Gallstones

Gallstones

What are gallstones?

Gallstones are hardened deposits which can be found in the gallbladder or in the duct between the gallbladder and the duodenum. The gallbladder is a small organ placed below the liver, and it holds a digestive fluid called bile. The bile is produced in the liver and is released from the gallbladder into the small intestine after meals. The bile contributes to the digestion of especially fatty acids and to the neutralisation of stomach acid. Components in the bile might form small gallstones which can grow and cause blockage of the duct between the gallbladder and the duodenum.

 

What are the symptoms of gallstones?

Many people who have gallstones are unaware of it. It is estimated that more than 10 % of the UK population and 33 % of the elderly generation have gallstones. Around 80 % of those who have gallstones are unaware of it, as they don’t experience any symptoms.
 

Symptoms often occur in sudden attacks and involve:

  • Pain in the upper right portion of the abdomen
  • Back pain or pain in the right shoulder
  • Fever
  • Yellowing of your skin and the whites of the eyes (jaundice)
  • Nausea and vomiting
  • Grey stools and dark urine


The intensity of the symptoms may vary tremendously if the gallstones are present in the bile ducts, as they only cause blockage from time to time in this case.

 

What causes gallstones?

Gallstones can consist of calcium salts, cholesterol and bilirubin; in 80 % of the cases they consist of cholesterol. Bilirubin is a chemical produced when the liver destroys old red blood cells. All three components are usually present in the gallbladder along with other substances, but if the balance between the components in the bile is off, and the components mentioned above are present in large quantities, they might start forming clumps. The bile can’t dissolve or break down cholesterol in large quantities, and if the concentration of cholesterol is high, small cholesterol crystals start to form and grow. Gallstones range in size from as small as a grain of sand to as large as a hen’s egg. Big gallstones don’t necessarily cause more complications than the small ones, as the symptoms depend on whether the stones get lodged in – and block – the bile ducts.

Several factors are associated with an increased risk of developing gallstones and most are related to diet. Especially people who are overweight and who consume large amounts of cholesterol and saturated fat suffer from gallstones. In addition, rapid weight loss, a diet rich in fibres, and diabetes can increase the risk. It is not possible to protect yourself completely against gallstones, but it is possible to organise your lifestyle, so that the risk of developing gallstones is reduced. This lifestyle involves a healthy, balanced diet with plenty of fluids where skipping meals is avoided.

 

How are gallstones treated?

Tests and procedures used to diagnose gallstones include checking for jaundice as well as diagnostic tests such as CT and MRI scans, ultrasound examinations, or through blood tests. If a patient experiences sharp pain caused by gallstones in the gallbladder, this can be removed surgically by means of laparoscopic surgery through small incisions in the skin of the abdomen, through which the gallbladder is removed. It is possible to live without the gallbladder, but it might cause occasional symptoms like diarrhoea.

Gallstones in the gallbladder can be removed using an endoscope which is passed through the mouth and stomach and into the area of the small intestine where the bile duct enters. Here, a small claw-shaped instrument catches the gallstones. The doctor can attempt to remove remaining stones using high-frequency sound waves. Additionally, a variety of different medications can contribute to the dissolution of gallstones consisting of cholesterol. This process could, however, take years.

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