The human liver produces bile, which is a greenish-brown fluid that is composed of fatty compounds, bile salts, cholesterol and other chemicals. The fluid mentioned above is stored and concentrated in the gallbladder and is required by the body to digest fats in the small intestine.
Now what happens is that, as we eat the gallbladder contracts and releases bile through the cystic duct and into the common bile duct. The function of this duct is to carry the bile into the upper part of the small intestine, where it begins to break down the fat contained in the food we eat. At this stage if the bile that is in the gallbladder becomes chemically unbalanced, it may turn into particles that later grow into stones.
These gallstones can be as small as a grain of sand or as large as a golf ball. It may also be smooth and round or irregular with quite a few edges. A person suffering from gallstones may just have one stone or even hundreds of them.
Basically there are two categories of gallstones, they are:
- Cholesterol Gallstones
Gallstones of this kind are often yellow in color and are composed of mainly undissolved cholesterol, though there can also be other components such as bilirubin and calcium. The latter components are residue from the breakdown of red blood cells. Cholesterol stones form about 80% of gallstones.
- Pigment Gallstones
When the bile has too much bilirubin, small, dark brown or black stones are formed. These stones tend to form in people who have conditions such as cirrhosis, biliary tract infection and sickle cell anemia. All the conditions named above result in the formation of excess bilirubin.
- Chronic Indigestion
The signs and symptoms associated with chronic indigestion may include bloating, nausea and even abdominal pain sometimes. Even if you have these symptoms it is advisable to visit the doctor because there are other conditions which have similar symptoms.
- Pain in the Upper Abdomen
A gallbladder attack, if often signaled by a sudden, steady and moderate to intense pain in the upper middle or upper right abdomen. This pain may occur one or two hours after eating or at night. The steady, sudden or moderate to intense pain lasts for about 30 minutes to several hours and usually begins in the upper middle or upper right abdomen. There are times when this pain may shift to your back or right shoulder blade. A mild aching or soreness in the upper abdomen usually accompanies the pain. Other symptoms of gallstones are nausea and vomiting.
There are times when the small gallstones escape the gallbladder and enter the duct that leads from the liver and gallbladder to the small intestine. These small stones may also occasionally enter the duct that leads into the pancreas. Pancreatitis is a condition that might develop when a stone blocks the duct. When such a condition does develop, it is accompanied by pain and fever.
Some of the other gallstone symptoms and signs of bile duct obstruction being :
- Stool that is clay in color
- Yellowing of the skin and whites of the eyes
The doctor will conduct an exam in which he/she will check for jaundice of the skin or the whites of the eyes. He/she will also feel your abdomen to see if it is tender. Once the doctor goes through the above steps, he/she will conduct a blood test in order to check for signs of infections, abnormal levels of pancreatic or liver enzymes or excess bilirubin.
The other tests that the doctor may conduct based on the results of the blood test are:
This test uses sound waves rather than X-rays to display and image of the organs that are located in the abdomen. Ultrasonography is often the best way to detect gallstones in the gallbladder and at times the common bile duct too.
- Computerized Tomography (CT) scan
This test is a diagnostic imaging procedure that uses a series of computer-generated X-rays to provide a view of the internal organs.
- Endoscopic Retrograde Cholangiopancreatography (ERCP)
This procedure is used to help locate and thus remove stones in the ducts. During this procedure, a flexible, lighted viewing instrument, called an endoscope, is gently passed down the throat, through the stomach and into the upper part of the small intestine. Once this is done, air is used to inflate the intestinal tract so that the doctor is able to see the openings of the pancreatic ducts and the bile. Now a tiny hollow tube is passed through the endoscope and is used to inject a dye into these ducts. Once all this is over, an X-ray is taken of the ducts.
- Endoscopic Ultrasound (EUS)
This technique may be used in some cases to help diagnose stones in the common bile duct. During this procedure, an ultrasound transducer is placed in the tip of an endoscope which is then passed in gently through the throat and through the stomach. This technique provides a clearer and more accurate image than a traditional ultrasound.
Since the majority of gallstones do not produce any symptoms, they do not require any treatment. Of course if the gallstones do not fall into this category and you are experiencing symptoms then there are several possibilities, which have been enumerated below:
One of the most preferred treatments is to remove the gallbladder. This surgery can be performed in two ways :
- Laparoscopic Surgery
This method is performed using a pencil-thin tube with its own miniature camera and lightings system. This instrument is inserted the abdomen through a hollow instrument called a cannula. Once this is done, the camera produces a magnified view of the inside of the abdomen on a television monitor. This assists the surgeon and helps him/her remove the gallbladder using tiny instruments inserted through various abdominal incisions. Since this form of surgery uses small incisions, there is less postoperative pain, less scarring and an earlier return to normal activity.
- Open Surgery
In this procedure the gallbladder is removed through a large abdominal incision. This method of surgery is used when the gallbladder walls are thick and hard, the gallbladder is affected or there is scar tissue from an earlier abdomen operation. In open surgery a cutting instrument is inserted through the endoscope and the entrance of the bile duct is enlarger so that the stone can pass through it. This procedure may also be used to remove a stone from a blocked pancreatic duct.
Sometimes the gallstone is treated without surgery using the following treatment options.
- Bile Salt Tablets
In this method of treatment, the doctor may prescribe a medication that dissolves cholesterol stones over a period of time. Of course do remember that this method works best only on small cholesterol stones and is only effective about 50% of the time. Most people who use this treatment are required to take medications for a number of years.
- Sound Wave Therapy (Extracorporeal Shock Wave Lithotripsy)
This form of treatment is appropriate only for a small percentage of people who have gallstones. People who have more than one stone, or the stone is large, or you have cholangitis or cholecystitis, then the treatment would not be right for you!
- Percutaneous Electrohydraulic Lithotripsy
This type of treatment can be used on any type of gallstones, including pigment stones. In this procedure a catheter is inserted into the gallbladder several weeks before the treatment. Once that is done, a probe is inserted into the catheter to deliver short bursts of energy to break up the stones. This procedure isn't widely available and is time-consuming. It is because of these two reasons that it is usually considered for people who have a high risk of surgical complications.
- Topical Gallstone Dissolution
In this treatment a small catheter is inserted into the gallbladder and a solution that dissolves cholesterol gallstones is then delivered through the catheter into the gallbladder over several hours. This method is still considered experimental and thus is not widely available.
Here are a few suggestions that may help lower the risk of you developing gallstones :
- Exercise regularly.
- Maintain healthy weight.
- Avoid a crash diet and a diet that has a very low intake of calories.
- Choose a diet that is low in fat and high in fiber. To do so include fresh fruits, vegetables and whole grains in your diet. Try and reduce foods like, animal fat, margarine, butter, mayonnaise and fried foods.