Gallstones form when liquid stored in the gallbladder hardens into pieces of stone-like material.
The liquid, called bile, is used to help the body digest fats.
Bile is made in the liver, then stored in the gallbladder until the body needs to digest fat.
At that time, the gallbladder contracts and pushes the bile into a tube called a duct that carries it to the small intestine, where it helps with digestion.
Bile contains water, cholesterol, fats, bile salts, and bilirubin.
Bile salts break up fat, and bilirubin gives bile and stool a brownish color.
If the liquid bile contains too much cholesterol, bile salts, or bilirubin, it can harden into stones.
The two types of gallstones are cholesterol stones and pigment stones.
Cholesterol stones are usually yellow-green and are made primarily of hardened cholesterol.
They account for about 80 percent of gallstones.
Pigment stones are small, dark stones made of bilirubin.
Gallstones can be as small as a grain of sand or as large as a golf ball.
The gallbladder can develop just one large stone, hundreds of tiny stones, or almost any combination.
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.
The cause of pigment stones is uncertain.
It is believed that the mere presence of gallstones may cause more gallstones to develop.
Obesity is a major risk factor for gallstones, especially in women.
Excess estrogen from pregnancy, hormone replacement therapy, or birth control pills appears to increase cholesterol levels in bile and decrease gallbladder movement, both of which can lead to gallstones.
Women between 20 and 60 years of age are twice as likely to develop gallstones as men.
People over age 60 are more likely to develop gallstones than younger people.
Fasting decreases gallbladder movement, causing the bile to become overconcentrated with cholesterol, which can lead to gallstones.
Symptoms of gallstones are often called a gallstone "attack" because they occur suddenly.
A typical attack can cause :
People who also have the following symptoms should see a doctor right away :
Sweating.
Many gallstones, especially silent stones, are discovered by accident during tests for other problems.
But when gallstones are suspected to be the cause of symptoms, the doctor is likely to do an ultrasound exam.
Ultrasound uses sound waves to create images of organs.
Sound waves are sent toward the gallbladder through a handheld device that a technician glides over the abdomen.
The sound waves bounce off the gallbladder, liver, and other organs, and their echoes make electrical impulses that create a picture of the organ on a video monitor.
If stones are present, the sound waves will bounce off them, too, showing their location.
Other tests used in diagnosis include :
Cholecystogram or cholescintigraphy.
The patient is injected with a special iodine dye, and x-rays are taken of the gallbladder over a period of time.
(Some people swallow iodine pills the night before the x-ray.)
The test shows the movement of the gallbladder and any obstruction of the cystic duct.
Endoscopic retrograde cholangiopancreatography (ERCP).
The patient swallows an endoscope, a long, flexible, lighted tube connected to a computer and TV monitor.
The doctor guides the endoscope through the stomach and into the small intestine.
The doctor then injects a special dye that temporarily stains the ducts in the biliary system.
ERCP is used to locate stones in the ducts.
Blood tests may be used to look for signs of infection, obstruction, pancreatitis, or jaundice.
Gallstone symptoms are similar to those of heart attack, appendicitis, ulcers, irritable bowel syndrome, hiatal hernia, pancreatitis, and hepatitis.
Surgery to remove the gallbladder is the most common way to treat symptomatic gallstones.
(Asymptomatic gallstones usually do not need treatment.
Nonsurgical approaches are used only in special situations such as when a patient's condition prevents using an anesthetic and only for cholesterol stones.
Stones recur after nonsurgical treatment about half the time.
Drugs made from bile acid are used to dissolve the stones.
The drugs, ursodiol (Actigall) and chenodiol (Chenix), work best for small cholesterol stones.
Months or years of treatment may be necessary before all the stones dissolve.
Both drugs cause mild diarrhea, and chenodiol may temporarily raise levels of blood cholesterol and the liver enzyme transaminase.
This experimental procedure involves injecting a drug directly into the gallbladder to dissolve stones.
The drug methyl tert butyl can dissolve some stones in 1 to 3 days, but it must be used very carefully because it is a flammable anesthetic that can be toxic.
The procedure is being tested in patients with symptomatic, noncalcified cholesterol stones.
Extracorporeal shockwave lithotripsy (ESWL).
This treatment uses shock waves to break up stones into tiny pieces that can pass through the bile ducts without causing blockages.
Attacks of biliary colic (intense pain) are common after treatment, and ESWL's success rate is not very high.
Remaining stones can sometimes be dissolved with medication.
Fortunately, the gallbladder is an organ that people can live without.
Losing it won't even require a change in diet.
Once the gallbladder is removed, bile flows out of the liver through the hepatic ducts into the common bile duct and goes directly into the small intestine, instead of being stored in the gallbladder.
However, because the bile isn't stored in the gallbladder, it flows into the small intestine more frequently, causing diarrhea in some people.
Also, some studies suggest that removing the gallbladder may cause higher blood cholesterol levels, so occasional cholesterol tests may be necessary.
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Gallstones can block the normal flow of bile if they lodge in any of the ducts that carry bile from the liver to the small intestine.
If a gallstone blocks the opening to that duct, digestive enzymes can become trapped in the pancreas and cause an extremely painful inflammation called pancreatitis.
Steady, severe 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.
Gallstone attacks often follow fatty meals, and they may occur during the night.
Abdominal bloating.
Recurring intolerance of fatty foods.
Colic.
Belching.
Gas.
Indigestion.
Chills.
Low-grade fever.
Yellowish color of the skin or whites of the eyes.
Clay-colored stools.
Many people with gallstones have no symptoms.
These patients are said to be asymptomatic, and these stones are called "silent stones."
They do not interfere in gallbladder, liver, or pancreas function and do not need treatment.
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