A gallstone is a lump of hard material usually ranging in size from a grain of sand to 3-4 cms. They are formed inside the gall bladder as a result of precipitation of cholesterol and bile salts from the bile.

Types of gallstones and causes

  • Cholesterol stones
  • Pigment stones
  • Mixed stones – the most common type. They are comprised of cholesterol and salts

Cholesterol stones are usually yellow-green and are made primarily of hardened cholesterol. They account for about 80 percent of gallstones. Scientists believe cholesterol stones form when bile contains too much cholesterol, too much bilirubin, or not enough bile salts, or when the gallbladder does not empty as it should for some other reason.

Pigment stones are small, dark stones made of bilirubin. The exact cause is not known. They tend to develop in people who have cirrhosis, biliary tract infections, and hereditary blood disorders such as sickle cell anemia in which too much bilirubin is formed.

Other causes are related to excess excretion of cholesterol by the liver through bile. They include the following.

  • Gender. Women between 20 and 60 years of age are twice as likely to develop gallstones as men.
  • Obesity. Obesity is a major risk factor for gallstones, especially in women.
  • Estrogen. Excess estrogen from pregnancy, hormone replacement therapy, or birth control pills
  • Cholesterol-lowering drugs.
  • Diabetes. People with diabetes generally have high levels of fatty acids called triglycerides.
  • Rapid weight loss. As the body metabolizes fat during rapid weight loss, it causes the liver to secrete extra cholesterol into bile, which can cause gallstones.

Symptoms

Many people with gallstones have no symptoms. These patients are said to be asymptomatic, and these stones are called “silent stones.” Gallstone symptoms are similar to those of heart attack, appendicitis, ulcers, irritable bowel syndrome, hiatal hernia, pancreatitis, and hepatitis. So accurate diagnosis is important.

Symptoms may vary and often follow fatty meals, and they may occur during the night.

  • Abdominal bloating
  • Recurring intolerance of fatty foods
  • Steady pain in the upper abdomen that increases rapidly and lasts from 30 minutes to several hours
  • Pain in the back between the shoulder blades
  • Pain under the right shoulder
  • Nausea or vomiting
  • Indigestion & belching

Diagnoses

Ultrasound is the most sensitive and specific test for gallstone diseases.

Treatment

Surgery

Surgery to remove the gallbladder is the most common way to treat symptomatic gallstones. The most common operation is called laparoscopic cholecystectomy.

For this operation, the surgeon makes few tiny incisions in the abdomen and inserts surgical instruments and a miniature video camera into the abdomen. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close up view of the organs and tissues. While watching the monitor, the surgeon uses the instruments to carefully separate the gallbladder from the liver, ducts, and other structures.

If gallstones are in the bile ducts, the physician (usually a gastroenterologist) may use endoscopic retrograde cholangiopancreatography (ERCP) to locate and remove them before or during the gallbladder surgery

Laparoscopic cholecystectomy with Distorted Callots at Sunrise Hospital, New Delhi

Frequently Asked Questions

What are gallstones?

A: They are ‘stones’ that form within the gallbladder. Gallstones are made of a mixture of bile salts, cholesterol and calcium

Why do they form?

A: The gallbladder normally stores bile in the liquid form. When the gallbladder is diseased, stones are precipitated in the viscous bile and gradually increase in size.

Do they need to be removed?

A: Yes if the stones cause symptoms. Symptoms include right or central abdomen pain on eating, ‘indigestion’, ‘gastric’, fever and/or jaundice (yellow eyes and skin).Sometimes gallstones may also present as pain in the right shoulder or back. Because stones form when the gallbladder is not functioning well, the gallbladder is removed together with the stones.

Is it alright not to have a gallbladder?

A: Removing the gallbladder does not lead to any serious consequence. The function of the gallbladder is to store bile. Without the gallbladder, bile is stored in the bile ducts. Removing the gallbladder does not interfere with the production of bile that occurs in the liver.

What can happen if I ignore the gallstones?

A: The gallbladder normally stores bile in the liquid form. When the gal
Common complications include:

  • acute infection of the gallbladder leading to severe upper abdominal pain and fever (acute cholecystitis).
  • pus formation in the gallbladder (empyema) leading to high fever and sepsis, a life-threatening infection.
  • jaundice when the stone blocks the bile duct that connects the liver to the small intestine leading to yellow eyes and skin.This may damage the liver.
  • blockage of the pancreatic ducts leading to a severe, life-threatening infection of the pancreas(pancreatitis).