the necessity of referral for specialist consultation. Most often, these incidental gallstones are left alone and do not require treatment.

  • What are the treatment options for gallstones?

    See the section under how gallstones are removed. 

  • Can gallstones cause pancreatitis?

    Yes. When the gallstone falls into the common bile duct, it can cause an obstruction in the pancreatic duct which joins the common bile duct. This results in the back pressure into the pancreas and causes inflammation. The inflammation in the pancreas and that is termed pancreatitis.