Gallstones
To
understand the nature of gallstones, it is helpful to first look at the anatomy
of the gallbladder and bile ducts. The gallbladder is a pear-shaped organ that
rests under the liver in the right upper abdomen. The liver produces bile, a
yellow liquid needed by the intestine to help digest fat and oils. Ducts, or
tubes, carry bile from the liver to the gallbladder and on to the intestine.
Bile is stored in the gallbladder, which contracts periodically to force the
bile into the intestine.
How Do Gallstones Form?
Bile is composed of a variety of chemicals, including cholesterol, salts, and
certain pigments. The gallbladder absorbs water from the bile, causing it to
thicken. In some people, tiny crystals form from the cholesterol and pigments.
These crystals gradually grow until one or even hundreds of gallstones develop.
About 80 percent of gallstones are composed of cholesterol, while the remainder
are made of pigments, salts, and other chemicals.
Who
Develops Gallstones?
It is well known that in the Western world middle-aged, white females are most
likely to develop gallstones. However, by age 60, almost 30 percent of all men
and women have gallstones. Losing weight very rapidly produces stones in some
people. Asian and African people have a low incidence of gallstones, while
certain American Indian tribes have almost a 100 percent incidence in females by
middle age. Therefore, heredity, age, and diet are probably all important
factors in developing gallstones. Practically anyone, at any age and under
certain conditions, can develop these stones.
Symptoms
Many patients with gallstones never experience symptoms. However, as many as
one-half of all gallstone patients eventually experience one of the following:
Colic -- Colicy pain usually occurs after meals when the gallbladder
contracts. During this process, gallstones can lodge in the outlet neck of the
gallbladder or even in the main bile duct to the intestine. This situation
causes intermittent, often severe pain, which is experienced in the
upper-middle or right side of the upper abdomen, or even in the right shoulder
and, sometimes, under the breast bone. Colic attacks last from a few minutes
to several hours.
Gallbladder Inflammation -- Occasionally, the stones irritate the
gallbladder to such an extent that active and acute inflammation results. This
condition produces steady, dull, and usually severe pain in the upper-right
abdomen. This is known as acute cholecystitis. It is a serious condition.
Yellow Jaundice -- When a gallstone becomes permanently lodged in
the main bile duct, the bile flow is blocked and cannot reach the intestine.
Therefore, bile backs up in the liver and spills into the blood. The skin
turns yellow, the urine dark and, perhaps, the stool white, since it is bile
that colors the stool brown.
Other Symptoms -- Gallstones are frequently blamed for causing
indigestion, nausea, and intolerance to fatty foods. However, it has been
found that persons without gallstones experience these symptoms as frequently
as those with stones. Therefore, the physician cannot be certain that
gallstones are causing these symptoms.
Diagnosis
The physician, and even the patient, may suspect the presence of gallstones
simply from the medical history. An ultrasound or sonography exam provides a
simple, quick method of diagnosis. In this test, sound waves are beamed into the
gallbladder. This test looks at the anatomy of the gallbladder. Another way of
testing is to evaluate its function. In this test (a hepatobiliary scan) a small
amount of radioactive material is injected by vein (IV). It then concentrates in
the gallbladder. An agent is then given by IV that will cause the gallbladder to
contract and empty. A diseased gallbladder does not do this very well and so
this test can indicate a gallbladder problem.
Treatment
Because many patients with gallstones never develop symptoms, watchful waiting
is often indicated. In fact, it is usually recommended that patients without
symptoms receive no treatment. When treatment is needed, it usually involves one
of the following:
Laparoscopic Surgery -- This technique has rapidly become the treatment
of choice for many gallstone patients. A tiny incision is made through the
navel. A microvideo tube is then inserted through it. Three other needle-like
instruments are then inserted through the upper abdomen. These are used to
pick up and dissect the gallbladder which, together with the stones, is teased
out of the small incision. With this technique, patients can usually go home
the same or next day.
General Surgery -- In the past, general surgery was the treatment of
choice for symptomatic gallstones. Laparoscopic surgery is now possible in
most patients. With general surgery there is a 3 to 6 inch incision in the
right upper abdomen and a 3 to 6 day hospital stay. There are instances in
which this type of surgery is still necessary.
Gallstone Dissolving -- Drugs are now available that dissolve
cholesterol gallstones. Complete dissolving of gallstones takes from six
months to two years, with maintenance treatment often required afterward. This
approach works best on small stones.
Because of the speed and simplicity of laparoscopic surgery, this technique
is by far the one most commonly used. The body can function quite well without
the gallbladder, although diarrhea can be an occasional problem, especially in
patients with irritable bowel syndrome.
Prevention
There is now enough known about gallstones that certain recommendations can be
made about how to prevent them in the first place. Some of this knowledge is
pretty firm while some is only suggestive at this time.
Hard Evidence -- Achieve and maintain ideal body weight but do not lose
more than 3 lbs per week, especially using the super low-calorie liquid
fasting diets.
Soft Evidence -- Increased fiber in the diet, vitamin C (no more
than 500 mg a day) and caffeinated coffee may all be helpful. Additionally,
regular recreational and physical activity - vigorous walking, gardening,
aerobics - seem to have protective value.
Summary
Gallstones are a common disorder and often cause no symptoms. However, they can
produce severe pain and serious problems which, when discovered, require a
well-developed plan of action. The goal should be to avoid emergency
complications and surgery. For symptomatic stones, laparoscopic surgery is most
commonly performed, although other forms of treatment are available. By
consulting with the physician, the right treatment choice can be made.
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