Why do I have gallstones, Doctor?

Why do I have Gallstones, Doctor?

Pinkal Shah (not her real name), a 43-year-old mother of 2 children, recently had an episode of abdominal pain and hyperacidity, that woke her up in the middle of the night. She had been having bloating of her abdomen especially after a heavy meal since the past few months. Her family physician advised an ultrasound exam of the abdomen which showed a distended gallbladder with multiple small stones (calculi).

She was then referred to me by her family doctor, for further treatment. After telling me her complaints and on being told that the pain and other symptoms were due to gallstone disease, her first question to me was, “Why do I have gallstones, Doctor?”

A brief description of gallstone disease and its treatment

Gallstones are hardened deposits of digestive fluid that can form in your gallbladder. Your gallbladder is a small, pear-shaped organ on the right side of your abdomen, just beneath your liver. The gallbladder holds a digestive fluid called bile that’s released into your small intestine.

Gallstones range in size from as small as a grain of sand to as large as a golf ball. Some people develop just one gallstone, while others develop many gallstones at the same time.

People who experience symptoms from their gallstones usually require gallbladder removal surgery. Gallstones that don’t cause any signs and symptoms may or may not require immediate treatment, depending on various factors that your doctor will discuss with you.

Symptoms of Gallstones

Gallstones may cause no signs or symptoms. If a gallstone lodges in a duct and causes a blockage, the resulting signs and symptoms may include:

  • Gradually or rapidly intensifying pain in the upper right portion of your abdomen
  • Sudden, intensifying pain in the center of your abdomen, just below your breastbone
  • Back pain between your shoulder blades
  • Pain in your right shoulder
  • Nausea or vomiting

Gallstone pain may last several minutes to a few hours.

When to see a doctor

Make an appointment with your doctor if you have any abdominal symptoms that worry you.

Seek immediate care if you develop signs and symptoms of a serious gallstone complication, such as:

  • Abdominal pain so intense that you can’t sit still or find a comfortable position
  • Yellowing of your skin and the whites of your eyes (jaundice)
  • High fever with chills

What causes Gallstones?

It’s not clear what causes gallstones to form. Doctors think gallstones may result when:

Your bile contains too much cholesterol. Normally, your bile contains enough chemicals to dissolve the cholesterol excreted by your liver. But if your liver excretes more cholesterol than your bile can dissolve, the excess cholesterol may form into crystals and eventually into stones.

Your bile contains too much bilirubin. Bilirubin is a chemical that’s produced when your body breaks down red blood cells. Certain conditions cause your liver to make too much bilirubin, including liver cirrhosis, biliary tract infections and certain blood disorders. The excess bilirubin contributes to gallstone formation.

Your gallbladder doesn’t empty correctly. If your gallbladder doesn’t empty completely of the stored bile often after a meal, due to a stone blocking the outlet, the muscles of the gallbladder squeeze against this resistance, giving sudden, spasmodic or continuous pain.

Types of gallstones

Types of gallstones that can form in the gallbladder include:

Cholesterol gallstones
The most common type of gallstone, called a cholesterol gallstone, often appears yellow in color. These gallstones are composed mainly of undissolved cholesterol, but may contain other components.

Pigment gallstones
These dark brown or black stones form when your bile contains too much bilirubin.

What increases your risk of gallstones?

Some of the factors that may increase your risk of gallstones include:

  • Being female
  • Being age 40 or older
  • Being a Native American
  • Being a Mexican American
  • Being overweight or obese
  • Being sedentary
  • Being pregnant
  • Eating a high-fat diet
  • Eating a high-cholesterol diet
  • Eating a low-fibre diet
  • Having a family history of gallstones
  • Having diabetes
  • Having certain blood disorders, such as sickle cell anemia or leukemia
  • Losing weight very quickly eg. after extreme dieting or Bariatric surgery
  • Taking medications that contain estrogen, such as oral contraceptives or hormone therapy drugs
  • Having liver disease

Complications of gallstones

Complications of gallstones may include:
Inflammation of the gallbladder.
A gallstone that becomes lodged in the neck of the gallbladder can cause inflammation of the gallbladder (cholecystitis). Cholecystitis can cause severe pain and fever.

Blockage of the common bile duct
Gallstones can block the tubes (ducts) through which bile flows from your gallbladder or liver to your small intestine. Severe pain, jaundice and bile duct infection can result.

Blockage of the pancreatic duct 
The pancreatic duct is a tube that runs from the pancreas and connects to the common bile duct just before entering the duodenum. Pancreatic juices, which aid in digestion, flow through the pancreatic duct.
A gallstone can cause a blockage in the pancreatic duct, which can lead to inflammation of the pancreas (pancreatitis). Pancreatitis causes intense, constant abdominal pain and usually requires hospitalization.

Gallbladder cancer
People with a history of gallstones have an increased risk of gallbladder cancer.

Reducing the risk of Gallstones

  • You can reduce your risk of gallstones if you:
  • Don’t skip meals. Try to stick to your usual mealtimes each day. Skipping meals or fasting can increase the risk of gallstones.
  • Lose weight slowly. If you need to lose weight, go slow. Rapid weight loss can increase the risk of gallstones. Aim to lose 1 or 2 pounds (about 0.5 to 1 kilogram) a week.
  • Eat more high-fiber foods. Include more fiber-rich foods in your diet, such as fruits, vegetables and whole grains.
  • Maintain a healthy weight. Obesity and being overweight increase the risk of gallstones. Work to achieve a healthy weight by reducing the number of calories you eat and increasing the amount of physical activity you get. Once you achieve a healthy weight, work to maintain that weight by continuing your healthy diet and continuing to exercise.
  • Often, bile may become very concentrated, due to dehydration, contributing to the formation of gallstones.

The Treatment

Laparoscopic cholecystectomy

Most people with gallstones that don’t cause symptoms will never need treatment. Your doctor will determine if treatment for gallstones is indicated based on your symptoms and the results of diagnostic testing.

Your doctor may recommend that you be alert for symptoms of gallstone complications, such as intensifying pain in your upper right abdomen. If gallstone signs and symptoms occur in the future, you can have treatment.

Treatment options for gallstones include:

  • Surgery to remove the gallbladder (cholecystectomy)
     Your doctor may recommend surgery to remove your gallbladder, since gallstones frequently recur. Once your gallbladder is removed, bile flows directly from your liver into your small intestine, rather than being stored in your gallbladder. (You don’t need your gallbladder to live, and gallbladder removal doesn’t affect your ability to digest food, but it can cause diarrhoea, which is usually temporary.)
  • Medications to dissolve gallstones. Medications you take by mouth may help dissolve gallstones. But it may take months or years of treatment to dissolve your gallstones in this way, and gallstones will likely form again if treatment is stopped.

Sometimes medications don’t work. Medications for gallstones aren’t commonly used and are reserved for people who can’t undergo surgery due to other severe co-existing diseases. Whatever it may be, don’t delay your consult with a doctor.

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