What are Gallstones?
Gallstones are found in gallbladder or common bile duct. There may be one to several gallstones of different sizes seen in gallbladder. Presence of gallstone within the gallbladder may not cause any symptoms. Symptoms are observed when gallstone blocks common bile duct or gallstones cause inflammation of gallbladder resulting in cholecystitis. Gallbladder lies underneath liver on right upper quadrant of abdomen. In this article, we will study about the various types of gallstones, what causes gallstones, its symptoms, and treatments for gallstones.
Gallstones-Explained in Brief (Definition)
- The gallbladder is a very small organ and lies underneath the surface of liver.
- The bile is secreted by liver and stored in gallbladder.
- Gallbladder contracts to releases bile into intestine.
- The gallbladder contraction is initiated by food in intestine, which increases hormonal levels.
- Gallstones are aggregated hardened particles of cholesterol, bilirubin mixed with calcium carbonate. The particles are precipitate of bile fluid in the gallbladder.
- Gallstones vary in their size from being very small like a grain of sand to as big as a golf ball.
- Gallstone in gallbladder may be single or collection of multiple stones.
- Collection of gallstone in gallbladder is known as Cholelithiasis. This condition caused by single or multiple Gallstones in common bile duct are known as Choledocholithiasis.3
What are the Different Types of Gallstones?
- Cholesterol Stones- Cholesterol stones are a type of gallstone that are yellow, dark green or brown in color. Size of this type of gallstone (cholesterol stone) could be between 0.2 mm to 3 cm.1
- Pigment Stones- Pigment stones are the type of gallstone that are small dark brown stones that contains bilirubin and calcium salt. Size of this type of gallstone (Pigment stone) varies from tiny grains to 1 cm.2
- Mixed Stones- This type of gallstone mostly contains cholesterol (20 to 90%) and calcium carbonate.4 Mixed stones are dark green or brown in color.
- Gallstones with Calcium Content- 5 to 20% of the solid content of the gallstone are calcium carbonate. Presence of calcium carbonate makes stone radio-opaque.
What Causes Gallstones or How Are Gallstones Formed?
Presence of Excess Cholesterol1 Can Cause Gallstones
- Cholesterol is secreted by liver and dissolved in bile. Bile is stored in gallbladder for sometime before getting discharged in to intestine. Cholesterol in bile helps to digest food in intestine. Higher concentration of cholesterol in bile causes precipitation of cholesterol particles and crystals. Particles eventually aggregate to form larger particles and eventually form a bile stone or gallstone.
Gallstones Caused Due to Excessive Bilirubin Excretion2
- The bile also contains bilirubin. Medical conditions like liver cirrhosis, biliary infections and other blood disorders causes the liver to produce excessive bilirubin, which then contributes to formation of gallstones.
Gallstones Caused Due to Obstruction of Bile Duct
- Partial or complete obstruction of common bile duct results in inadequate emptying of bile. Bile is stored in gallbladder for prolonged period. Prolonged storage of bile in gallbladder results in absorption of water molecules by mucosal membrane. Absorption of water results in precipitation of cholesterol and bile particles. Large amount of precipitation of excessive cholesterol and bilirubin results in bile stone or gallstone formation.
Risk Factors of Gallstones
- Gender- Females are at more risk for developing gallstone. Gallstone is more common among female patients.
- Age- Aged or elderly people are at higher risk for developing gallstone. Gallstone is more common among elderly people of age 60 years or more.
- Increased Weight- Obese people are at higher risk for developing gallstones. Obesity is associated with gallstone.
- Decreased Weight- causes storage of thick concentrated bile either because of dehydration or malnourishment. Concentrated bile often results in higher precipitation of cholesterol or bilirubin crystals.
- Hormonal Changes- Pregnant women are also at risk for developing gallstones. Hormonal changes during pregnancy causes gallstone formation. Estrogen hormone increases cholesterol concentration in blood and bile.
- Diet- Consumption of a high-fat and high-cholesterol diet causes increased concentration of cholesterol in bile leading to gallstone formation.
- Family History- Gallstone is common among family members.
- Proton pump inhibitor decreases contraction ability of gallbladder. Bile is stored in gallbladder for prolonged period resulting in increased concentration of bile resulting in precipitation of cholesterol, bilirubin and calcium carbonate.
- Estrogen or birth control pills increases cholesterol concentration in blood and bile causing gallstone foramtion.
- Diseases Causing Gallstones-
- Hemolytic or sickle cell anemia- causes increased bilirubin concentration in bile.
- Cirrhosis- Causes increased elimination and thus increased concentration of bilirubin in bile.
- Gallbladder infection causes rapid absorption of water from bile resulting in higher concentration and precipitation of cholesterol and bilirubin.
Symptoms and Signs of Gallstones
Asymptomatic Gallstone Disease
- In few cases single or multiple gallstones does not cause any symptoms or sign for several years.
- Diagnosis of gallstone is incidental among asymptomatic patients following routine blood or radiological studies.
Symptom of Gallstone –
Pain as a Symptoms of Gallstone-
- Excruciating pain symptom (gallbladder pain) is felt at upper right part of abdomen or beneath the breastbone.
- Pain is often referred between shoulder blades.
Nausea and Vomiting Symptoms in Gallstone Disease
- Obstruction of bile duct results in colic pain followed by nausea and vomiting.
Symptoms of Fever and Chills Associated with Gallstone
- Infection of gallbladder also known as cholecystitis is sometime associated with gallstone. Cholecystitis causes fever with chills.
Signs of Gallstones
- Person suffering from gallstones may show signs of tenderness in right upper quadrant of abdomen
- Jaundice can also be a sign of gallstone
Diagnosis of Gallstones
Radiological Examination to Diagnose Gallstone-
- Ultrasound Examination- An abdominal ultrasound examination shows the picture of gallstones. Ultrasound images assists in counting number of gallstones and identifying the size of those gallstone.
- CT Scans- CT scan shows the size of gallbladder and gallstone.
- MRI- MRI of gallbladder and bile duct is essential to evaluate the gallstone obstructing common bile duct.
- ERCP- This Procedure is performed for diagnosis of common bile duct stone and also as therapeutic procedure to remove the gallstone from common bile duct.
Blood Examination to Diagnose Gallstone-
- White blood cell (WBC) counts- WBC is elevated if gallstone is associated with gallbladder infection.
- Red Blood Cells- Abnormal sickle red blood cells are observed in patient suffering with sickle cell anemia.
- Serum Bilirubin- Elevated serum bilirubin is observed in jaundice.
- Hemoglobin (Hb)- Hb is decreased in hemolytic anemia
- Blood Cholesterol- Elevated blood cholesterol suggests possible cholesterol gallstone.
What is the Treatment for Gallstones?
Treatment for Asymptomatic Gallstones-
No Treatment is required to be done in patients who do not have any symptoms of gallstone or pain due to gallstone.
Treatment for Symptomatic Gallstones-
Treatment to Control Pain Due to Gallstone-
- NSAIDs- Tylenol, Motrin or Naproxen prescribed for mild to moderate gallbladder pain.
- Opioids may be prescribed for severe pain in gallbladder due to gallstones.
Treatment of Infection Caused Due to Gallstone-
- Antibiotic sensitivity test
- Antibiotic treatment prescribed for 2 to 4 weeks.
- Antibiotics are selected according to recommendation following antibiotic sensitivity test results.
Medications to Dissolve Gallstones 5-
- Ursodeooxycholic Acid- Prescribed to dissolve Cholesterol gallstone.
Surgery for Gallstone Removal-
- Endoscopic Retrograde Sphincterotomy (ERS) to Remove Gallstone- Endoscopy is performed to locate bile duct sphincter. Sphincter is excised using endoscopic surgical instruments. The procedure is known as sphincterotomy. Sphincterotomy helps to open the drainage of bile through bile duct.
- Surgery is performed during diagnostic Endoscopic Retrograde Cholangiopancreatography (ERCP).
- Extracorporeal Shock Wave Lithotripsy 6- This treatment is advised when gallbladder is filled with few bile stones. Lithotripsy treatment involves passing of high velocity ultra-sound waves through gallstone. Procedure results in breakage of gallstone.
- Cholecystectomy: This procedure is done to remove the gallbladder altogether so that bile moves directly to the intestine from the liver instead of being accumulated in the gallbladder
What Are The Complications Caused By Gallstones?
- Inflammation- Irritation of gallbladder wall resulting in Inflammation of gallbladder
- Common bile duct obstruction.
- Obstruction of Pancreatic duct
- Cancer of the Gallbladder.
Watch 3D Video of Gallbladder Surgery Procedure for Removing Gallstones:
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