Gallstones

Your gallbladder is a small organ located in your upper right abdomen, right below your liver. It’s a pouch that stores bile, a green-yellow liquid that helps with digestion. Issues with your gallbladder typically occur when something is blocking its bile duct like a gallstone.

Causes #

• The actual cause of gallstones is thought to be due to a chemical imbalance of bile inside of the gallbladder. While researchers still aren’t clear about what exactly causes that imbalance to happen, there are a few possible reasons:

Too much cholesterol in your bile #

• Having too much cholesterol in your bile can lead to yellow cholesterol stones. These hard stones may develop if your liver makes more cholesterol than your bile can dissolve.

Too much bilirubin in your bile #

• Bilirubin is a chemical produced during the normal breakdown of red blood cells. After it’s created, it passes through the liver and is eventually excreted out of the body.

• Some conditions, such as liver damage and certain blood disorders, cause your liver to produce more bilirubin than it should. Pigment gallstones form when your gallbladder can’t break down the excess bilirubin. These hard stones are often dark brown or black.

Concentrated bile due to a full gallbladder #

• Your gallbladder needs to be able to empty its bile to function properly. If it fails to empty its bile content, the bile becomes overly concentrated, which can cause stones to form.

Symptoms #

If gallstones are left untreated or unidentified, the symptoms may increase to include:

• A high temperature

• Rapid heartbeat

• Yellowing of the skin and whites of the eyes (jaundice)

• Itchy skin

• Diarrhea

• Chills

• Confusion

• A loss of appetite

• These symptoms can be signs of a gallbladder infection, or inflammation of the gallbladder, liver, or pancreas.

Risk factors #

Lifestyle risk factors #

• Living with obesity

• A diet high in fat or cholesterol and low in fiber

• Undergoing rapid weight loss

• Living with type 2 diabetes

Genetic risk factors #

• Being born female

• Being of Native American or Mexican descent

• Having a family history of gallstones

• Being 60 years or older

Medical risk factors #

• Living with cirrhosis

• Being pregnant

• Taking certain medications to lower cholesterol

• Taking medications with a high estrogen content (like certain birth controls)

Diagnosis #

• Ultrasound - An ultrasound produces images of your abdomen. It’s the preferred imaging method to confirm that you have gallstone disease. It can also show abnormalities associated with acute cholecystitis.

• Abdominal CT scan - This imaging test takes pictures of your liver and abdominal region.

• Gallbladder radionuclide scan - This important scan takes about one hour to complete. A specialist injects a radioactive substance into your veins - The substance travels through your blood to the liver and gallbladder. On a scan, it can reveal evidence to suggest infection or blockage of the bile ducts from stones.

• Blood tests - Your doctor may order blood tests that measure the amount of bilirubin in your blood. The tests also help determine how well your liver is functioning.

Treatment #

Surgical treatments #

Cholecystectomy, which is surgery to remove the gallbladder, is one of the most common operationsTrusted Source performed on adults in the United States. Because the gallbladder isn’t an essential organ, it’s possible to live a healthy life without it.

There are two types of cholecystectomy:

Laparoscopic cholecystectomy #

This is a common surgery that requires general anesthesia. The surgeon will usually make three or four incisions in your abdomen. They’ll then insert a small, lighted device into one of the incisions, check for stones, and carefully remove your gallbladder. You can usually go home on the day of the procedure or the day after if you have no complications.

Open cholecystectomy #

This surgery is typically performed when the gallbladder is inflamed, infected, or scarred. This surgery may also happen if problems occur during a laparoscopic cholecystectomy. You may experience loose or watery stools after gallbladder removal. Removing a gallbladder involves rerouting the bile from the liver to the small intestine. Bile no longer goes through the gallbladder and it becomes less concentrated. The immediate result is a laxative effect that can cause diarrhea, but this issue should resolve on its own for most people.

Nonsurgical treatments #

• If surgery can’t be performed, such as if the patient is a much older individual, there are a few other ways doctors can try to get rid of your gallstones.

• Oral dissolution therapy typically includes using the medications ursodiol (Actigall) and chenodiol (Chenix) to break up gallstones. These medications contain bile acids, which work to break up the stones. This treatment is best suited for breaking up cholesterol stones and can take many months or years to work completely.

• Shock wave lithotripsy is another option. A lithotripter is a machine that generates shock waves that pass through a person. These shock waves can break gallstones into smaller pieces.

• Percutaneous drainage of the gallbladder involves placing a sterile needle into the gallbladder to aspirate (draw out) bile. A tube is then inserted to help with additional drainage. This procedure isn’t typically a first line of defense and tends to be an option for individuals who may not be suited for other procedures.