Under the human liver, there is a tiny sac called the gallbladder. The gallbladder stores bile that the liver manufactures. The small intestine requires bile to digest fats. Bile moves to the small intestine from the gallbladder via the common bile duct and the cystic duct. Gallstones are tiny stones found in bile. They are made either from cholesterol and other waste matter, or, when the gallbladder does not function properly and empty efficiently. Gallstones can be as big as golf balls or as infinitesimal as grains of sand.
Symptoms of gallstones
Gallstones symptoms usually do not occur when the stones are tiny. In fact, many people could have gallstones and not know it. Symptoms normally occur only when the bile ducts get obstructed.
Biliary colic : The commonest and mildest gallstones symptoms are biliary colic that is an intermittent pain, which occurs in the right or mid-portion of the upper abdominal region. Symptoms are non-specific and a typical attack of biliary colic can contain the following features:
- A gripping steady pain in the upper right abdominal region, close to the rib cage, which can become severe and spread out to the upper back and behind the breast bone.
- Nausea and vomiting
- People do not get relief if they take mild medications and pass gas or change position.
- Biliary colic symptoms usually occur at the similar times in a day but a few days apart. The symptoms last for one to a few hours and then disappear.
- If a person eats fatty and huge meals, pain can be triggered at night.
- Sometimes, the attacks can occur after a few years when conditions reappear.
Acute Cholecystitis : When gallstones symptoms like biliary colic recur persistently, it leads to a more severe form called acute cholecystitis. This occurs when sludge or gallstones block the gallbladder ducts. The symptoms are similar to biliary colic but extremely severe. Upper right abdominal pain will be constant and sever, last for days, extend to below the shoulder blades, to the back, behind, or to the left of the breastbone. The pain will be so severe that even drawing a breath will be difficult. Nausea, vomiting, fever and chills will accompany acute cholecystitis.
Chronic cholecystitis : Mild inflammation of the gallbladder accompanied with gallstones leads to chronic cholecystitis. This causes a dysfunctional gallbladder that becomes stiff and scarred. Common symptoms are gas, abdominal discomfort and nausea soon after meals. Unfortunately, these are not easy to distinguish from other medical conditions that have nothing to do with gallstones. Patients can even suffer from chronic diarrhea – at least 3-4 times daily over a 3 month period.
Choledocholithiasis : This occurs when stones are lodged in the common bile duct and cause symptoms such as:
- Yellow skin (jaundice)
- Light stools / dark urine
- Abrupt fall in blood pressure
- Rapid heartbeat
- Vomiting, nausea, fever, chills, relentless pain in abdominal region (upper right)
What to do?
Anyone who has acute cholecystitis symptoms must go to the hospital immediately for this condition can lead to perforation or gangrene of the gallbladder if not treated at once. Those with diabetes are especially vulnerable and are at risk of serious complications if these gallstones symptoms are left untreated. Similarly, those who have choledocholithiasis symptoms must seek emergency medical treatment.
Treatment for gallstones
When pain from gallstones symptoms becomes unmanageable, medical help is needed. Here diagnostic procedures will be undertaken to ensure that other conditions and complications are ruled out. After this, treatment for gallstones normally follows a three-step approach.
- Step 1 – expectant management (‘wait and see policy)
- Step 2 – remove the stones using non-surgical procedures
- Step 3 – surgical intervention to remove the gallbladder
Step 1: When a person displays no symptoms, any form of treatment for gallstones will not be beneficial. Hence, experts suggest the ‘wait and see ‘approach or expectant management. There is a few risks attached to this policy, for pain due to gallstones could intensify when left untreated and lead to complications. Some suggest that younger patients be treated and early symptoms in patients older than 70 years be left without surgery unless required. Those at risk of gallbladder cancer, those with large stones or tiny stones that could cause pancreatitis must be treated.
Step 2: Non-surgical methods are used only if the patient cannot undergo surgery and even then for cholesterol stones alone. Two non-surgical procedures are adopted:
- Oral dissolution therapy where drugs made using bile acid dissolves gallstones. Chenodiol and ursodiol are the common drugs to dissolve gallstones and it can take several years for the stones to disappear completely.
- Contact dissolution therapy where relevant drugs are injected directly into the gallbladder and they dissolve the stones. This is an experimental procedure and is being tested on patients with small stones and who are symptomatic.
Step 3: Cholecystectomy is surgical removal of the gallbladder and is the standard procedure. Gallstones are removed using laparoscopy or via a large abdominal incision. The former is less painful and recovery is quicker. Cholecystectomy is not complicated. If complications do occur, it could be due to the anesthesia, damage to bile ducts or leakage of bile.
Sphincterotomy is another surgical method of extracting gallstones when they are stuck in the common bile ducts. The common bile duct is reached by incising the junction of the duodenum and common bile duct. The stones are then extracted or crushed.
Prevention and precaution
Gallstones cannot be completely prevented. However, the risk of developing them can be reduced by maintaining a healthy weight. When you gain weight and then try to lose it, chances are that you will regain the weight. This is the time you when can develop gallstones – especially women. Gallstones can form when a person tries to lose weight rapidly by following starvation crash diets. Eat regularly, make sure you eat foods rich in calcium, do not consume high cholesterol foods and exercise regularly to keep triglyceride and cholesterol levels low. Women on birth-control pills or hormonal medications post-menopause are also at risk of developing gallstones.